Differential Diagnosis of Peripheral Neuropathy

Overview

Neuropathies can be caused by metabolic-endocrine, toxic, and hereditary disorders, various conditions of nutrition deficiency, inflammatory or systemic diseases, vasculopathies, and they can be part of the paraneoplastic symptomatology as well. Diabetes mellitus (DM) is the most common cause of neuropathy in our population. Diabetic polyneuropathy represents the most frequent form of polyneuropathy in well-developed countries, indicates more admissions that other diabetic complications and has important impact on the quality of patients’ life. From the differential diagnostic point of view, it is important that signs of the diabetic neuropathy are non-specific and identical for all neuropathies. Each neuropathy represents complex of sensory, motor and vegetative signs. In addition to the clinical features, biochemical and paraclinical investigations are conclusive for identifying the etiology of neuropathy. Suspicion for non-diabetic etiology of neuropathy is increased in neuropathy developed earlier to DM, neuropathy in very good controlled DM, and asymmetric neuropathy. After elucidation of an atypical neuropathy signs, neurological and electromyographical studies should follow. With the development of serological and genetic tests, autoimmune and hereditary neuropathies are increasingly diagnosed in cases of to that time unclassified idiopathic neuropathies. Even after complex investigation procedures, the etiology of polyneuropathy remains unrevealed in approximately 50 % of cases. 

Key words:
peripheral neuropathy, diabetic polyneuropathy, autoantibodies, electromyography.