1. Peripheral neuropathy
Damage to peripheral nerves

2. Types
 Mononeuropathy- affects single nerve
 Compression, trauma, ischemia, inflammation
 Mononeuritis multiplex- multiple nerves
involved, asymmetrically
 DM, vasculitides, SLE, sarcoidosis, leprosy, amyloid
 Polyneuropathy- multiple nerves
involved, concurrently & symmetrically
 DM, AIDP/CIDP, toxic/metabolic, hereditary

3. Polyneuropathy- classification
 Axonopathy
 Stocking & glove type sensory loss, diminished DTR
& autonomic function in involved areas
 Toxins, DM, SACD, alcoholism, chemotherapy drugs
 Myelinopathy
 AIDP, CIDP
 Neuronopathy
 MND, Herpes zoster, Vincristine

4. Symptoms & signs
 -ve symptoms/signs-
 Sensory- numbness, tremor, gait abnormality
 Motor- weakness, heaviness, gait abnormality
 +ve symptoms/signs-
 Sensory- tingling, pain, itching, pins & needles
 Motor- cramps, tremor, fasciculations
 Absent ankle jerk

5. Evaluation
 History-
 Pattern of onset- mostly LL>UL & distal>proximal
 Progression- acute-AIDP or chronic-DM/hereditary
 Fluctuation- toxin exposure
 Other systemic diseases
 Family history
 Examination-
 Palpate nerve- thickened-leprosy
 Small-fibre- predominantly spinothalamic tract-
dysesthesias, impaired pain/temperature sensation,
autonomic dysfunction ±, Fabry’s dis./DM/amyloid
 Large-fibre- predominantly posterior column-
areflexia, ataxia, severe motor dysfunction,
minor cutaneous sensory deficit

6. Diagnosis
Nerve conduction studies
Sural nerve (at ankle) biopsy,
specially for mononeuritis multiplex

7. Treatment
 Correct underlying cause
 Control of DM
 Correction of vitamin deficiency
 Rx of leprosy
 Avoid alcohol
 Immunosuppression for AIDP/CIDP
 Surgery for carpal tunnel syndrome
 Neuropathic pain-
 Amitriptyline, Carbamazepine, Gabapentin,
Pregabalin

8. SACD
 Sub-acute combined degeneration
 Due to vitamin B12 deficiency
 Manifestation-
 Paresthesias, sensory loss- LE>UE
 Ataxia
 Loss of ankle jerk, extensor plantar
 Memory loss
 Reduced vision, central scotoma
 Sphincter disturbance
 Rx- vitamin B12 supplementation, IM