Peripheral neuropathy

Published on 05/05/2015 by admin

Filed under Internal Medicine

Last modified 05/05/2015

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55 Peripheral neuropathy

Instruction

Examine this patient’s legs.

Carry out a neurological examination of this patient’s legs.

Salient features

History

• Progressive and symmetrical numbness in the hands and feet that spreads proximally in a glove and stocking distribution

• Distal weakness, which also ascends

• History of diabetes, alcohol, connective tissue disorder, malignancy.

Examination

• Bilateral symmetrical sensory loss for all modalities with or without motor weakness

• Proceed by looking for evidence of the following (mnemonic: DAD,RUM):

• Diabetes mellitus (diabetic chart, insulin injection sites, insulin pump)
• Alcoholic liver diease (palmar erythema, spider naevi, tender liver)
• Drug history
• Rheumatoid arthritis
• Uraemia
• Malignancy.

• Palpate for thickened nerves and look for Charcot’s joints

• Tell the examiner that you would like to do the following:

• Look for anaemia and jaundice (vitamin B12 deficiency)
• Check urine for sugar
• Take a history of alcohol consumption and a drug history.

Diagnosis

This patient has symmetrical, bilateral sensory loss for touch and pain (lesion) caused by diabetes mellitus (aetiology).

Questions

How are polyneuropathies classified?

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