Peripheral neuropathy DDx

Overview

Diseases that affect the the peripheral nerves, either motor or sensory. Important subgroups for differential diagnosis are: predominately motor, painful peripheral neuropathies and mononeuritis multiplex

Mononeuritis multiplex is a painful, asymmetrical, asynchronous sensory and motor peripheral neuropathy involving isolated damage to at least 2 separate nerve areas that can be in random areas of the body.

Causes

Peripheral neuropathies

“DAM IT BICH”

  • drugs and toxins – e.g. heavy metals, isoniazid, vincristine, phenytoin, nitrofurantoin, cis-platinum, amiodarone, larges of vitamin B6,
  • alcohol and amyloid
  • metabolic – e.g. DM (30%), acromegaly, hypothyroidism
  • infectious/post- – e.g. Lyme, diptheria, GBS
  • tumor – e.g. lung CA
  • B12, B1, B5 or B6 deficiency
  • idiopathic (30%)
  • CTD or vasculitis, e.g. SLE, PAN
  • hereditary (30%)

or the alternative “DAM IT BITCH”:

  • D Drugs and chemicals (Pb, phenytoin, metronidazole, amiodarone, hydralazine, vincristine, isoniazid, organic solvents, sulphonamides, nitrofurantoin, CO, OPs).
  • A alcohol (with or without Thiamine deficiency)
  • M metabolic (diabetes, hypoglycemia, uraemia)
  • I infection (HIV, leprosy, lyme, diptheria, syphilis) or post infectious (GBS)
  • T tumour (paraneoplastic phenomenon – lung, lymphoma, myeloma)
  • B B12 & other vitamin deficiency states, as well as pyridoxine excess
  • I idiopathic and infiltrative (e.g. amyloidosis)
  • T toxins (botulism, ciguatera, Tetrodotoxin, Saxitoxin, BRO, tick paralysis)
  • C connective tissue diseases (e.g. SLE, PAN, RhA) and congenital (e.g. CMT)
  • H Hypothyroidism

Predominately motor peripheral neuropathy

  • Guillain-Barré syndrome, chronic inflammatory polyradiculoneuropathy
  • Hereditary motor and sensory neuropathy
  • Diabetes mellitus
  • Others-e.g. acute intermittent porphyria, lead poisoning, diphtheria, multifocal conduction block neuropathy

Painful peripheral neuropathy

“BADCAP”

  • Diabetes mellitus
  • Alcohol
  • Vitamin B1 or B12 deficiency
  • Carcinoma
  • Porphyria
  • Arsenic or thallium poisoning

Mononeuritis multiplex

Acute

  • Diabetes mellitus
  • Polyarteritis nodosum
  • Connective tissue diseases, e.g. SLE, Rheumatoid arthritis

Chronic

  • multiple compressive neuropathies
  • sarcoidosis
  • acromegaly
  • leprosy
  • Lyme disease
  • idiopathic

Polyneuropathies with autonomic involvement

These are the common ones:

  • diabetes mellitus
  • amyloidosis
  • Guillain-Barre Syndrome
  • Paraneoplastic neuropathy (usually lung cancer)
  • Sogren’s syndrome-associated neuropathy

References and Links

Journal Articles and Textbooks

  • Burns JM, Mauermann ML, Burns TM. An easy approach to evaluating peripheral neuropathy. J Fam Pract. 2006 Oct;55(10):853-61. Review. PubMed PMID: 17014750. [Free Full Text]
  • Talley NJ, O’Connor S. Clinical Examination: A Systematic Guide to Physical Diagnosis. MacLennan and Petty. 3rd edition, 1998.

CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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