Peripheral neuropathies are a group of disorders that affect the peripheral nervous system, for which hundreds of etiologies have been identified. This article presents a stepwise approach to the evaluation and workup of peripheral neuropathy, which starts with a detailed history of symptoms, family and occupational history, and a neurological as well as general physical exam. Pattern recognition of various neuropathies can help to build a differential diagnosis based on the presentation. Such patterns include acute versus chronic, primary demyelinating versus axonal, hereditary versus acquired, asymmetric versus symmetric, presence of facial palsies, sensory or motor predominant, and presence of prominent autonomic symptoms. Early categorization of the type of neuropathy can help focus the workup for peripheral neuropathy. Nerve conduction studies and electromyography (NCS/EMG) is the primary diagnostic tool in the evaluation of patients with large-fiber polyneuropathy. One of the most important roles of NCS/EMG is to help categorize polyneuropathy as primary axonal versus primary demyelinating. The finding of a primary demyelinating polyneuropathy narrows the differential diagnosis of polyneuropathy dramatically and increases the chances of finding a treatable etiology. Laboratory workup includes serum studies and potentially cerebrospinal fluid, genetic studies, immunological markers, and fat pad biopsy for select patients. Skin biopsy may be used to assess intraepidermal nerve fiber density if small-fiber neuropathy is suspected, and nerve biopsy may be useful in select cases. In recent years, magnetic resonance imaging and neuromuscular ultrasound have also shown promise in the evaluation of peripheral neuropathy. Identification of the etiology of neuropathy is crucial and often time-sensitive, as an increasing number of causes are now reversible or treatable.
Lateral femoral cutaneous neuropathy is a focal neuropathy caused by compression of the lateral femoral cutaneous nerve (LFCN) at the level of anterior-superior iliac spine or inguinal ligament. It is commonly associated with diabetes mellitus, obesity, and wearing tight clothing. 1 It can
Background:The progressive myoclonic epilepsies (PMEs) are a disparate group of syndromes whose common features include disabling myoclonus, progressive cognitive decline, and seizures, typically with a relentless deterioration over time.
Background and Aim: There are rare cases of multifocal motor neuropathy (MMN) with single nerve involvement published. The aim of the present study was to describe two cases of MMN with single nerve involvement and long-term follow up. The first consisted of an isolated wrist drop, which developed conduction block later in the course of the disease. The second presented with longstanding left thumb weakness and near complete radial conduction block. Both responded to intravenous immunoglobulin. Methods: The clinical and electrodiagnostic findings of two cases with long-term follow up are discussed, and six cases published in the literature are reviewed. Results: Both patients responded to intravenous immunoglobulin. One developed conduction block later in the course of the disease. Conclusion: Monofocal motor neuropathy, a pure motor immune-mediated mononeuropathy, is a rare disorder, which responds to intravenous immunoglobulin. Although it might resemble MMN, some of its features lead us to consider it as a distinct entity.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.