Laboratory Evaluation of Peripheral Neuropathy

Abstract

Peripheral neuropathy is a common neurological disorder, with high prevalence especially in the aged population. The general evaluative approach is to first identify the type of peripheral neuropathy prior to investigating for a possible underlying etiology, which is an increasingly important endeavor, as many causes of peripheral neuropathy are now recognized as treatable. To this end, laboratory testing plays an important adjunctive role to a detailed history and examination. This review will discuss possible diagnostic laboratory testing pathways for different types of peripheral neuropathy, with the goal of minimizing costs and false-positive results while maximizing the likelihood of identifying a potentially reversible etiology.

Xeroderma Pigmentosum: A Model for Human Premature Aging

“…In the general population, peripheral neuropathy is common in older individuals, resulting in ataxia and debilitating falls. The incidence increases with age and may be as high as 50% in adults aged >85 years (Lau, 2019). In the elderly, the causes include diabetes, medications, and chronic toxin exposure as well as vascular, nutritional, and idiopathic causes.…”

Clinical Reasoning: A 67-Year-Old Woman With Progressive Tingling Sensations and Imbalance

“…Anti-MAG antibodies and vascular endothelial growth factor should also be considered, the former especially if NCS demonstrate CMAPs with markedly prolonged distal motor latencies and the latter if features of POEMS are present. 4 Antibodies against gangliosides should also be considered. Cerebrospinal fluid (CSF) studies are helpful for detecting albuminocytologic dissociation, although this finding may be seen in multiple diagnoses.…”

Overview of the Clinical Approach to Individuals With Cerebellar Ataxia and Neuropathy

“… 20 For guidance on the laboratory investigation of peripheral neuropathies, we refer the reader to Lau. 39 …”

“…20 For guidance on the laboratory investigation of peripheral neuropathies, we refer the reader to Lau. 39 Magnetic Resonance Imaging Clinical radiologic assessment using MRI is often used after ataxia symptom presentation, particularly in the absence of an established genetic etiology, to qualitatively identify and grade any atrophy or detect lesions in the posterior fossa. 23 However, the value of quantitative assessments of cerebellar, brainstem, and spinal cord macrostructure (i.e., atrophy), microstructure (i.e., diffusion), and even neurochemistry (i.e., spectroscopy) in differential diagnosis and disease monitoring of degenerative ataxias is becoming increasingly clear.…”