Peripheral Neuropathies Key Points

• In developed countries, diabetes and alcoholism are the most common causes of peripheral neuropathy in adults.

• Polyneuropathies are often inflammatory and caused by HIV infection, Lyme disease, and leprosy; no cause can be found in up to 20% of cases.

• There is no specific laboratory study or serum marker for the diagnosis of peripheral neuropathy.

• Electromyography and nerve conduction studies are most useful for evaluation of peripheral neuropathy and should be considered early.

• Mononeuropathies are usually caused by entrapment, compression, or other physical injury to a specific nerve.

• Carpal tunnel syndrome is a common mononeuropathy caused by decreased tunnel size (Colles' fracture, rheumatoid arthritis), enlargement of median nerve (diabetes, amyloidosis), or increased volume of other structures (tenosynovitis, gout).

• Common symptoms of CTS include numbness and paresthesias in the median nerve sensory distribution, pain at rest (especially at night), weakness in the thumb, and thenar atrophy.

The incidence of peripheral neuropathy is not known, but it is a common feature of many systemic diseases. In developed countries, diabetes and alcoholism are the most common causes of peripheral neuropathy in adults (Poncelet, 1998). Worldwide, leprosy is the primary treatable cause of peripheral neuropathy, and HIV is one of the fastest-growing causes (Sabin et al., 1993).

Peripheral neuropathies are frequently overlooked. The evaluation can be time-consuming and costly without a systematic approach based on a careful history, clinical evaluation, and select studies. Despite a thoughtful approach, however, no cause can be found in up to 20% of cases (Dyck et al., 1981; McLeod et al., 1984). The goal in treating peripheral neuropathy should be to identify the treatable cause or underlying medical condition, such as diabetes, alcohol, drugs, or nutritional disorder. Hereditary neuropathies are uncommon but underdiagnosed; thus a careful family history (e.g., longstanding distal neuropathy) should not be neglected.

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