Temporal Classification

Acute peripheral neuropathies develop over a few days. When motor signs are predominant, GBS should be suspected first. Vasculitic or toxic processes can also present acutely. A sub-acute presentation may be seen in toxic, inflammatory, infil-trative, or carcinomatous processes that develop over weeks. A chronic-onset neuropathy may develop gradually and progress over months to years, as is the case in metabolic or hereditary neuropathies. Peripheral neuropathies may also have a relapsing course (Box 42-13).

Box 42-13 Neuropathies Classified by Temporal Presentation

Acute Onset (within days)

Vasculitis Porphyria Diphtheria Thallium toxicity Ischemia

Penetrating trauma Rheumatoid arthritis

Diabetic plexopathy or cranial neuropathy Acute nerve compression Polyarteritis nodosa Burns

Iatrogenic (e.g., improper injection techniques)

Subacute Onset (weeks to months)

Most toxins Most drugs

Nutritional deficiencies Abnormal metabolic state Diabetic plexopathy Neoplasms Uremia

Chronic Course (months to years)




Hereditary neuropathies Relapsing


Porphyria Refsum's disease CIDP

GBS, Guillain-Barre syndrome; CIDP, chronic inflammatory demyelinating polyradiculoneuropathy; HIV, human immunodeficiency virus.

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