Peripheral Neuropathy

vi. Dorsal root ganglion

2.

1. Axonal polyneuropathy : axon, length

dependent neuropathy, foot > hand,
gloves and stockings pattern,

2. Demyelinating polyneuropathy :
myelin sheath, distal or proximal

Peripheral polyneuropathy :

Neuro: motor system, DTR, sensory

system (pinprick, light touch,
temperature, vibration,
proprioceptive)

,
hyporeflexia
a. Hereditary polyneuropathy
b. Immune-mediated
polyneuropathy
i. Guillain-Barre syndrome
(GBS)
ii. Chronic demyelinating
polyneuropathy (CIDP)
3. Multiple mononeuropathy,

(length

mononeuropathy multiplex :

weakness and sensory loss ()

axonal neuropathy,

a. Bilateral symmetrical distal

weakness and sensory loss

a. Focal neuropathy or peripheral

polyneuropathy
b. Focal neuropathy : nerve, root,

c. Polyneuropathy :

1. Bilateral symmetrical distal

a. Vasculitis
b. Chronic granulomatous
infection
c. Tumor infiltration

plexus, peripheral nerve

dependent), glove and stocking

1.

motor + sensory
i. DM, Thyroid, ESRD
ii. Toxin
iii. Vit def
iv. Charcot-Marie-Tooth,
amyloidosis (genetic)
b. Bilateral symmetrical or
asymmetrical distal weakness
without sensory loss

motor
i. Lead neuropathy
ii. dapsone
c. Bilateral symmetrical sensory

loss without weakness

sensory

i. Motor nerve
ii. Sensory nerve
iii. Motor and sensory
nerve
iv. Autonomic nerve
v. Small fiber sensory
nerve

a
d. Bilateral proprioceptive
sensory loss without weakness

sensory

ganglion (sensory
neuronopathy,

dorsal root

ganglionopathy)
proprioception

nodusa/ Churg Strauss

syndrome/ SLE/ RA/
cryoglobulinemia/ HepB & C
b. Demyelinating polyneuropathy
: CIDP

vibration

c. Infect : , HIV
d. Tumor infiltration :
hematologic malignancy
e. Sarcoidosis

i. Paraneoplastic
syndrome
ii. Sjogrens syndrome
iii. Cisplatinum
iv. HIV
e. Prominent autonomic
symptom and sign

DM
Amyloidosis
GBS (some)
Vincristine
Porphyria
HIV
Idiopathic
pandysautonomia
Pure loss of temperature,
pinprick sensation (small fiber
involvement)
myelin

3. Bilateral symmetrical distal and

proximal weakness and sensory loss

polyradiculoneuropathy

autonomic
Protein

DTR

LP

length dependence 3-

8 wk DTR
i. Idiopathic CIDP
ii. CIDP

immune
1. Monoclonal
gammopathy of
undetermined
significant
(MGUS)
2. Osteosclerotic
myeloma
3. Multiple myeloma
4. Waldenstromm
macroglobulinemi
a
5. Cryoglobulinemia
6. Hep C

peroneal
a. Vasculitis : Wegener
granulomatosis/ Polyarthritis

b. CIDP (immune) :

primal distal
a. GBS (immune) : acute

median

length

dependence DTR

(mononeuropathy multiplex)

autonomic
i. DM
ii. Amyloidosis
iii. Toxin, alcohol
iv. Hereditary sensory
neuropathy, Tangiers
disease, Fabrys disease
(genetic)
v. HIV
vi. Idiopathic
2. Bilateral asymmetrical weakness and
sensory loss

Entrapment neuropathy

myelin sheath

i.
ii.
iii.
iv.
v.
vi.
vii.

f.

f.

Lab

EMG

neuropathy/

root, plexus.

Focal/ axonal or demyelinating/

motor nerve or sensory nerve or both
( small fiber

myelin

pure small fiber

neuropathy )
o Nerve conduction study
o Needle electromyography

Nerve biopsy

o
o
o
o

Vasculitis
Amyloidosis
Leprosy
Chronic granulomatous
inflammation ex sarcoidosis

Hereditary polyneuropathy