Peripheral Neuropathy

Outline

Background

• Peripheral neuropathies are very common in Neurology and in PACES examinations

Assessment

Presentation

• Insidious gradual onset of weakness & numbness

• Poorly controlled chronic disease (diabetes, alcohol, nutrition, immune related disease)

Examination

• Weakness LMN: reduced power with hyporeflexia & hypotonia

• Sensory loss: glove & stocking distribution (peripheral)

Investigations

• Nerve conduction studies- ?demyelinating 

• Bloods: B12, folate, lead, TFT, protein electrophoresis, HIV, Syphilis, Lyme serology, connective tissue disorder screen, Cr 

Diagnosis

Diagnostic criteria: clinical- LMN weakness + sensory impairment, pattern: distal & bilateral

Differentials: 

• Mononeuropathy

• Radiculopathy

• Plexopathy

Classified by underlying cause: 

DA NHS IIM

• Diabetes

• Alcohol

-

• Nutritional & drugs: 

  • B12, Folate, B1, B6

  • Lead

  • Drugs: amiodarone, chemotherapy

• Hereditary- Charcot Marie Tooth,

• Systemic: Hypothyroidism, Renal failure, 

-

• Immune

  • Demyelinating: GBS, CIDP

  • Amyloidosis, SLE

• Infective: Lyme Disease, Syphilis, HIV, Leprosy

• Malignancy

  • Paraproteinemia- myeloma

  • Nerve sheath tumour, paraneoplastic

Management

MDT

• Consultant Neurologist +- consultant in underlying condition (e.g. Haematology), GP, 

• PT, orthotics, OT, SW, psychologist, dietician, psychologist, pain team

Lifestyle

• Improve nutrition, strength training

• Reduce alcohol, smoking

Medical

• Symptomatic: neuropathic pain analgesia

• Treat underling cause- e.g. diabetes, infection, immune modulation

References and Resources

Page written in 2026.