CLINICAL EVALUATION AND INVESTIGATION OF NEUROPATHY
- 1Division of Clinical Neurosciences, Southern General Hospital, Glasgow, UK
- 2Department of Neurology, University Hospital Birmingham, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK
- Correspondence to: Professor Hugh J Willison, Division of Clinical Neurosciences, Southern General Hospital, Glasgow G51 4TF, UK; h.j.willison{at}udcf.gla.ac.uk
- neuropathy
- chronic inflammatory demyelinating polyradiculoneuropathy
- Charcot-Marie-Tooth
- Guillain-Barré syndrome
The assessment and investigation of a possible neuropathy is one of the most common clinical problems facing the general neurologist. Studies of the prevalence of neuropathy in the community are rare but suggest a figure of between 2–8%,1 making peripheral neuropathy at least as common as stroke. Despite this high prevalence of neuropathy, it is only a small proportion of patients with neuropathies who are referred for detailed evaluation, principally those individuals with disabling disease, or with none of the obvious risk factors such as diabetes or alcoholism.
A logical approach to the assessment of such patients is essential and can be organised into a number of basic questions. The neurologist faced with a patient with a neuropathy has to deal with literally thousands of possible causes, many extremely uncommon, and these can only be simplified by defining the neuropathy by other features that lead to the select few of most likely diagnoses. This is in part a process of pattern recognition but can be helped by a stepwise approach. Several algorithms2 and review articles3 have been published to aid this process and a typical one has been constructed here (fig 1).
Algorithm showing a stepwise approach to the assessment and investigation of a possible neuropathy. CIDP, chronic inflammatory demyelinating polyradiculoneuropathy; CMT, Charcot-Marie-Tooth; EMG, electromyography; GBS, Guillain-Barré syndrome; HNPP, hereditary neuropathy with liability to pressure palsies; NCS, nerve conduction studies.
The approach adopted in this article is to present the evaluation as a list of commonly asked questions that, if correctly addressed and answered, are likely to yield diagnostically important information, and hence direct appropriate management. This is not intended as an exhaustive account of neuropathy but is a personal view, illustrative of a diagnostic process that is commonly adopted.
DOES THE HISTORY AND EXAMINATION SUGGEST THAT THE PATHOLOGICAL PROCESS IS LOCALISED TO THE PERIPHERAL NERVE?
This question can usually be answered easily, …
