Peripheral Neuropathy

Question 1

What are the common examination findings?

Answer 1

• REMEMBER IT CAN BE MOTOR
• • Inspection - Charcot foot, skin ulcerations, finger prick marks (DM), walking aid, pes cavus
• Tone - May be flaccid if severe weakness
• Power - Distal weakness
• Reflexes - Hyporeflexic at peripheries
• Sensation - reduced, particularly pain and vibration - GLOVE AND STOCKING

Gait may be affected

Question 2

What are the investigations?

Answer 2

• To finish the exam i would like to do - Upper/lower limb exam and cranial nerves
• By the bed - History, obs
• Bloods - Glucose, FBC for anaemia, ESR, U/E, TFTs, CRP, AI screen, ANA, ANCAs
• Other - CXR ?malignancy, nerve conduction studies

Question 3

What are the key investigation findings?

Answer 3

Depends on cause:

Causes:

ABCDEFGH

A - Alcohol/Amyloid

B - B12 deficiency

C - Connective tissue/ Cancer (Paraneoplastic)

D - Diabetes and drugs

E - Everything else sg sarcoid, lupus, drugs - amioderone

F - Friedrichs Ataxia

G - Guillian barre

H - Heriditary - CMT

Question 4

What is the treatment?

Answer 4

Conservative - MDT input, footcare

Medical - manage causes and symptoms

Surgical - eg carpal tunnel decompression