peripheral neuropathy patterns

Question 1

Pattern 1: Symmetric proximal and distal weakness with sensory loss

Answer 1

Consider: inflammatory demyelinating polyneuropathy (GBS and CIDP)

Question 2

Pattern 2: Symmetric distal sensory loss with or without distal weakness

Answer 2

Consider: cryptogenic sensory polyneuropathy (CSPN)
metabolic disorders
drugs, toxins
hereditary (Charcot-Marie-Tooth, amyloidosis and others)

Question 3

Pattern 3: Asymmetric distal weakness with sensory loss

Answer 3

Multiple nerves, consider: vasculitis
hereditary neuropathy with liability to pressure palsies (HNPP)
multifocal acquired demyelinating sensory and motor (MADSAM) neuropathy infectious (leprosy, lyme, sarcoid, HIV)
Single nerves/regions, consider: compressive mononeuropathy and radiculopathy

Question 4

Pattern 4: Asymmetric proximal and distal weakness with sensory loss

Answer 4

Consider: polyradiculopathy or plexopathy due to diabetes mellitus,
meningeal carcinomatosis or lymphomatosis, sarcoidosis, amyloidosis, Lyme, idiopathic, hereditary (HNPP, familial)

Question 5

Pattern 5: Asymmetric distal weakness without sensory loss

Answer 5

Consider: A. with upper motor neuron findings

1. motor neuron disease/ALS/PLS B. without upper motor neuron findings
2. progressive muscular atrophy (PMA)
   a. brachial amyotrophic diplegia (BAD)
   b. leg amyotrophic diplegia (LAD)
3. multifocal motor neuropathy
4. multifocal acquired motor axonopathy (MAMA)
5. juvenile monomelic amyotrophy

Question 6

Pattern 6: Symmetric sensory loss and distal areflexia with upper motor neuron findings

Answer 6

Consider: B12 deficiency and other causes of combined system degeneration with peripheral neuropathy Copper deficiency (including Zinc toxicity)
Inherited disorders (adrenomyeloneuropathy, MLD, Friedreich’s)

Question 7

Pattern 7: Symmetric weakness without sensory loss*

Answer 7

Consider: A. Proximal and distal weakness
1. Spinal muscular atrophy
B. Distal weakness
1. Hereditary motor neuropathy

Question 8

Pattern 8: Focal midline proximal symmetric weakness*

Answer 8

Consider: Neck extensor weakness - ALS

Bulbar weakness - ALS, PLS

Question 9

Pattern 9: Asymmetric proprioceptive sensory loss without weakness

Answer 9

Consider: sensory neuronopathy (ganglionopathy) (Table 10) chronic immune sensory polyradiculopathy (CISP)

Question 10

Pattern 10: Autonomic Symptoms and Signs

Answer 10

Consider: neuropathies associated with autonomic dysfunction (Table 7)
Hereditary sensory autonomic neuropathy Diabetes mellitus
Amyloidosis (familial and acquired) Guillain-Barre syndrome
Vincristine induced
Porphyria
HIV-related autonomic neuropathy Idiopathic pandysautonomia