Presentation of Chronic Neuropathy:
Pattern 1: Symmetrical diastal and proximal sensory loss thaen consider CIDP,vasculitis
Pattern 2:Symmetrical distal weakness with sensory loss consider metabolic disorder(eg. DM),drugs & toxin,hereditary neuropathy (eg. CMT l & ll,amyloidosis)
Pattern 3: Asymmteric distal weakness with sensory loss then if
*Single nerve or root: Consider compressive lesions and radiculopathy
*Multiple nerve involvement: Consider vasculitis,HNPP,Infections(eg Lyme disease,leprosy),HIV,infiltration with lymphoma,carcinoma,sarvoidosis.
Pattern 4: Asymmetric distal or proximal weakness without sensory loss.Consider MND,MMM-CB,neuralgic amyoyrophy
Pattern 5: Asymmetric proximal and distal weakness with with sensory loss.Vonsifer polyradivulopathy or plexopathy due to DM,malignant infiltration,neuralgic amyotrophy,HNPP
Pattern 6: Symmetric sensory neuropathy without weakness(mainly small fibre involvement with pain and temperature dysfunction).Consider diabetes,HIV,amyloidosis,Fabrys disease,idiopathic
Pattern 7:Symmetric sensory loss without weakness(large and small fibre dysfunction).Consider diabetes,drugs,toxins.
Pattern 8: Marked prorioceptive sensory loss.Consider gangliopathy due to paraneoplastic disorders,Sjogren’s syndrome,B6 & cis-platinum toxicity,HIV.
Pattern 9: Neuropathy with autonomic involvement.Consider diabetes,amyloid,porphyria,GBS.
Pattern 10: Neuropathy with cranial nerve involvement(most often facial nerve).Consider Lyme disease,HIV,CIDP,sarcoidosis,malignant infiltration,Tangier disease.
(CIDP: Chronic demyelinating neuropathy,CMT: Charcot Marie tooth disease, MMNCB:multifocal motor neuropathy with conduction block)