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. 1999 Dec;75(890):723–726. doi: 10.1136/pgmj.75.890.723

Diagnostic work-up in peripheral neuropathy: an analysis of 171 cases

D Lubec 1, W Mullbacher 1, J Finsterer 1, B Mamoli 1
PMCID: PMC1741419  PMID: 10567598

Abstract

This study was set up to evaluate retrospectively the efficacy of a standard diagnostic procedure, including non-invasive and invasive (spinal tap, nerve/muscle biopsy) investigations, in the diagnosis of peripheral neuropathy. The medical records of 171 in-patients with the final diagnosis of peripheral neuropathy of determined or undetermined cause were reviewed and each individual diagnostic work-up was analysed. Basic investigations included the patient's history, a clinical examination and basic laboratory tests. Depending on the individual presentation, course, and severity, further non-invasive and invasive examinations were added according to the department's standard diagnostic procedure. The aetiology could be clarified in 124 patients (73%) and remained unclear in 47 cases. Excluding cases with acute and chronic inflammatory polyneuropathy (n=14), the number of idiopathic peripheral neuropathies dropped to 33. Non-invasive investigations were sufficient to reveal the underlying aetiology in 114 cases (83 %). It is concluded that, with the application of a standard procedure for the diagnosis of peripheral neuropathy, the aetiology can be clarified in 81% of patients. In the other 19% of patients the aetiology remains idiopathic. In the majority of cases, non-invasive investigations were sufficient for diagnosis.


Keywords: neuromuscular disorders; diagnosis; electrophysiology; peripheral neuropathy

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Selected References

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  1. Argov Z., Steiner I., Soffer D. The yield of sural nerve biopsy in the evaluation of peripheral neuropathies. Acta Neurol Scand. 1989 Mar;79(3):243–245. doi: 10.1111/j.1600-0404.1989.tb03745.x. [DOI] [PubMed] [Google Scholar]
  2. Barohn R. J. Approach to peripheral neuropathy and neuronopathy. Semin Neurol. 1998;18(1):7–18. doi: 10.1055/s-2008-1040857. [DOI] [PubMed] [Google Scholar]
  3. Berek K., Margreiter J., Willeit J., Berek A., Schmutzhard E., Mutz N. J. Polyneuropathies in critically ill patients: a prospective evaluation. Intensive Care Med. 1996 Sep;22(9):849–855. doi: 10.1007/BF02044106. [DOI] [PubMed] [Google Scholar]
  4. Chalk C. H. Acquired peripheral neuropathy. Neurol Clin. 1997 Aug;15(3):501–528. doi: 10.1016/s0733-8619(05)70331-5. [DOI] [PubMed] [Google Scholar]
  5. Chia L., Fernandez A., Lacroix C., Adams D., Planté V., Said G. Contribution of nerve biopsy findings to the diagnosis of disabling neuropathy in the elderly. A retrospective review of 100 consecutive patients. Brain. 1996 Aug;119(Pt 4):1091–1098. doi: 10.1093/brain/119.4.1091. [DOI] [PubMed] [Google Scholar]
  6. Cohen J. A., Gross K. F. Peripheral neuropathy: causes and management in the elderly. Geriatrics. 1990 Feb;45(2):21-6, 31-4. [PubMed] [Google Scholar]
  7. Davies L., Spies J. M., Pollard J. D., McLeod J. G. Vasculitis confined to peripheral nerves. Brain. 1996 Oct;119(Pt 5):1441–1448. doi: 10.1093/brain/119.5.1441. [DOI] [PubMed] [Google Scholar]
  8. Dyck P. J., Oviatt K. F., Lambert E. H. Intensive evaluation of referred unclassified neuropathies yields improved diagnosis. Ann Neurol. 1981 Sep;10(3):222–226. doi: 10.1002/ana.410100304. [DOI] [PubMed] [Google Scholar]
  9. Emeryk-Szajewska B., Badurska B., Kostera-Pruszczyk A. Electrophysiological findings in hereditary motor and sensory neuropathy type I and II--a conduction velocity study. Electromyogr Clin Neurophysiol. 1998 Mar;38(2):95–101. [PubMed] [Google Scholar]
  10. Finsterer J., Muellbacher W., Halbmayer W. M., Fischer M., Mamoli B. Anti-GM1 antibodies in polyneuropathies of unknown origin. J Clin Pathol. 1996 May;49(5):422–425. doi: 10.1136/jcp.49.5.422. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Griffin J. W., Hsieh S. T., McArthur J. C., Cornblath D. R. Laboratory testing in peripheral nerve disease. Neurol Clin. 1996 Feb;14(1):119–133. doi: 10.1016/s0733-8619(05)70246-2. [DOI] [PubMed] [Google Scholar]
  12. Hawke S. H., Davies L., Pamphlett R., Guo Y. P., Pollard J. D., McLeod J. G. Vasculitic neuropathy. A clinical and pathological study. Brain. 1991 Oct;114(Pt 5):2175–2190. doi: 10.1093/brain/114.5.2175. [DOI] [PubMed] [Google Scholar]
  13. Kelly J. J., Jr The electrodiagnostic findings in polyneuropathies associated with IgM monoclonal gammopathies. Muscle Nerve. 1990 Dec;13(12):1113–1117. doi: 10.1002/mus.880131205. [DOI] [PubMed] [Google Scholar]
  14. König F., Neundörfer B., Kömpf D. Polyneuropathien im höheren Lebensalter. Dtsch Med Wochenschr. 1984 May 11;109(19):735–737. doi: 10.1055/s-2008-1069265. [DOI] [PubMed] [Google Scholar]
  15. McLeod J. G. Investigation of peripheral neuropathy. J Neurol Neurosurg Psychiatry. 1995 Mar;58(3):274–283. doi: 10.1136/jnnp.58.3.274. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. McLeod J. G., Tuck R. R., Pollard J. D., Cameron J., Walsh J. C. Chronic polyneuropathy of undetermined cause. J Neurol Neurosurg Psychiatry. 1984 May;47(5):530–535. doi: 10.1136/jnnp.47.5.530. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Mitsumoto H., Wilbourn A. J. Causes and diagnosis of sensory neuropathies: a review. J Clin Neurophysiol. 1994 Nov;11(6):553–567. doi: 10.1097/00004691-199411000-00003. [DOI] [PubMed] [Google Scholar]
  18. Notermans N. C., Wokke J. H., Franssen H., van der Graaf Y., Vermeulen M., van den Berg L. H., Bär P. R., Jennekens F. G. Chronic idiopathic polyneuropathy presenting in middle or old age: a clinical and electrophysiological study of 75 patients. J Neurol Neurosurg Psychiatry. 1993 Oct;56(10):1066–1071. doi: 10.1136/jnnp.56.10.1066. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Prineas J. Polyneuropathies of undetermined cause. Acta Neurol Scand Suppl. 1970;44:1–72. doi: 10.1111/j.1600-0404.1970.tb07459.x. [DOI] [PubMed] [Google Scholar]
  20. Reilly M. M. Genetically determined neuropathies. J Neurol. 1998 Jan;245(1):6–13. doi: 10.1007/s004150050167. [DOI] [PubMed] [Google Scholar]
  21. Said G. Diabetic neuropathy: an update. J Neurol. 1996 Jun;243(6):431–440. doi: 10.1007/BF00900495. [DOI] [PubMed] [Google Scholar]
  22. Shefner J. M., Dawson D. M. The use of sensory action potentials in the diagnosis of peripheral nerve disease. Arch Neurol. 1990 Mar;47(3):341–348. doi: 10.1001/archneur.1990.00530030121028. [DOI] [PubMed] [Google Scholar]
  23. Sluga E., Mamoli B., Pateisky K. Vergleichende bioptische und elektrophysiologische Untersuchungen bei Polyneuropathien. Wien Klin Wochenschr. 1977 Feb 10;89(4):113–122. [PubMed] [Google Scholar]
  24. Steiner I., Kidron D., Soffer D., Wirguin I., Abramsky O. Sensory peripheral neuropathy of vitamin B12 deficiency: a primary demyelinating disease? J Neurol. 1988 Jan;235(3):163–164. doi: 10.1007/BF00314308. [DOI] [PubMed] [Google Scholar]
  25. Thomas P. K. Undiagnosed neuropathies: the impact of ancillary investigations. Baillieres Clin Neurol. 1996 Mar;5(1):157–170. [PubMed] [Google Scholar]
  26. Thrush D. Investigation of peripheral neuropathy. Br J Hosp Med. 1992 Jun 17;48(1):13–22. [PubMed] [Google Scholar]
  27. Vallat J. M. Electron microscopy as a tool to diagnose neuropathies. Baillieres Clin Neurol. 1996 Mar;5(1):143–156. [PubMed] [Google Scholar]
  28. Wokke J. H., van Dijk G. W. Sensory neuropathies including painful and toxic neuropathies. J Neurol. 1997 Apr;244(4):209–221. doi: 10.1007/s004150050075. [DOI] [PubMed] [Google Scholar]
  29. van der Meché F. G., van Doorn P. A. Future developments in the treatment of immune-mediated polyneuropathies. Eur Neurol. 1997;38(3):230–237. doi: 10.1159/000113378. [DOI] [PubMed] [Google Scholar]

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