TABLE 10.

Ten Patterns of Neuropathic Disorders

Pattern 1: Symmetric proximal and distal weakness with sensory loss Consider: inflammatory demyelinating polyneuropathy (GBS and CIDP) Pattern 2: Symmetric distal sensory loss with or without distal weakness Consider: cryptogenic sensory polyneuropathy (CSPN) metabolic disorders drugs, toxins hereditary (Charcot-Marie-Tooth, amyloidosis and others) Pattern 3: Asymmetric distal weakness with sensory loss 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 Pattern 4: Asymmetric proximal and distal weakness with sensory loss Consider: polyradiculopathy or plexopathy due to diabetes mellitus, meningeal carcinomatosis or lymphomatosis, sarcoidosis, amyloidosis, Lyme, idiopathic, hereditary (HNPP, familial) Pattern 5: Asymmetric distal weakness without sensory loss Consider: A. with upper motor neuron findings motor neuron disease/ALS/PLS B. without upper motor neuron findings progressive muscular atrophy (PMA) brachial amyotrophic diplegia (BAD) leg amyotrophic diplegia (LAD) multifocal motor neuropathy multifocal acquired motor axonopathy (MAMA) juvenile monomelic amyotrophy Pattern 6: Symmetric sensory loss and distal areflexia with upper motor neuron findings Consider: B12 deficiency and other causes of combined system degeneration with peripheral neuropathy Copper deficiency (including Zinc toxicity) Inherited disorders (adrenomyeloneuropathy, MLD, Friedreich’s) Pattern 7: Symmetric weakness without sensory loss* Consider: A. Proximal and distal weakness Spinal muscular atrophy B. Distal weakness Hereditary motor neuropathy Pattern 8: Focal midline proximal symmetric weakness* Consider: Neck extensor weakness - ALS Bulbar weakness - ALS, PLS Pattern 9: Asymmetric proprioceptive sensory loss without weakness Consider: sensory neuronopathy (ganglionopathy) (Table 10) chronic immune sensory polyradiculopathy (CISP) Pattern 10: Autonomic Symptoms and Signs Consider: neuropathies associated with autonomic dysfunction (Table 7)

^*Overlaps with myopathies and NMJ disorders