Table 1. Basic diagnostic methods and main clinical symptoms in polyneuropathy (selected from [40, e15]).
| Patient history: personal, system, occupational, social, and family history | |||
| Main symptoms and clinical findings | Symptoms | Clinical findings* | |
| Sensory | Sensation of furriness and numbness | Hypesthesia for various qualities, hypalgesia | |
| Tingling, burning, and cold parasthesia | Heat and cold allodynia | ||
| Burning pain, stinging, electric shock-like pain | Dysesthesia, allodynia | ||
| Gait instability, falls | Sensory ataxia | ||
| Motor | Weakness, muscle loss | Paresis, reduced muscle tone, muscle atrophy, reduced reflexes | |
| Muscle cramps, fasciculations | Muscle cramps on strength testing, fasciculations | ||
| Autonomic | Dry skin | Hypo- and anhidrosis | |
| Body hair loss, skin changes | Trophic disorders | ||
| Sensation of glare | |||
| Bladder dysfunction | |||
| Diarrhea | |||
| Rapid heartbeat | For example, resting tachycardia | ||
| Gastrointestinal symptoms | For example, gastroparesis | ||
| Urogenital symptoms (e.g., impaired micturitionerectile dysfunction) | |||
| Neurophysiology: Neurography and EMG, evoked potential | |||
| Laboratory tests | Basic program | Optional advanced program | |
| CRP, differential blood count, electrolytes, liver and kidney function, protein electrophoresis, immunofixation, ‧Bence Jones proteins, TSH, HbA1c, CDT, vitamin B12 | Holotranscobalamin; vitamins B1, B6 and E, ANA, p- and c-ANCA, cryoglobulins, hepatitis/HIV/Borrelia serology, anti-IgM-GM1, anti-GQ1b, anti-MAG; cerebrospinal fluid analysis, including bacterial and viral serology | ||
| Imaging | Nerve ultrasound and MR neurography | ||
| Biopsy | Nerve biopsy, skin biopsy | ||
| Small-fiber diagnostic methods | Quantitative sensory testing, special evoked potentials, skin biopsy | ||
| Genetics | PMP22, GJB1, MPZ, and MFN2, gene panel, trio exome/genome | ||
On neurological examination, the combination of distal reflex loss and reduced vibration or pinprick sensitivity is a sensitive and specific clinical sign in the diagnosis of polyneuropathy (e22).
* Determine medical and neurological status
ANA, autoantibodies; ANCA, antineutrophil cytoplasmic antibodies; CDT, carbohydrate deficient transferrin; CRP, C-reactive protein; EMG, electromyography;
HbA 1c, adult 1c fraction hemoglobin; HIV, human immunodeficiency virus; MAG, myelin-associated glycoprotein; MR, magnetic resonance; TSH, thyroid-stimulating hormone