Chronic polyneuropathy - evaluation and diagnosis

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Tidsskr Nor Laegeforen. 2007 Feb 1;127(3):291-5.

Chronic polyneuropathy - evaluation and diagnosis

Mygland A.

Nevrologisk avdeling Sorlandet sykehus 4604 Kristiansand og

Spesialsykehuset for rehabilitering, Kristiansand Rikshospitalet og

Institutt for klinisk medisin Universitetet i Bergen.

BACKGROUND:Chronic polyneuropathy is a common disorder with

heterogenic clinical presentation and many possible etiologies. This

review presents diagnostic guidelines for physicians without

specialist competence in neuromuscular disorders.

MATERIAL AND METHOD:The article is based on a review of articles

identified in PubMed using the search terms " peripheral

neuropathy " , " cause " and " investigation " , relevant book chapters and

own clinical experience.

RESULTS AND INTERPRETATION:All patients should undergo a routine

investigation for the most common causes of polyneuropathy, such as

diabetes, heredity, alcohol abuse, toxic medications and agents,

symptoms of Sjogren's syndrome and renal failure. The following

laboratory assessments should be done if the medical history proves

negative: glucose, haemoglobin, leucocytes, thrombocytes, ESR,

creatinin, ALAT, GT, vitamin B12, serum electrophoresis, TSH and

thyroxin.

If the routine investigation proves negative, a targeted approach

based on clinical type and electrophysiological findings is

recommended. The most common sensory type with slowly progressing,

symmetric sensory symptoms beginning in the feet can often be

classified as cryptogenic without further investigation.

Polyneuropathies with subacute onset, progressive weakness,

asymmetric symptoms, proximal weakness, selective involvement of

sensory fibres or demyelinating pathology, or other organ

manifestations, have different etiologies that necessitate

individually focused investigations.