Polyneuropathy: diagnosis and treatment

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Rinsho Shinkeigaku. 2007 Nov;47(11):769-73.

Polyneuropathy: diagnosis and treatment

Kanda T.

Department of Neurology and Clinical Neuroscience, Yamaguchi

University Graduate School of Medicine.

Polyneuropathy is a common disorder with heterogenic clinical

presentation and many possible etiologies. This review presents

diagnostic clues for physicians and neurologists without specialist

competence in neuromuscular disorders.

Diagnostic procedure of polyneuropathy include cerebrospinal fluid

examination, electrophysiological examinations, and sural nerve

biopsy. Although pathologic examinations using biopsied sural nerve

rarely reach specific diagnosis and are recently seem to be

underestimated, careful scrutiny of the morphology of each

myelinated nerve fiber as well as evaluation of

clinical/pathological correlation may be powerful tools to reach

proper diagnosis.

Polyneuropathy presents symmetric motor and sensory impairment

with " gloves and stockings " distribution. This characteristic

clinical presentation is based on two different types of

pathophysiology.

One, neuronal malfunction which leads to inability in keeping

homeostasis of axonal endings; the other, the " sum " of scattered

focal lesions throughout the peripheral nervous system: longer axons

have more chances to get local injuries. The former pathomechanism

is shared by most of hereditary neuropathies and toxic neuropathies,

and the latter includes inflammatory neuropathies as well as some

vasculitic neuropathy, and possibly, diabetic neuropathy.

Hence, we should keep in mind that the exact lesion site does not

necessarily present at sural nerve, especially in inflammatory

neuropathies and vasculitic neuropathies.