SYMPTOMS/EXAM
■ Distal, symmetric, stocking glove distribution of sensory and motor dys-
function
■ Pain and paresthesias
■ Loss of deep tendon reflexes
■ Typically involves lower extremities and moves proximally
■ Before reaching knees →fingertips involved
■ May involve any peripheral nerve
■ Gastrointestinal →dysphagia, diarrhea
■ Genitourinary →incontinence, impotence
DIFFERENTIAL
■ Other causes of distal symmetric polyneuropathy include:
■ Alcoholic neuropathy
■ HIV neuropathy
■ Toxic and metabolic neuropathy (eg, B 12 deficiency, medications)
DIAGNOSIS
■ Primarily based on clinical exam findings and exclusion of toxic-metabolic
causes
TREATMENT
■ Tricyclic antidepressants, carbamazepine and/or gabapentin to control pain
■ Improve glycemic control
Isolated Mononeuropathies
Neuropathy involving a single peripheral nerve; most commonly due to com-
pression of the nerve or trauma (Table 15.16)
Carpel tunnel syndrome is uniquely associated with multiple conditions:
■ Diabetes mellitus (most common)
■ Hypothyroidism
■ Pregnancy
■ Amyloid
■ Arthritis
■ Obesity
DIAGNOSIS
■ Mostly a clinical diagnosis
■ Carpel tunnel provocative testing
■ Tinel’s sign: Tapping at volar wrist →symptoms.
■ Phalen’s sign: Holding wrist in flexion for 30–60 seconds →symptoms.
■ Electrodiagnostic studies if confirmation needed
TREATMENT
■ Once compression is relieved, most mononeuropathies will resolve spon-
taneously over a period of weeks.
■ Radial mononeuropathy
■ Splint wrist in 60º of dorsiflexion.
NEUROLOGY