Peripheral Neuropathies

Peripheral neuropathies can present with symmetric distal weakness, distal paresthesias and sensory loss, hypoactive or absent reflexes, and gait impairment. Depending on the distribution of involvement, specific patterns such as polyneuropathy, mononeuropathy multiplex and mononeuropathy can be recognized. Small fiber neuropathy typically presents with pain and paresthesias, but may have normal objective examination and electrodiagnostic studies. Electromyography and nerve conduction studies help to distinguish between axonal and demyelinating varieties. It is important to try to identify the cause of neuropathy, but it is often idiopathic. A judicious approach to investigations is important to avoid unnecessary testing. Treatment approaches include correction of the cause, if possible, immune mediation when indicated, symptomatic control of neuropathic pain, and providing supportive and preventive care.