Asymmetric Peripheral Neuropathy

Aka: Asymmetric Peripheral Neuropathy, Focal Peripheral Neuropathy, Mononeuropathy, Multifocal Peripheral Neuropathy, Mononeuropathy Multiplex

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II. Causes: Proximal and Distal Sensorimotor Asymmetric Neuropathy (Type 3)

  1. Radiculopathy (e.g. Lumbar Disc Disease)
  2. Plexopathy
    1. Brachial (e.g. Stinger, Thoracic Outlet Syndrome)
    2. Lumbosacral (e.g. HSV, VZV, CMV, HIV)

III. Causes: Distal Asymmetric Neuropathy

  1. Mixed Motor and Sensory Neuropathy
    1. Sensorimotor Mononeuropathy (Type 4)
      1. Carpal Tunnel
      2. Cubital Tunnel
      3. Morton's Neuroma
      4. Meralgia Paresthetica
    2. Sensorimotor Mononeuropathy Multiplex (Type 5)
      1. Diabetes Mellitus
      2. Lyme Disease
      3. HIV Infection
      4. Lead Poisoning
      5. Polycythemia Vera
      6. Vaculitis (RA, SLE, Sjogren's Syndrome)
  2. Pure Neuropathy
    1. Pure Motor Neuropathy (Type 6)
      1. Amyotrophic Lateral Sclerosis (ALS)
    2. Pure Sensory Neuropathy, Ganglionopathy (Type 7)
      1. Herpes Simplex Virus
      2. Varicella Zoster Virus (Shingles)
      3. Primary Biliary Cirrhosis
      4. Sjogren's Syndrome
      5. Vitamin B6Overdose
      6. Mercury Poisoning
      7. Vitamin E deficiency
      8. Leprosy

IV. Causes: Focal Neuropathy (Mononeuropathy)

  1. Characteristics
    1. Primarily sensory Neuropathy (e.g. pain and Paresthesias)
    2. Motor symptoms (e.g. Muscle Weakness, atrophy) occur in severe or chronic cases
  2. Causes
    1. Acromegaly
    2. Amyloidosis
    3. Cancer infiltration
    4. Direct nerve Trauma (e.g. Burn Injury, frost bite, Radiation Injury, traction)
    5. Entrapment Neuropathy
    6. Ischemic injury
    7. Leprosy
    8. Myxedema (Hypothyroidism)
    9. Rheumatoid Arthritis
    10. Sarcoidosis

V. Causes: Multifocal Neuropathy (Mononeuropathy Multiplex)

  1. Characteristics
    1. Asymmetric, multifocal sensory (pain, Paresthesias, proprioception), motor (weakness, atrophy) deficits
    2. Autonomic deficits may occur
  2. Causes
    1. Connective Tissue Disorders and Vasculitis
    2. Diabetes Mellitus
    3. Hereditary predisposition to Compression Neuropathy
    4. HIV Infection or AIDS
    5. Leprosy

VI. References

  1. Gallagher in Marx (2002) Rosen's Emergency Med, p. 1506
  2. Pryse-Phillips in Noble (2001) Primary Care, p. 1579
  3. Castelli (2020) Am Fam Physician 102(12): 732-9 [PubMed]

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