Symmetric Peripheral Neuropathy

Aka: Symmetric Peripheral Neuropathy, Polyneuropathy

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II. Causes: Symmetric Proximal Motor Neuropathy (Type 1)

  1. Characteristics
    1. Symmetric proximal Muscle atrophy and weakness
  2. Acute Inflammatory Demyelinating Polyneuropathy (Guillain-Barre Syndrome)
    1. Guillain-Barre Syndrome typically starts in the distal extremities (esp. legs) and ascends
  3. Chronic Inflammatory Demyelinating Polyneuropathy
  4. Primary Myelinopathy
  5. Hypothyroidism(
  6. Diabetes Mellitus
  7. Lyme Disease
  8. Diphtheria
  9. Malignancy
  10. HIV or AIDS
  11. Hepatitis B
  12. Buckthorn
  13. Vincristine
  14. Acute Arsenic Poisoning

III. Causes: Symmetric Distal sensorimotor Polyneuropathy or DSPN (Type 2)

  1. Characteristics
    1. Symmetric distal sensory (pain, Paresthesias, proprioception, autonomic) and motor (weakness, atrophy) Neuropathy
  2. Diabetic Neuropathy (Diabetic DSPN)
  3. Alcoholism induced Neuropathy (Alcoholic DSPN)
  4. HIV Infection or AIDS
  5. Malignancy (paraneoplastic syndrome)
  6. Charcot-Marie-Tooth
  7. Toxins
    1. Acrylamide
    2. Allyl chloride
    3. Carbon disulfide
    4. Carbon Monoxide
    5. Ethylene oxide
    6. Hexacarbons
    7. Trichloroethylene
    8. OPIDP, PCBs, PNU
    9. Organophosphates
    10. Nitrous Oxide Abuse (due to secondary Vitamin B12 Deficiency)
  8. Heavy Metal Poisoning
    1. Arsenic
    2. Lead Poisoning
    3. Gold
    4. Mercury
    5. Thallium
  9. Medications
    1. See Drug-Induced Polyneuropathy
  10. Vitamin Deficiency
    1. Thiamine deficiency (Beriberi)
    2. Niacin Deficiency (Pellagra)
    3. Vitamin B12 Deficiency (Pernicious Anemia)
    4. Nitrous Induced Subacute Combined Degeneration of the Spinal Cord
    5. Vitamin B6 deficiency
    6. Trace Element Deficiency (e.g. copper deficiency)
    7. Folate Deficiency
  11. Paraproteinemia
    1. Amyloidosis
    2. Multiple Myeloma
    3. Waldenstrom's Macroglobulinemia
  12. Miscellaneous causes
    1. Acromegaly
    2. Chronic lung disease
    3. Hypothyroidism
    4. Chronic Kidney Disease
    5. Porphyria
    6. Cryoglobulinemia
    7. Chronic Liver Disease
    8. Tic Paralysis
    9. Lyme Disease
    10. Celiac Disease
    11. Connective Tissue Disorder of Vasculitis
    12. Gouty Neuropathy
    13. Whipple Disease

IV. 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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