Peripheral Neuropathy

Scope

Peripheral neuropathy is a primary condition of the peripheral nerves most commonly, with longer nerves being affected more than shorter ones, in a symmetrical motor and/ or sensory symptoms and signs in the four limbs.

Assessment

Signs and Symptoms

The usual sensory change is a symmetrical glove and stocking loss to all modalities. This pattern of sensory loss is unlike that of individual nerve or nerve root disease. In the latter cases the sensory loss is asymmetrical or confined to one limb.

History and Examination

Pertinent details of the suspected neuropathy:

  • In a focal area(s) or 'glove and stocking'
  • Affecting sensory function / motor function or both
  • Duration of symptoms and rapidity of onset
  • Presence or absence of known rheumatological disease or malignancy
  • A drug history, including anything recently discontinued
  • Presence or absence of a Family History of neuropathy

Investigations

  • Thyroid function test
  • Diabetes screen
  • Serum B12
  • Myeloma screen
  • ANA
  • Alcohol history

Management

Following triage, you may be requested to:

  • Initiate further directed testing for sensory axonal polyneuropathy if appropriate and not already part of the original referral.
  • If these tests are normal, the individual may be managed conservatively for idiopathic sensory polyneuropathy (see guidance at Polyneuropathies)
  • If abnormal on the result or any doubt, then refer on to appropriate specialty e.g. orthopaedics for an entrapment neuropathy or to neurology as indicated

Referral

Referral Criteria

Please provide results of all tests:

  • Thyroid function
  • Diabetes screen
  • Serum B12
  • Myeloma screen
  • ANA
  • Alcohol history

Referral Instructions

e-Referral Service

  • Specialty: Neurology
  • Clinic Type: Not Otherwise Specified
  • Service: DRSS-South Devon & Torbay-Neurology- Devon CCG - 15N

Referral Form

DRSS referral form

Torbay and South Devon seeking advice form

Supporting Information

Patient Information

Patient.co.uk - Polyneuropathies

Pathway Group

This guideline has been signed off by Dr Alex Rowe - GP and Clinical Lead for Planned Care South Devon and Torbay CCG.

Author: D Lashley, Consultant Neurologist, PHNT / Dr G Lenden DRSS Clinical Lead Wesern

Publication date: January 2017

 

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