Peripheral Neuropathy:

Please examine the Lower Limbs of this 60 year old lady who presents with
difficulty walking and proceed as appropriate.

Clinical Examination:

Classical Signs Additional Signs

- Impaired sensation to all - Evidence relating to

modalities (light touch, aetiology:
pinprick, vibration, o insulin chart,
proprioception) o stigmata of liver
- ‘Glove and stocking’ disease
distribution of sensory loss in o rheumatoid hands,
upper and lower limbs o medication chart,
- Distal weakness in a LMN o marked pes cavus
pattern - Walking aids
- Diminished reflexes - Nerve biopsy scar
- High stepping gait
Common discussion topics:
Diagnosis and differentials
How would you investigate this patient?

Quick Revision:
Sensory/sensorimotor neuropathy: Diabetes mellitus, Alcohol, Chronic kidney
disease, B12-def, Rheumatoid arthritis, Sarcoidosis, hypothyroidism, malignancy
Drugs – amiodarone, phenytoin, isoniazid, metronidazole, chemotherapy
Inherited neuropathies – Charcot-Marie tooth disease
Motor neuropathy: Guillaine-Barre, Lead toxicity, Porphyria

Investigations: Management

o History: family history, alcohol o Treat cause

consumption and medications
o Fasting blood sugar, B12 levels,
ESR, TFT’s, autoantibodies
o Nerve conduction studies
o Nerve biopsy
o Walking aids
o Tricyclic for neuropathic pain:
antidepressants, anticonvulsants
(pregabalin, gabapentin)