PERIPHERAL NEUROPATHY

 Sensory symptom:

Positive symptoms -

1st site involved then progression – peripheral nerve pattern vs radicular pattern vs length
dependant pattern (Lower limbs upper limbs, trunk involvement )

Character - tingling, pins and needles, burning sensations

Negative:

loss of sensations, unable to feel hot and cold water the texture of the ground

Any facial sensory loss

Washbasin phenomenon, ataxia in darkness, unable to open buttons without seeing

Muscle cramps

 Motor weakness,

Onset - distal vs proximal

Association with wasting

Tremulousness of the hands

Cranial nerve involvement - vision

Facial palsy, taste

Hearing

Any facial sensory loss

Voice change

 Autonomic - decreased/increased sweat in a particular areas

Orthostatic hypotension’/ giddiness

Palpitations

Post prandial loose motions

Bladder symptoms

Erectile dysfunction

 Skin lesions – suggestive of vasculitis, leprosy, vitamin deficiency

 Change in urinary colour,
 Negative history relevant

History, suggestive of any connective tissue disorders ( joint pains, abortions, malar rash)

Sicca symptoms, Recurrent oro-genital ulcers

Pedal oedema

Systemic symptoms, fever/ weight loss

Trophic ulcers

Family history of foot/hand grip weakness,

History diabetic, hypothyroid, renal dysfunction, drug exposure,

Occupational exposure

Toxin/medication history – lead, glue, OP, arsenic, siddha medications, metronidazole, dapsone,
sulpha drugs used for PCP, INH, chemotherapeutics, disulfiram, pyridoxine, alcohol.

Alcohol history- type, quantity, years of usage.

 General examination

Height, weight, arm span –

To look for marfanoid habitus

Hyper extension of joints

Head to Toe examination

Hair,

Eye brows

Xanthelesma

Angular chelitis

Tongue –

Skin lesions

Peripheral nerve thickenings – neck, face, limbs, should know all the sites and place of evaluation.

Trophic ulcers

Skin changes like, loss of hair, dryness of skin, icthyosis, sweating abnormalities if present.
Skin changes – especially for hansens – eyebrows, madarosis, skin hypopigmentataiona nd sensory
loss

Nails – any mees lines, blue lines

Blood pressure, postural BP drop

You will mention about tonsil examination if and only if u r suspecting tangiers or if its in your
differentials

Skeletal examination – spine – spine deformity, foot – pes casus, hammer toes, equinovarus
deformity

Champagne glass deformity, if its there to be mentioned

 CNS examination

Speech

HMF

Fundus

EOM, Ptosis, facial sensations, facial palsy, palatal movements

Wasting , fasciculation, tremors , tone

Power, neck and limbs

DTR-

Sensory loss mapping

Plantar

Romberg test

Gait

Pseudoathetosis

Bed side Autonomic function tests

Hear rate variability – to valsalva maneuver, (ECG required)

BP changes to Isometric hand grip, cold immersion of the hand

PITFALLS

1. Large fiber/myelon
2. Associated both
3. Autonomic
4. Skin changes
5. GPE associated with that
6. Wasting
7. Skin change
8. Nerve thickening
9. Hypoaesthetic patches
10.