Peripheral neuropathy differential diagnosis: Difference between revisions

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{{Peripheral neuropathy}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Peripheral_neuropathy]]
{{CMG}}; {{AE}} {{MMJ}}
{{CMG}}; {{AE}} {{MMJ}}


==Overview==
==Overview==
[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
Peripheral neuropathy must be differentiated from other diseases that cause , [[sensorineural]], [[Motor skill|motor]], [[autonomic]] and [[Balance disorder|balance]] problems, such as [[spinal cord]] lesions and [[Brain|brain lesion]]<nowiki/>s. Peripheral neuropathy usually causes lower motor nerve damage, while lesions in brain and [[spinal cord]] usually cause [[lower motor neuron]] damage. The difference between [[Upper motor neuron|upper]] and [[lower motor neuron]] symptoms and signs may be very helpful to differentiate peripheral neuropathy from brain and [[spinal cord]] lesions. Lower motor neuron signs and symptoms in peripheral neuropathy typically present with [[Diminished stature|diminished]] [[Deep tendon reflex|deep tendon reflexes]], [[flaccid paralysis]], severe [[muscle atrophy]], negative [[babinski reflex]] and[[fasciculation]] whereas upper motor neuron signs and symptoms in brain and [[spinal cord]] lesions typically present with [[Hyperactive reflexes|hyperactive]] [[Deep tendon reflex|deep tendon reflexes]], [[spastic paralysis]], no [[muscle atrophy]], positive [[babinski reflex]] and no [[fasciculation]].


OR
==Differentiating peripheral neuropathy from other diseases==
* Peripheral neuropathy must be differentiated from other diseases that cause , [[sensorineural]], [[Motor skill|motor]], [[autonomic]] and [[Balance disorder|balance]] problems, such as [[spinal cord]] lesions and [[Brain|brain lesion]].<ref name="pmid23642725">{{cite journal| author=Saporta MA, Shy ME| title=Inherited peripheral neuropathies. | journal=Neurol Clin | year= 2013 | volume= 31 | issue= 2 | pages= 597-619 | pmid=23642725 | doi=10.1016/j.ncl.2013.01.009 | pmc=3646296 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23642725  }} </ref><ref name="pmid18615140">{{cite journal| author=Marchettini P, Lacerenza M, Mauri E, Marangoni C| title=Painful peripheral neuropathies. | journal=Curr Neuropharmacol | year= 2006 | volume= 4 | issue= 3 | pages= 175-81 | pmid=18615140 | doi= | pmc=2430688 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18615140  }} </ref><ref name="pmid22548615">{{cite journal| author=Brannagan TH| title=Current issues in peripheral neuropathy. | journal=J Peripher Nerv Syst | year= 2012 | volume= 17 Suppl 2 | issue=  | pages= 1-3 | pmid=22548615 | doi=10.1111/j.1529-8027.2012.00387.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22548615  }} </ref>


[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].
* Peripheral neuropathy usually causes lower motor nerve damage, while lesions in brain and [[spinal cord]] usually cause [[lower motor neuron]] damage.<ref name="pmid28003344">{{cite journal| author=Garg N, Park SB, Vucic S, Yiannikas C, Spies J, Howells J et al.| title=Differentiating lower motor neuron syndromes. | journal=J Neurol Neurosurg Psychiatry | year= 2017 | volume= 88 | issue= 6 | pages= 474-483 | pmid=28003344 | doi=10.1136/jnnp-2016-313526 | pmc=5529975 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28003344  }} </ref>


==Differentiating [Disease name] from other Diseases==
* The difference between [[Upper motor neuron|upper]] and [[lower motor neuron]] symptoms and signs may be very helpful to differentiate peripheral neuropathy from brain and [[spinal cord]] lesions.<ref name="pmid28003344">{{cite journal| author=Garg N, Park SB, Vucic S, Yiannikas C, Spies J, Howells J et al.| title=Differentiating lower motor neuron syndromes. | journal=J Neurol Neurosurg Psychiatry | year= 2017 | volume= 88 | issue= 6 | pages= 474-483 | pmid=28003344 | doi=10.1136/jnnp-2016-313526 | pmc=5529975 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28003344  }} </ref>
[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
 
OR
 
[Disease name] must be differentiated from [differential dx1], [differential dx2], and [differential dx3].
 
OR
 
As [disease name] manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtype. [Subtype name 1] must be differentiated from other diseases that cause [clinical feature 1], such as [differential dx1] and [differential dx2]. In contrast, [subtype name 2] must be differentiated from other diseases that cause [clinical feature 2], such as [differential dx3] and [differential dx4].
 
===Differentiating [disease name] from other diseases on the basis of [symptom 1], [symptom 2], and [symptom 3]===
 
On the basis [symptom 1], [symptom 2], and [symptom 3], [disease name] must be differentiated from [disease 1], [disease 2], [disease 3], [disease 4], [disease 5], and [disease 6].
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="4"  style="background: #4479BA; color: #FFFFFF; text-align: center;|Diseases
| colspan="6" rowspan="1"  style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Clinical manifestations'''
! colspan="7" rowspan="2"  style="background: #4479BA; color: #FFFFFF; text-align: center;|Para-clinical findings
| colspan="1" rowspan="4"  style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Gold standard'''
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Additional findings
|-
| colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Symptoms'''
! colspan="3" rowspan="2"  style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical examination
|-
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;|Lab Findings
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;|Imaging
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Histopathology
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Symptom 1
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|Symptom 2
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Symptom 3
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical exam 1
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical exam 2
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical exam 3
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Lab 1
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Lab 2
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Lab 3
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Imaging 1
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Imaging 2
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Imaging 3
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 1
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 2
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 3
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Diseases
!Symptom 1
! colspan="1" rowspan="1" |Symptom 2
!Symptom 3
!Physical exam 1
! colspan="1" rowspan="1" |Physical exam 2
!Physical exam 3
!Lab 1
!Lab 2
!Lab 3
!Imaging 1
!Imaging 2
!Imaging 3
!Histopathology
|'''Gold standard'''
!Additional findings
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 4
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 5
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 6
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|}


* Lower motor neuron signs and symptoms in peripheral neuropathy typically present with [[Diminished stature|diminished]] [[Deep tendon reflex|deep tendon reflexes]], [[flaccid paralysis]], severe [[muscle atrophy]], negative [[babinski reflex]] and[[fasciculation]] whereas upper motor neuron signs and symptoms in brain and [[spinal cord]] lesions typically present with [[Hyperactive reflexes|hyperactive]] [[Deep tendon reflex|deep tendon reflexes]], [[spastic paralysis]], no [[muscle atrophy]], positive [[babinski reflex]] and no [[fasciculation]].<ref name="pmid28003344">{{cite journal| author=Garg N, Park SB, Vucic S, Yiannikas C, Spies J, Howells J et al.| title=Differentiating lower motor neuron syndromes. | journal=J Neurol Neurosurg Psychiatry | year= 2017 | volume= 88 | issue= 6 | pages= 474-483 | pmid=28003344 | doi=10.1136/jnnp-2016-313526 | pmc=5529975 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28003344  }} </ref>
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Latest revision as of 22:21, 8 March 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]

Overview

Peripheral neuropathy must be differentiated from other diseases that cause , sensorineural, motor, autonomic and balance problems, such as spinal cord lesions and brain lesions. Peripheral neuropathy usually causes lower motor nerve damage, while lesions in brain and spinal cord usually cause lower motor neuron damage. The difference between upper and lower motor neuron symptoms and signs may be very helpful to differentiate peripheral neuropathy from brain and spinal cord lesions. Lower motor neuron signs and symptoms in peripheral neuropathy typically present with diminished deep tendon reflexes, flaccid paralysis, severe muscle atrophy, negative babinski reflex andfasciculation whereas upper motor neuron signs and symptoms in brain and spinal cord lesions typically present with hyperactive deep tendon reflexes, spastic paralysis, no muscle atrophy, positive babinski reflex and no fasciculation.

Differentiating peripheral neuropathy from other diseases

References

  1. Saporta MA, Shy ME (2013). "Inherited peripheral neuropathies". Neurol Clin. 31 (2): 597–619. doi:10.1016/j.ncl.2013.01.009. PMC 3646296. PMID 23642725.
  2. Marchettini P, Lacerenza M, Mauri E, Marangoni C (2006). "Painful peripheral neuropathies". Curr Neuropharmacol. 4 (3): 175–81. PMC 2430688. PMID 18615140.
  3. Brannagan TH (2012). "Current issues in peripheral neuropathy". J Peripher Nerv Syst. 17 Suppl 2: 1–3. doi:10.1111/j.1529-8027.2012.00387.x. PMID 22548615.
  4. 4.0 4.1 4.2 Garg N, Park SB, Vucic S, Yiannikas C, Spies J, Howells J; et al. (2017). "Differentiating lower motor neuron syndromes". J Neurol Neurosurg Psychiatry. 88 (6): 474–483. doi:10.1136/jnnp-2016-313526. PMC 5529975. PMID 28003344.

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