Peripheral Neuropathy
Summary
Peripheral neuropathy is damage to peripheral nerves causing sensory, motor, or autonomic dysfunction. Common patterns include length-dependent polyneuropathy (glove and stocking), mononeuropathy, and mononeuritis multiplex. Diabetes is the most common cause in developed countries. Other causes include alcohol, B12 deficiency, medications, and inflammatory conditions (GBS, CIDP). Investigation aims to identify the underlying cause. Treatment is directed at the cause plus symptomatic management of neuropathic pain.
Key Facts
- Definition: Damage to peripheral nerves
- Classification: Polyneuropathy vs mononeuropathy vs mononeuritis multiplex
- Most common cause: Diabetes (30-40%)
- Investigation: HbA1c, B12, TFTs, LFTs, protein electrophoresis, nerve conduction studies
Clinical Pearls
Length-Dependent Pearl: Classic diabetic neuropathy is symmetric, length-dependent (affects feet before hands), sensory-predominant.
Red Flag Pearl: Rapid onset (days-weeks) or asymmetric = think acute inflammatory (GBS, vasculitis).
| Pattern | Description | Causes |
|---|---|---|
| Polyneuropathy | Symmetric, distal, "glove and stocking" | Diabetes, alcohol, B12, drugs |
| Mononeuropathy | Single nerve | Compression (carpal tunnel), trauma |
| Mononeuritis multiplex | Multiple individual nerves | Vasculitis, diabetes, Lyme |
| Test | Purpose |
|---|---|
| HbA1c/glucose | Diabetes |
| B12, folate | Deficiency |
| TFTs | Hypothyroidism |
| LFTs | Alcohol |
| Serum electrophoresis | Paraprotein |
| ESR/CRP, ANCA | Vasculitis |
| Nerve conduction studies | Confirm, characterise (axonal vs demyelinating) |
- Treat underlying cause (glycaemic control, B12, stop alcohol)
- Neuropathic pain: amitriptyline, duloxetine, pregabalin, gabapentin
- Foot care (diabetic neuropathy)
- Physiotherapy
- Callaghan BC et al. Distal symmetric polyneuropathy: A review. JAMA. 2015;314(20):2172-2181. PMID: 26599185
Last Reviewed: 2026-01-01 | MedVellum Editorial Team