Overview of polyneuropathy
- Seward B Rutkove, MD
Seward B Rutkove, MD
- Professor of Neurology
- Harvard Medical School
INTRODUCTION AND TERMINOLOGY
The terms "polyneuropathy," "peripheral neuropathy," and "neuropathy" are frequently used interchangeably, but are distinct. Polyneuropathy is a specific term that refers to a generalized, relatively homogeneous process affecting many peripheral nerves, with the distal nerves usually affected most prominently. Peripheral neuropathy is a less precise term that is frequently used synonymously with polyneuropathy, but can also refer to any disorder of the peripheral nervous system including radiculopathies and mononeuropathies. Neuropathy, which again is frequently used synonymously with peripheral neuropathy and/or polyneuropathy, can refer even more generally to disorders of the central and peripheral nervous system.
The polyneuropathies must be distinguished from other diseases of the peripheral nervous system, including the mononeuropathies and mononeuropathy multiplex (multifocal neuropathy), and from some disorders of the central nervous system.
●Mononeuropathy refers to focal involvement of a single nerve, usually due to a local cause such as trauma, compression, or entrapment. Carpal tunnel syndrome is a common example of a mononeuropathy.
●Mononeuropathy multiplex refers to simultaneous or sequential involvement of noncontiguous nerve trunks. Used loosely, this term can refer to multiple compressive mononeuropathies. However, in its more specific meaning, it identifies multiple nerve infarcts due to a systemic vasculitic process that affects the vasa nervorum. (See "Clinical manifestations of vasculitic neuropathy".)
●Diseases of the central nervous system such as a brain tumor, stroke, or spinal cord lesion occasionally present with symptoms that are difficult to distinguish from polyneuropathy. (See "Differential diagnosis of peripheral nerve and muscle disease".)
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- INTRODUCTION AND TERMINOLOGY
- ETIOLOGY AND PATHOGENESIS
- Other systemic
- CLINICAL PRESENTATION
- Physical examination
- Clinical course
- DIFFERENTIAL DIAGNOSIS
- DIAGNOSTIC EVALUATION
- Diagnostic criteria
- Electrodiagnostic testing
- Laboratory tests
- Nerve biopsy
- Skin biopsy
- Autonomic testing
- Quantitative sensory testing
- Treatment of the underlying process
- - Axonal polyneuropathies
- - Demyelinating polyneuropathies
- Treatment of symptoms and prevention of complications
- SUMMARY AND RECOMMENDATIONS