Peripheral Neuropathy Differential Diagnosis

Peripheral neuropathy is a condition characterized by damage to the part of the nervous system that sends signals from the spinal cord and brain to the rest of the body. This can result in symptoms like burning pain, tingling, prickling sensation and muscle weakness; all of which can be mistaken for other conditions. A differential diagnosis uses the process of elimination to rule out these other conditions to come to a diagnosis.

Peripheral Neuropathy Facts

• According to the Mayo Clinic, peripheral neuropathy most commonly causes numbness and pain in the feet and hands. Many patients explain the pain as burning or tingling and the numbness as being similar to wearing a glove or sock. Sensory information may not be received in its normal manner. This is largely dependant on the type of nerve damage, since each nerve functions in a specific part of the body. Sensory nerves are responsible for sensations and feelings such as pain. Autonomic nerves control automatic bodily functions like digestion, heart beat and bladder control. Motor nerves control the movement of muscles.

Symptoms

• A person with peripheral neuropathy may not sense that his hand has been burned or that his feet are cold, or he may lose control of his bladder.

  According to the Mayo Clinic, symptoms commonly include sensitivity to touch, weakness or paralysis of the muscles, sharp or electric pain, bladder problems, coordination problems, and a gradual beginning of numbness which radiates up into the arms and legs from the hands and feet.

Other Conditions Which Cause Acute Symptoms

• According to WrongDiagnosis.com, other conditions may also cause acute motor symptoms with sensory involvement. This includes exposure to toxins (such as thallium, organophosphorus compounds, rabies vaccine or typhoid); viral hepatitis; Guillain-Barré syndrome; porphyria; diphtheria; or infectious mononucleosis. Nutritional deficiencies associated with alcoholism may also create similar symptoms as can atherosclerosis, diabetes and exposure to certain medications and toxic substances (i.e. carbon monoxide, arsenic, industrial solvents and prolonged usage of neuromuscular blocking medications).

Other Conditions Which Cause Chronic Symptoms

• The doctor may also need to rule out conditions which can cause chronic sensory and motor problems. These include Lyme disease, leukemia, alcoholism, lymphoma, disease of the connective tissues, leprosy, diabetes mellitus, amyloidosis, carcinoma, and hereditary diseases such as Charcot-Marie-Tooth disease or autonomic neuropathies.

Diagnosis

• To make a diagnosis, a doctor will obtain a patient's medical history and perform examinations (like neurological and physical exams) to determine whether she is able to feel specific sensations, determine the strength of her muscles and check her coordination. The doctor will likely order blood tests which will check levels of vitamin B-12, thyroid function and urinalysis, as well as indicate other conditions such as diabetes or liver dysfunction. Nerve conduction studies measure the speed at which nerves transmit electrical signals and are commonly used to diagnose peripheral nerve disorders.

Additional Testing

• Based on the results from a patient's history and all examinations/testing, the doctor may need to order additional tests which can identify the extent of the neuropathy. This may include a CT scan, MRI, EMG (electromyography, a test which involves inserting a needle into a muscle to determine electrical activity) or NCV (nerve conduction velocity, a test which stimulates the nerves and determines the speed of the signal). Nerve and skin biopsies can reveal the extent of nerve damage.