When we think about the
These are patients presenting often
with sensorimotor polyneuropathies.
The vast majority of these
They start in the most,
in the longest nerves out in the legs
and work their way proximally.
They often follow a
stocking glove distribution
and present chronically and
progressively over time.
Immunologic work-up for
AIDP or CIDP is negative.
There's no increased inflammation in the
body that is precipitating the attack.
This is the result of a
chronic toxic ingestion
or a metabolic
deficiency or overload.
Some of the things that we consider
on the differential diagnosis
for a toxic metabolic
is alcoholism which presents
with prominent sensory findings
and often a paucity
of motor weakness.
Diabetes is the
most common cause
of distal symmetric polyneuropathy
in the United States,
and presents with a sensorimotor
polyneuropathy with some demyelinating,
as well as a prominent
Uremia can present with a polyneuropathy
that has a sensory predominance
and is reversible and can be treated
and is important to recognize.
Vitamin B12 may often present in the
combination of neuropathy and myelopathy,
It's a Myeloneuropathy.
Rarely patients will present
with neuropathic symptoms early
and slow development of myelopathy and
so this needs to be a consideration
in patients presenting
with a polyneuropathy.
Vitamin B1 deficiency as
well as others vitamin B6
can also present
Importantly, vitamin B6 presents
with a sensory neuropathy
that is a result of an
overdose of vitamin B6
and needs to be a consideration
in selected patients.
There's a long list of drugs
or medications that can present
with side effects
You can see a short
list on the slide
and any patient presenting
with a chronic onset,
symmetric sensorimotor polyneuropathy
should have a robust medication review to
evaluate any potential offending agents.
Heavy metals can present
with a polyneuropathy,
arsenic with a
and lead or plumbism with a
motor predominant polyneuropathy.
And then lastly,
is can be present in some patients,
this presents with a motor predominant
often proximal involving