Urinalysis (including 24-hour urine collection)
Lead and mercury mainly cause motor neuropathyĢ4-hour urine collection for heavy metal titers Heavy metals (e.g., arsenic, lead, mercury, gold) Neuropathy with liability to pressure palsies Peripheral neuropathy is intermixed with upper motor neuron signsĬBC vitamin B 12 and homocysteine levels methylmalonic acid test Rapid plasma reagin, VDRL, cerebrospinal fluid analysis Monoclonal gammopathy of undetermined significance Urine and serum protein electrophoresis with immunofixationĪxonal damage predominates after treatment Phenolic glycolipid-1 antibody, skin biopsy Usually acute or subacute, but can be chronic Serum creatinine and blood urea nitrogen levels Hepatic transaminase, bilirubin, albumin, and alkaline phosphatase levelsįasting blood glucose level, glucose tolerance test, A1C level Mainly demyelinating, especially in viral hepatitis Paraneoplastic panel (anti-Hu, anti-Yo, anti-Ri, anti-Tr, anti-Ma, and anti-CV2 antibodies) Treatment should address the underlying disease process, correct any nutritional deficiencies, and provide symptomatic treatment. Electrodiagnostic studies, including nerve conduction studies and electromyography, can help in the differentiation of axonal versus demyelinating or mixed neuropathy. Lumbar puncture and cerebrospinal fluid analysis may be helpful in the diagnosis of Guillain-Barré syndrome and chronic inflammatory demyelinating neuropathy. Initial blood tests should include a complete blood count, comprehensive metabolic profile, and measurement of erythrocyte sedimentation rate and fasting blood glucose, vitamin B 12, and thyroid-stimulating hormone levels specialized tests should be ordered if clinically indicated. A systematic approach begins with localization of the lesion to the peripheral nerves, identification of the underlying etiology, and exclusion of potentially treatable causes. The diagnosis requires careful clinical assessment, judicious laboratory testing, and electrodiagnostic studies or nerve biopsy if the diagnosis remains unclear. The most common treatable causes include diabetes mellitus, hypothyroidism, and nutritional deficiencies. Peripheral neuropathy has a variety of systemic, metabolic, and toxic causes.
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