*MOST COMMON TYPE of neuropathy

a.k.a. Stocking-glove syndrome, length dependent polyneuropathy, polyneuropathy

Presentation

• Lower limb before upper limb (longest nerve first)
  • NOT simultaneously hand and foot
  • Expect hand symptom when symptom reaches the knee
• Symmetric (not just bilateral)
• Sensory before motor
  • Vibration lost before pinprick
    • Vibration test
    • 10g monofilament Test (≥ 5.5/8)
  • Motor = Muscle Cramp in the feet

DDx

• Co-existing CTS - Carpal Tunnel Syndrome
• !Compressive Cervical Myelopathy (early motor symptom)

<aside> 💡

• *Note: late-stage, Mononeuropathy Multiplex (MM) can become confluent → mimics DSP. So it is important to get a time course </aside>

• Red flag

  • NOT DISTAL
    • Hand onset
    • proximal or cranial nerve involvement
    • motor-predominant symptom
  • NOT SYMMETRICAL
    • Asymmetric onset
    • Patchy exam findings
    • Disproportionate reflex loss

Etiology

Major Causes

• Metabolic: Diabetes Mellitus ** MOST COMMON CAUSE

• Nutritional: Vitamin B12 (Cobalamin) Deficiency, Thiamine B1 Deficiency

• Toxic: Alcohol (RF), Chemotherapy

• Malignancy: MM - Multiple Myeloma

• Autoimmune: !GBS - Guillain-Barré syndrome

• Idiopathic/cryptogenic