PERIPHERAL NERVOUS SYSTEM DISORDERS: A DIAGNOSTIC APPROACH

Abstract

Peripheral neuropathy though a common neurological illness has complex aetiology and several different presentations. The term peripheral neuropathy includes symmetric polyneuropathy, single and multiple mononeuropathy, and radiculopathy. Further classication depends on a mixture of phenomenological, pathological, and genetic or other aetiological features. It is heterogeneous in aetiology, diverse in pathology, and varied in severity. Managing a case of perpipheral neuropathy brings along numerous challenges include identifying a case of peripheral neurophy and differentiating it from mimicks, working up for etiology and treatment based on aetiology. Patients can present with either positive or negative symptoms (or both) linked to motor and sensory systems or with autonomic disturbances in some neuropathies. A detailed history and physical examination provides information regarding onset, course and progression of the disease and the type of involvement like generalized, distal or proximal, symmetric or asymmetric, also the type of bre involvement like large myelinated or small unmyelinated and may give clues to neuro anatomic localization of the disease. The diagnosis can be conrmed through a appropriate investigation for the neuropathic pattern like blood tests, Cerebrospinal uid (CSF) analysis, MRI Brain, Ultrasound (USg). These test along with Electro diagnostic investigations like Nerve Conduction Studies (NCS), needle electromyography (EMG) can narrow down differentials and possible aetiologies, However in signicant cases etiology remain undiagnosed. Genetic testing is most diagnostic in carefully selected cases. Sometimes nerve biopsy and skin biopsy may be needed to conrm the etiologies.