Cause Of Polyneuropathy Research Articles

Difficult patient with polyneuropathy: CIDP associated with type 1 diabetes mellitus

Polyneuropathies are a heterogeneous group of diseases that can be caused both by a primary lesion of peripheral nerves, and secondarily, against the background of various somatic diseases. The most common cause of chronic polyneuropathy is distal symmetrical diabetic polyneuropathy. In clinical practice, it is important to be aware of dysimmune polyneuropathy, such as Guillain Barré syndrome, chronic inflammatory demyelinating polyneuropathy, and paraproteinemic polyneuropathy, which lead to severe motor impairment and disability in patients. Identification of the cause of polyneuropathy requires real art, which includes knowledge of the clinical, electrophysiological picture and variants of the course of the disease, as well as a wide range of conditions leading to their development. Timely diagnosis of polyneuropathies and early assignment of etiological and pathogenetic therapy reduce the risk of developing irreversible changes in peripheral nerves caused by axonal degeneration. In the treatment of polyneuropathy of various origins, a special place is occupied by B vitamins, which have a neurotropic effect. Cyanocobalamin is a pathogenetic therapy in patients with diabetes who take metformin for a long time and who developed polyneuropathy due to vitamin B12 deficiency. In one patient, a combination of several variants of polyneuropathies is possible. The article presents a clinical case of a patient with type 1 diabetes mellitus (DM) who developed dysimmune chronic inflammatory demyelinating polyneuropathy (CIDP) associated with DM on the background of distal symmetrical painless diabetic polyneuropathy after a COVID- 19 infection. A feature of the development of CIDP was the acute onset of the disease. Variants of the clinical picture, ENMG criteria, as well as features of treatment, the effectiveness of therapy and the prognosis of CIDP in patients with DM are discussed.

Difficulties of differential diagnosis of polyneuropathy developed after Gam-COVID-Vac vaccination on the background of combined infectious pathology (clinical case)

The clinical case describes the difficulties of differential diagnosis of polyneuropathy that developed after Gam-Covid-Vac vaccination on the background of combined infectious pathology (HIV infection, tick-borne borreliosis, COVID-19) in a young woman. It is shown that various infectious and non-infectious diseases with similar clinical symptoms (peripheral nervous system affliction) occurring simultaneously in one patient can significantly affect each other’s course and complicate the establishment of the true cause of polyneuropathy. It should be noted that in this example, the establishment of a final diagnosis was carried out collectively, by consensus, and was based on the effectiveness of etiotropic (antibacterial) treatment, which in fact was an ex juvantibus therapy option, which made it possible to establish the most probable etiology of polyneuropathy – tick-borne borreliosis. In turn, HIV infection and possibly vaccination, according to the authors, could cause immunosuppression, which affected the degree of dissemination of Borrelia burgdorferi. It is also likely that the insufficient immune response in combination with the cascade plasma filtration session affected the initial dubious results of the serological tests, which further complicated the diagnosis.

P.102 Role of interdigital sensory nerve conduction study as a noninvasive approach for early diagnosis of diabetic peripheral neuropathy

Background: Diabetes mellitus is a common cause of polyneuropathy. Despite numerous diagnostic tools such as routine electrophysiologic procedures, its early detection is challenging. This study compares a distal electrodiagnostic technique, with conventional approaches to investigate its role in confirming early polyneuropathy. Methods: Thirty-one symptomatic diabetic outpatients and 23 asymptomatic nondiabetic subjects were included in our study. We performed nerve conduction studies on the dorsal sural, medial plantar, and digital branches of the interdigital nerves to toes I, II, and III (as a new antidromic technique). All techniques were applied with the surface stimulator and pick-up electrodes. Results: Only 9 (29%) of patients had impaired routine NCSs. Interestingly, the results of interdigital nerve studies were abnormal in 17 out of 22 patients with normal routine NCSs. Also, 11 and 13 subjects had impaired medial plantar and dorsal sural nerves conduction studies, respectively. According to this method, the prevalence of detectable diabetic neuropathy increased from 46% to 83%. Conclusions: The digital sensory branches can be easily evaluated with the new antidromic SNAP technique for the early diagnosis of diabetic polyneuropathy, especially in presymptomatic and subclinical neuropathies. This method is simple, non-invasive, sensitive, and reproducible. There is no need for needle electrodes or averaging techniques.

Патогенетически обусловленные подходы к диагностике и лечению полинейропатии

Дистальный симметричный сенсомоторный синдром довольно часто встречается в клинической практике. Очень важно вовремя и наиболее точно установить причину развития полинейропатии. Насчитывается около 100 причин поражения периферической нервной системы. В последнее время все больше внимания уделяется инструментальным и лабораторным методам исследования, тогда как клиническая диагностика, тщательный сбор анамнеза, внимательный ­осмотр могут дать более 70 % диагноза. Очень важно не прекращать поиск возможного этиологического фактора, даже когда на первый взгляд причина очевидна, но клинически наблюдаются несоответствия. В процессе поиска причинных факторов важно не терять время и начать лечение как можно раньше. Для этого подходят препараты, направленные именно на универсальные факторы патогенеза — свободнорадикальное окисление, воспаление, отек, нарушение микроциркуляции.

Differential diagnosis of polyneuropathies in diabetes mellitus

Diabetic polyneuropathy (DPN) is heterogeneous in its clinical course and clinical manifestations. Depending on the primary lesion of large or small nerve fibers, different onset, course and clinical manifestations of polyneuropathy are possible. In patients with diabetes, the incidence of associated lesions of the peripheral nervous system is high. When verifying the diagnosis of DPN, it is necessary to carry out a differential diagnosis with a number of diseases: paraneoplastic neuropathies, metabolic neuropathies, neuropathies in vasculitis, toxic neuropathies, autoimmune neuropathies, inflammatory neuropathies and hereditary neuropathies. Diabetes is not the only cause of polyneuropathy. Up to 50% of all cases of polyneuropathies in diabetes have additional causes. Diagnosis of diabetic polyneuropathy - diagnosis of exclusion. The development of polyneuropathy in patients with a duration of type 1 diabetes less than 5 years, the absence of nephropathy and / or retinopathy, asymmetry in symptoms and signs, the predominance of motor symptoms, beginning with upper limb lesions, rapid progression should justify the doctor for differential diagnostic search. You should also take into account the characteristics of the patient (old age, vegetarianism and alcohol use), medical and toxic effects (taking metformin> 3 years and> 2 g / day; cytostatics, chemotherapy, heavy metals), family history of neuropathy. Therapeutic tactics should be individualized and take into account the polyneuropathy polyetiology. The purpose of this review is to discuss the most common reasons peripheral neuropathy in diabetes mellitus. The differential diagnosis of the diabetic polyneuropathy is the focus of this article.

Transthyretin -Related Familial Amyloid Polyneuropathy (TTR-FAP) Polineuropathy – Challenge Diagnosis and Case Presentation

Abstract Introduction Transthyretin -Related Familial Amyloid Polyneuropathy (TTR-FAP) is a rare cause of polyneuropathy, mainly in Romania, but also in other geographic area of Europe, Japan and north America. Polyneuropathies are common in neurology practice, but prevalence and incidence are not known, usually are underreported and misdiagnosis. Almost one third of polyneuropathies remain idiopathic, in spite of extensive work-out to identify etiology. Transthyretin-related familial amyloid polyneuropathy (TTR-FAP) is a multisystemic disease neurological manifestation caused by the accumulation of amyloidogenic transthyretin (TTR) protein in tissues. It is an autosomal dominant syndrome, and there are more than 100 forms of TTr associated with FAP. The disease is characterized by progressive peripheral and autonomic neuropathy, and visceral amyloid involvement like cardiac amyloidosis. Case presentation We present the case of a male, aged 48, who experienced from 18 month paresthesias of distal inferior limb and fatigue, with an important weight loss. The patient was diagnosed with mixed polyneuropathy, and he was extensively investigated. Etiology was not established. He began to feel dizziness and faints several times, and these new features lead to our final diagnosis. Conclusions Etiology of a polyneuropathy case could be very challenging for general neurologist due to a numerous causes. A large variety of signs and symptoms lead the clinician to a narrow diagnostic possibilities and still this might take a long time. Polyneuropathy and cardiac involvement make a mark for life threatening disease but potentially curable

Feasibility and Effectiveness of Electrochemical Dermal Conductance Measurement for the Screening of Diabetic Neuropathy in Primary Care. Decoding Study (Dermal Electrochemical Conductance in Diabetic Neuropathy).

Diabetes mellitus (DM) is the leading cause of polyneuropathy in the Western world. Diabetic neuropathy (DNP) is the most common complication of diabetes and is of great clinical significance mainly due to the pain and the possibility of ulceration in the lower limbs. Early detection of neuropathy is essential in the medical management of this complication. Early unmyelinated C-fiber dysfunction is one of the typical findings of diabetic neuropathy and the first clinical manifestation of dysfunction indicating sudomotor eccrine gland impairment. In order to assess newly developed technology for the measurement of dermal electrochemical conductance (DEC), we analyzed the feasibility and effectiveness of DEC (quantitative expression of sudomotor reflex) as a screening test of DNP in primary health care centers. The study included 197 people (with type 2 diabetes, prediabetes and normal tolerance) who underwent all the protocol tests and electromyography (EMG). On comparing DEC with EMG as the gold standard, the area under the receiver operating characteristic (ROC) curve (AUC, area under the curve) was 0.58 in the whole sample, AUC = 0.65 in the diabetes population and AUC = 0.72 in prediabetes, being irrelevant in subjects without glucose disturbances (AUC = 0.47). Conclusions: In usual clinical practice, DEC is feasible, with moderate sensitivity but high specificity. It is also easy to use and interpret and requires little training, thereby making it a good screening test in populations with diabetes and prediabetes. It may also be useful in screening general populations at risk of neuropathy.

Feasibility and effectiveness of electrochemical dermal conductance measurement for the screening of diabetic neuropathy in primary care. DECODING Study (Dermal Electrochemical Conductance in Diabetic Neuropathy). Rationale and design.

Diabetes mellitus is the leading cause of polyneuropathy in the Western world. Diabetic neuropathy is a frequent complication of diabetes and may have great clinical transcendence due to pain and possible ulceration of the lower extremities. It is also a relevant cause of morbidity and mortality in patients with diabetes. Although the cause of polyneuropathy in patients with diabetes is only partially known, it has been associated with chronic hyperglycemia suggesting the possible etiopathogenic implication of advanced glycosylation end products. The strategy of choice in the medical management of diabetic neuropathy is early detection since glycaemic control and the use of certain drugs may prevent or slow the development of this disease. Diabetic neuropathy most often presents with a dysfunction of unmyelinated C-fibers, manifested as an alteration of the sweat reflex of the eccrine glands. This dysfunction can now be demonstrated using a newly developed technology which measures dermal electrochemical conductivity. This noninvasive test is easy and cost-effective. The aim of the present study is to evaluate the feasibility and effectiveness of dermal electrochemical conductance measurement (quantitative expression of the sudomotor reflex) as a screening test for the diagnosis of diabetic neuropathy in patients in primary care.

Polyneuropathies

Background: Polyneuropathies (peripheral neuropathies) are the most common type of disorder of the peripheral nervous system in adults, and specifically in the elderly, with an estimated prevalence of 5-8%, depending on age. The options for treatment depend on the cause, which should therefore be identified as precisely as possible by an appropriate diagnostic evaluation. Methods: This review is based on the current guidelines and on large-scale cohort studies and randomized, controlled trials published from 2000 to 2017, with an emphasis on non-hereditary types of polyneuropathy, that were retrieved by a selective search in PubMed. Results: Diabetes is the most common cause of polyneuropathy in Europe and North America. Alcohol-associated polyneuropathy has a prevalence of 22-66% among persons with chronic alcoholism. Because of the increasing prevalence of malignant disease and the use of new chemotherapeutic drugs, chemotherapy-induced neuropathies (CIN) have gained in clinical importance;their prevalence is often stated to be 30-40%, with high variation depending on the drug(s) and treatment regimen used. Polyneuropathy can also arise from genetic causes or as a consequence of vitamin deficiency or overdose, exposure to toxic substances and drugs, and a variety of immunological processes. About half of all cases of polyneu ropathy are associated with pain. Neuropathic pain can be treated symptomatically with medication. Exercise, physiotherapy, and ergotherapy can also be beneficial, depending on the patient's symptoms and functional deficits. Conclusion: A timely diagnosis of the cause of polyneuropathy is a prerequisite for the initiation of appropriate specific treatment. Patients with severe neuropathy of unidentified cause should be referred to a specialized center for a thorough diagnostic evaluation.

Polyneuropathies.

Polyneuropathies (peripheral neuropathies) are the most common type of disorder of the peripheral nervous system in adults, and specifically in the elderly, with an estimated prevalence of 5-8%, depending on age. The options for treatment depend on the cause, which should therefore be identified as precisely as possible by an appropriate diagnostic evaluation. This review is based on the current guidelines and on large-scale cohort studies and randomized, controlled trials published from 2000 to 2017, with an emphasis on non-hereditary types of polyneuropathy, that were retrieved by a selective search in PubMed. Diabetes is the most common cause of polyneuropathy in Europe and North America. Alcohol-associated polyneuropathy has a prevalence of 22-66% among persons with chronic alcoholism. Because of the increasing prevalence of malignant disease and the use of new chemotherapeutic drugs, chemotherapy-induced neuropathies (CIN) have gained in clinical importance; their prevalence is often stated to be 30-40%, with high variation depending on the drug(s) and treatment regimen used. Polyneuropathy can also arise from genetic causes or as a consequence of vitamin deficiency or overdose, exposure to toxic substances and drugs, and a variety of immunological processes. About half of all cases of polyneu - ropathy are associated with pain. Neuropathic pain can be treated symptomatically with medication. Exercise, physiotherapy, and ergotherapy can also be beneficial, depending on the patient's symptoms and functional deficits. A timely diagnosis of the cause of polyneuropathy is a prerequisite for the initiation of appropriate specific treatment. Patients with severe neuropathy of unidentified cause should be referred to a specialized center for a thorough diagnostic evaluation.

Occupational exposure to ethylene oxide as a cause of polyneuropathy

Background: Nowadays the exposure to Ethylene Oxide (EO) is extremely rare thanks to the advent of personal protective equipment (PPE). This substance is a gas used to clean surgical material and operation room. The signs of acute intoxication can be dermatological lesions, cyanosis, dyspnea and loss of consciousness.

Chronic Inflammatory Demyelinating Polyneuropathy in Diabetes Patients

Diabetes mellitus (DM) is pandemic, and is the leading global cause of polyneuropathy, most commonly, a distal symmetric sensorimotor polyneuropathy (DSP). By contrast, chronic inflammatory demyelinating polyneuropathy (CIDP) is rare, and characterized mainly by symmetrical proximal and distal muscles weakness. There are currently 15 sets of criteria using a variable combination of clinical, electrophysiologic, laboratory, and biopsy features to identify CIDP, but it is unclear if these criteria are the same in patients with and without DM. Slowed conduction velocity, a feature of demyelination, is observed in patients with type 1 DM with poor control, and the clinical characteristics of these patients differ from those who have CIDP and DM, suggesting a different pathophysiology. Treatment response rates in CIDP patients, with and without DM, are as high as 80 %, and it is recommended that treatment be started early to prevent secondary axonal loss. However, patients with type 1 DM with CIDP are far less likely to be treated than CIDP patients who do not have DM. In patients with type 1 DM with polyneuropathy who have prominent weakness or demyelination in electrophysiologic studies, a diagnosis of CIDP and a trial of therapy should be considered.

P957: Mixed-type polyneuropathy in Wilson's disease

Wilson’s Disease (WD) is an autosomal recessive disorder of abnormal copper metabolism witch predominantly affects the central nervous system and the liver. Peripheral nervous system involvement is rarely reported in the context of WD and not well characterized. Here we describe a WD patient with peripheral neuropathy. A 58-year-old male suffering from WD on therapy with trientine referred to our center because of mild distal limb weakness with hypoesthesia. Clinical evaluation showed mild leg weakness with foot drop and hyporreflexia. A nerve conduction study was performed using standard techniques (Medtronic Keypoint v5.09). Distal motor latency, F-wave latency, motor nerve conduction velocity and CMAP were evaluated in the deep peroneal, posterior tibial, median and ulnar nerves; sensory nerve conduction velocity and SAP were measured in the sural, superficial peroneal, median, ulnar and radial nerve. No other cause of polyneuropathy was found. Electroneurographyc findings suggested an asymmetric length-dependent sensory-motor neuropathy of mixed type. We confirmed peripheral nervous system involvement in WD. According to the literature, also our findings showed both myelin and axonal damage. Polyneuropathy may appear despite therapy, although a iatrogenic contribution cannot be excluded.

70. Mixed-type polyneuropathy in Wilson’s Disease

Wilson’s Disease (WD) is an autosomal recessive disorder of abnormal copper metabolism witch predominantly affects the central nervous system and the liver. Peripheral nervous system involvement is rarely reported in the context of WD and not well characterized. Here we describe a WD patient with peripheral neuropathy. A 58-year-old male suffering from WD on therapy with trientine referred to our center because of mild distal limb weakness with hypoesthesia. Clinical evaluation showed mild leg weakness with foot drop and hyporreflexia. A nerve conduction study was performed using standard techniques (Medtronic Keypoint v5.09). Distal motor latency, F-wave latency, motor nerve conduction velocity and CMAP were evaluated in the deep peroneal, posterior tibial, median and ulnar nerves; sensory nerve conduction velocity and SAP were measured in the sural, superficial peroneal, median, ulnar and radial nerve. No other cause of polyneuropathy was found. Electroneurographyc findings suggested an asymmetric length-dependent sensory-motor neuropathy of mixed type. We confirmed peripheral nervous system involvement in WD. According to the literature, also our findings showed both myelin and axonal damage. Polyneuropathy may appear despite therapy, although a iatrogenic contribution cannot be excluded.

An electrophysiological study of peripheral polyneuropathy in brucellosis.

Brucellosis is an anthropozoonotic disease with heterogeneous clinical presentations. This study aims to investigate the peripheral nervous system (PNS) involvement in brucellosis. A total of 57 patients with brucellosis, and 42 age- and gender-matched healthy subjects were enrolled into the study. We performed motor conduction studies that included bilateral median, ulnar, tibial and peroneal nerves, and sensory nerve investigations from bilateral median, ulnar, radial, sural and medial plantar nerves. Among patients with brucellosis, 21 had neuropathic symptoms. Of these, 9 had abnormalities in nerve conduction studies. The electromyographic testing revealed abnormalities in 2 patients without neuropathic symptoms. Overall, 11 patients (4 males, 7 females) with brucellosis (19.3%) had polyneuropathy (PNP). The mean age of patients with PNP was 52.63 ± 19.06 years, being significantly higher than those without PNP (P = 0.006). The mean duration of brucellosis was also longer in patients with PNP, but not significant. The mean distal latency (DL) and nerve conduction velocity (NCV) values were almost always longer in patients with brucellosis than controls, though not statistically significant. Our results showed that brucellosis causes clinical or subclinical peripheral PNP, and should therefore be considered as a cause of PNP, especially in endemic regions.

Two‐point discrimination in diabetic patients (糖尿病患者的两点辨别力)

Diabetes mellitus (DM) is a common cause of polyneuropathy. The aim of the present study was to evaluate two-point discrimination (TPD) compared with nerve conduction studies in the early stages of DM. Forty-eight patients with early diagnosed (<5 years) type 2 DM and 17 healthy controls were evaluated. Of the patients with DM, 26 had neuropathic pain and 22 were asymptomatic. TPD and electrophysiological evaluations was obtained for all subjects. Nerve conduction studies in patients showed findings related to both demyelination and axonal damage. Patients with neuropathic pain had higher TPD values on the plantar surface of the foot and both groups of DM patients had higher TPD values on the outer lateral malleolus compared with the control group (P < 0.05). There was a correlation between TPD and axonal damage in patients with neuropathic pain (P < 0.05). In patients without neuropathic pain, there was a correlation between TPD values and distal latencies of motor or sensory nerves (P < 0.05). In the control group, only third digit TPD values were related to the distal motor latency of the median nerve (P < 0.05). In conclusion, the TPD method is a less painful, practical, cost-effective, and more easily applicable method that was completed in less time than nerve conduction studies. Higher TPD values in the lower extremities indicate nerve damage in patients. These findings suggest that increased TPD values can easily determine neuropathy starting in the early stages of diabetes in patients with DM.

Sensomotor axonal peripheral neuropathy as a first complication of polycythemia rubra vera: A report of 3 cases

Patient: Female, 64Final Diagnosis: Polycythemia rubra veraSymptoms: Burning pain • cramps • hypesthesia • itching • paresthesiaMedication: —Clinical Procedure: —Specialty: NeurologyObjective:Unusual clinical courseBackground:The association between polycythemia vera and peripheral neuropathy has been described previously but only as a late complication and only with sensory axonal polyneuropathy.We presume the cause of polyneuropathy was hypoxia due to higher blood viscosity and dysfunction of platelet aggregation.Cases Report:We report the cases of 3 female patients with symptoms and signs of slowly progressive sensorimotor axonal polyneuropathy confirmed with clinical and neurographic examination as first complication of polycythemia vera, which progressed to a major complication. Axonal damage was irreversible despite venipuncture.Conclusions:Polycythemia vera is rarely manifested with symptoms of sensomotor polyneuropathy as the first signs of the disease, and should therefore be recognized by physicians to prevent further axonal damage and major complications of disease by venipuncture or cytostatic therapy.

Effect of L-carnitine on diabetic neuropathy and ventricular dispersion in patients with diabetes mellitus

Diabetes is a common cause of polyneuropathy. Cardiac arrhythmias and markedly increased mortality rate have been demonstrated in patients with diabetic neuropathy and also demonstrated that abnormally prolonged QT dispersion interval (QTd) is associated with a higher risk of ventricular arrhythmias and sudden death. We investigated the efficacy and tolerability of L-carnitine (LC) in the treatment of diabetic neuropathy and ventricular dispersion, mainly by evaluating the effects of treatment on electrophysiological parameters. Materials and methods: We recruited 30 patients with type I or type II diabetes (mean age: 60 ± 9 years, range: 36-75; 18 males, 12 females) meeting clinical and neurophysiological criteria for diabetic neuropathy. All of the patients were given LC 2 g/day for 10 months. Blood glucose regulation was maintained by diet, oral antidiabetic, or insulin. To determine the nerve functions electrophysiologically, superficial electrode distal latency, amplitude, nerve conduction velocity in median and ulnar nerves in the upper extremities and peroneal, tibial and sural nerves in the lower extremities and F response in motor nerves were studied. Resting 12-lead electrocardiograms were recorded for measurements of QTd, corrected QTd (QTcd), JT dispersion (JTd), and corrected JT dispersion (JTcd). Results: After 10 months of treatment, median, ulnar, and tibial nerves' motor nerve conduction velocities (P < 0.05) and M-wave amplitudes (P < 0.05) increased; distal latencies and the F-wave latencies (P < 0.05) decreased; ulnar, sural, and median sensory nerve action potential amplitude (P < 0.01) and nerve conduction velocities (P < 0.05) increased; distal latencies (P < 0.05) decreased; and , QTd, QTcd, JTd, and JTcd (P < 0.05) decreased significantly when compared to basal values. The greatest changes in sensory nerve action potential amplitude and ventricular dispersion parameters were observed in the sensory sural nerve and QTcd, respectively. LC was well tolerated over the study period. Conclusion: LC, well tolerated by diabetic patients, may improve peripheral neuropathy and ventricular dispersion and may be useful in preventing the increased incidence of arrhythmias and sudden death observed in such patients. Larger clinical trials are needed to confirm these data before changes to clinical practice can be advocated.

Chemotherapy plus Stem Cell Transplantation for Primary Amyloid Polyneuropathy

Although primary amyloidosis is a rare cause of polyneuropathy, about 17% of patients with this condition develop neuropathy that is progressive and refractory to treatment. These authors describe the diagnosis, treatment with high-dose melphalan plus autologous stem cell transplantation (HDM/SCT), and follow-up of two patients with well-characterized primary systemic amyloidosis and polyneuropathy. …

Peripheral Neuropathy of the Upper Extremity

In the orthopedic patient, the diagnosis of a compression neuropathy may be straightforward. However, various medical comorbidities can obscure this diagnosis. It is paramount for the practicing orthopedic surgeon to have an appreciation for the medical pathology of common axonal neuropathies to properly diagnose, treat, and refer a patient with altered sensation in the upper extremity. The prevalence of diabetes in the United States is 10%, and roughly 20% of diabetic patients have peripheral neuropathy. In addition to diabetes, 32% of heavy alcohol users present with polyneuropathy. With advancements in the treatment of human immunodeficiency virus/acquired immunodeficiency syndrome clinicians may see the long-term effects of the virus manifested as axonal neuropathies and extreme allodynia. In some regions of the world, Hansen's disease usurps diabetes as the most common cause of polyneuropathy. Based on patient demographics and social habits, Lyme disease, multiple sclerosis, and syphilis can all manifest as polyneuropathies. Understanding the common medical causes of neuropathy will aid the orthopedic surgeon in differentiating simple compression neuropathies from diseases mimicking or confounding them.