HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Correspondence: Submit a response Alert me when this article is cited Alert me when Correspondence are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Dyck, P. J. Articles by Fealey, R. D. Search for Related Content PubMed PubMed Citation Articles by Dyck, P. J. Articles by Fealey, R. D.

Ten steps in characterizing and diagnosing patients with peripheral neuropathy

From the Peripheral Neuropathy Research Center, Department of Neurology, Mayo Clinic and Mayo Foundation, Rochester, MN.
Supported in part by grants obtained from the National Institute of Neurological and Communicative Disorders and Stroke NINCDS (14304).
Received November 10, 1995. Accepted in final form December 5, 1995.
Address correspondence and reprint requests to Dr. Peter James Dyck, Peripheral Neuropathy Center, Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.

Cost-effective approaches for arriving at correct diagnoses should be used. Herein, we compare three approaches for the differential diagnosis of a common neurologic syndrome, peripheral neuropathy. In the ``shotgun'' approach, a standard battery of hematologic, biochemical, serologic, antibody, enzyme, molecular genetic, and other tests are ordered after the presence of a neuropathy is established, without a detailed characterization of the neuropathy. In the ``gestalt'' approach, the specific variety of neuropathy is identified by recognition of a clinical pattern of symptoms, course, or disease associations. The ``10-step'' approach, encompassing components of the two other methods and adding others, evolved from our assessment of many patients with peripheral neuropathy. In the 10-step approach, the history and neurologic examination place the patient's disorder into one of perhaps 21 anatomic-pathologic patterns. Next, electrophysiologic and other tests confirm the correctness of this anatomic-pathologic pattern. Finally, a series of evaluations exclude or include an increasingly shorter list of diagnoses until only one likely one remains or the disorder remains undiagnosed. We advocate the 10-step over the shotgun or gestalt approach, because it emphasizes careful initial characterization of neuropathy and emphasizes use of a logical step-by-step inclusion or exclusion to arrive at a short list of diagnostic possibilities. The approach depends ultimately on the judgement of adequately trained and experienced physicians, not on the results of single tests. The 10-step approach is not a mindless algorithm, leading inevitably to the correct diagnosis, but depends on judgment based on extensive background and neurobiologic and clinical knowledge and training.

NEUROLOGY 1996;47: 10-17

This article has been cited by other articles:

				M. L. Mauermann and T. M. Burns Pearls and Oy-sters: Evaluation of peripheral neuropathies Neurology, February 10, 2009; 72(6): e28 - e31. [Full Text] [PDF]

				K C Gorson and A H Ropper Additional causes for distal sensory polyneuropathy in diabetic patients. J. Neurol. Neurosurg. Psychiatry, March 1, 2006; 77(3): 354 - 358. [Abstract] [Full Text] [PDF]

				P. J. Dyck The clinical heterogeneity of immune sensory and autonomic neuropathies with (or without) sicca Brain, November 1, 2005; 128(11): 2480 - 2482. [Full Text] [PDF]

				N R Rosenberg, C W Slotema, J E Hoogendijk, and M Vermeulen Follow up of patients with signs and symptoms of polyneuropathy not confirmed by electrophysiological studies J. Neurol. Neurosurg. Psychiatry, June 1, 2005; 76(6): 879 - 881. [Abstract] [Full Text] [PDF]

				A. G. Smith and J. R. Singleton The Diagnostic Yield of a Standardized Approach to Idiopathic Sensory-Predominant Neuropathy Arch Intern Med, May 10, 2004; 164(9): 1021 - 1025. [Abstract] [Full Text] [PDF]

				D. A. Chad and E. T. Hedley-Whyte Case 1-2004 - A 49-Year-Old Woman with Asymmetric Painful Neuropathy N. Engl. J. Med., January 8, 2004; 350(2): 166 - 176. [Full Text] [PDF]

				R Dickstein, R J Peterka, and F B Horak Effects of light fingertip touch on postural responses in subjects with diabetic neuropathy J. Neurol. Neurosurg. Psychiatry, May 1, 2003; 74(5): 620 - 626. [Abstract] [Full Text] [PDF]

				G. A. Suarez, C. H. Chalk, J. W. Russell, S. M. Kim, P. C. O'Brien, and P. J. Dyck Diagnostic accuracy and certainty from sequential evaluations in peripheral neuropathy Neurology, September 25, 2001; 57(6): 1118 - 1120. [Abstract] [Full Text] [PDF]

				N R Rosenberg, P Portegies, M de Visser, and M Vermeulen Diagnostic investigation of patients with chronic polyneuropathy: evaluation of a clinical guideline J. Neurol. Neurosurg. Psychiatry, August 1, 2001; 71(2): 205 - 209. [Abstract] [Full Text] [PDF]

				D. L. Menkes, D. E. Palmer-Toy, and E T. Hedley-Whyte Case 3-1999- A 41-Year-Old Woman with Muscle Weakness, Painful Paresthesias, and Visual Problems N. Engl. J. Med., January 28, 1999; 340(4): 300 - 307. [Full Text] [PDF]