Peripheral neuropathy consists of two words, peripheral meaning distal and neuropathy means nerve damage. It is the involvement of the peripheral nervous system and its components in the damage caused by various factors and resulting in a variety of symptoms including sensory, motor and autonomic symptoms.
What Are The First Symptoms Of Peripheral Neuropathy?
Symptoms of the peripheral neuropathy vary accordingly to the involvement of different types of nerve fibers. Also, the symptoms can be distinguished on the basis of sensations lost or new sensations added which are described as negative and positive symptoms respectively. In the sensory type of neuropathy, negative symptoms include numbness, loss of balance and positive symptoms include pins and needle sensation, tingling as the earliest symptoms to be experienced. A few other symptoms like gait abnormality, tremors, itching, pain, etc. can be added later.
The motor symptoms of the peripheral neuropathy include weakness, tiredness, and cramps, fasciculations as the few of the first negative and positive symptoms respectively. Gait abnormalities, muscle atrophy, wasting, movement disorders, loss of handgrip and other fine movements of the limbs get damaged later with the progression of peripheral neuropathy.
The autonomic symptoms are the least involved type in the peripheral neuropathy because of greater autonomic control of the body but once damaged they can produce a wide variety of symptoms belonging to the cardiovascular system, gastrointestinal system, genitourinary system, hematologic and circulatory system, metabolic system, etc. A few of the earliest symptoms found in autonomic peripheral neuropathy are hypotension, constipation, diarrhea, improper sweating, decreased libido, urge incontinence, syncope, dizziness, etc. (1) (2)
How To Test For Peripheral Neuropathy?
History of the patient plays an important part for diagnosis and testing of any disorder especially related to the nervous system. Physical examination is the first preliminary test done to diagnose peripheral neuropathy. Various physical symptoms like muscle atrophy, wasting, tremors, non-healing ulcers, erythema, gait abnormalities, etc. can itself be detected upon just examining the patient. Then the physical tests like passive movements, sensations recognition, deep tendon reflexes, tuning fork test, etc. can be done at the bedside of the patient. The involvement of the central nervous system should be ruled out before labeling the disorder as peripheral neuropathy.
Biochemical tests are also done to look for the cause of peripheral neuropathy. A complete blood panel, metabolic profile, random blood sugar, thyroid function test, liver function test, kidney function test, triple H test including HIV, HCV, and HBV, vitamin and mineral levels especially including vitamin b12 are usually done for the systemic causes of peripheral neuropathy.
Electrophysical tests like electromyography, nerve conduction studies, etc. are suggested to find out the degree and extent of nerve damage. Quantitative sensory testing, autonomic nervous testing in the controlled environment are specific for sensory and autonomic peripheral nervous systems respectively. Other studies like lumbar puncture, nerve biopsy, muscle and skin tissue histopathology are some of the invasive tests required in later stages when the diagnosis is not confirmed. Various imaging studies like computed tomography scanning, magnetic resonance imaging, of the spine are recommended to rule out the central causes as well as local causes of the spine. (1) (2)
Peripheral neuropathy is the involvement of any of the three groups of nerve fibers which are sensory, motor and autonomic. The symptoms faced during the early period are divided as positive and negative symptoms in which the positive symptoms are the addition of the new sensation and negative symptoms are loss of originally present sensation. Most of the diagnosis of peripheral neuropathy can be made upon history taking and the examination itself because it shows a very characteristic presentation associated with each cause of it. Nerve conduction studies and electromyography are some of the electrophysical studies which are used as confirmation tests for it and are also non-invasive. Before the confirmatory diagnosis of peripheral neuropathy is made, the central nervous system causes should be excluded.
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