Approach to Evaluation of Peripheral Neuropathies - Flowchart
Approach to Evaluation of Peripheral Neuropathies - Flowchart
«Flowchart»

Patient Complaint: ? Neuropathy

Patient Complaint: ? Neuropathy

Patient Complaint: ? Neuropathy

Patient Complaint: ? Neuropathy

Evaluation of other disorder or reassurance and follow up

Evaluation of other disorder or reassurance and follow up

Evaluation of other disorder or reassurance and follow up

EDx

EDx

EDx

Is the lesion axonal or demyelinating?
Is entrapment or compression present?
Is a contributing systemic disorder present?

Is the lesion axonal or demyelinating?
Is entrapment or compression present?
Is a contributing systemic disorder present?

Is the lesion axonal or demyelinating?
Is entrapment or compression present?
Is a contributing systemic disorder present?



Decision on need for surgery (nerve repair, transposition, or release procedure)

Decision on need for surgery (nerve repair, transposition, or release procedure)

Decision on need for surgery (nerve repair, transposition, or release procedure)

Consider vasculitis or other multifocal process

Consider vasculitis or other multifocal process

Consider vasculitis or other multifocal process

Consider multifocal form of CIDP

Consider multifocal form of CIDP

Consider multifocal form of CIDP

Possible nerve biopsy

Possible nerve biopsy

Possible nerve biopsy

Test for paraprotein, HIV, Lyme disease

Test for paraprotein, HIV, Lyme disease

Test for paraprotein, HIV, Lyme disease

Review history for toxins; test for associated systemic disease or intoxication

Review history for toxins; test for associated systemic disease or intoxication

Review history for toxins; test for associated systemic disease or intoxication

Test for paraprotein, if negative

Test for paraprotein, if negative

Test for paraprotein, if negative

Treatment appropriate for specific diagnosis

Treatment appropriate for specific diagnosis

Treatment appropriate for specific diagnosis

If tests are negative, consider treatment for CIDP

If tests are negative, consider treatment for CIDP

If tests are negative, consider treatment for CIDP

Treatment appropriate for specific diagnosis

Treatment appropriate for specific diagnosis

Treatment appropriate for specific diagnosis

Review family history; examine family members; genetic testing

Review family history; examine family members; genetic testing

Review family history; examine family members; genetic testing

Treatment for CIDP; see Ch. 385, HPIM-18

Treatment for CIDP; see Ch. 385, HPIM-18

Treatment for CIDP; see Ch. 385, HPIM-18

IVIg or plasmapheresis; supportive care including respiratory assistance

IVIg or plasmapheresis; supportive care including respiratory assistance

IVIg or plasmapheresis; supportive care including respiratory assistance

Genetic counseling if appropriate

Genetic counseling if appropriate

Genetic counseling if appropriate

End

End

End

History and examination compatible with neuropathy?

History and examination compatible with neuropathy?

History and examination compatible with neuropathy?

Yes

Yes

Yes

No

No

No

Mononeuropathy

Mononeuropathy

Mononeuropathy

Mononeuropathy multiplex

Mononeuropathy multiplex

Mononeuropathy Multiplex

Polyneuropathy

Polyneuropathy

Polyneuropathy

EDx

EDx

EDx

Axonal

Axonal

Axonal

Demyelinating with focal conduction block

Demyelinating with focal conduction block

Demyelinating

EDx

EDx

EDx

Axonal

Axonal

Axonal

Demyelinating

Demyelinating

Demyelinating

Subacute course (months)

Subacute course (months)

Subacute course

Chronic course (years)

Chronic course (years)

Chronic course

Uniform slowing chronic

Uniform slowing chronic

Uniform slowing

Nonuniform slowing, conduction block

Nonuniform slowing, conduction block

Nonuniform slowing

If chronic or subacute: CIDP

If chronic or subacute: CIDP

If chronic or subacute

If acute: GBS

If acute: GBS

If acute