Patterns of Neuropathic Disorders
| Pattern 1: Symmetric proximal and distal weakness with sensory loss |
| Consider: inflammatory demyelinating polyneuropathy (GBS and CIDP) |
| Pattern 2: Symmetric distal sensory loss with or without distal weakness |
| Consider: cryptogenic or idiopathic sensory polyneuropathy (CSPN), diabetes mellitus and other metabolic disorders, drugs, toxins, familial (HSAN), CMT, amyloidosis, and others |
| Pattern 3: Asymmetric distal weakness with sensory loss |
| With involvement of multiple nerves |
| Consider: multifocal CIDP, vasculitis, cryoglobulinemia, amyloidosis, sarcoid, infectious (leprosy, Lyme, hepatitis B, C, or E, HIV, CMV), HNPP, tumor infiltration |
| With involvement of single nerves/regions |
| Consider: may be any of the above but also could be compressive mononeuropathy, plexopathy, or radiculopathy |
| Pattern 4: Asymmetric proximal and distal weakness with sensory loss |
| Consider: polyradiculopathy or plexopathy due to diabetes mellitus, meningeal carcinomatosis or lymphomatosis, hereditary plexopathy (HNPP, HNA), idiopathic |
| Pattern 5: Asymmetric distal weakness without sensory loss |
| With upper motor neuron findings |
| Consider: motor neuron disease |
| Without upper motor neuron findings |
| Consider: progressive muscular atrophy, juvenile monomelic amyotrophy (Hirayama's disease), multifocal motor neuropathy, multifocal acquired motor axonopathy |
| Pattern 6: Symmetric sensory loss and distal areflexia with upper motor neuron findings |
| Consider: Vitamin B12, vitamin E, and copper deficiency with combined system degeneration with peripheral neuropathy, hereditary leukodystrophies (e.g., adrenomyeloneuropathy) |
| Pattern 7: Symmetric weakness without sensory loss |
| With proximal and distal weakness |
| Consider: SMA |
| With distal weakness |
| Consider: hereditary motor neuropathy (“distal” SMA) or atypical CMT |
| Pattern 8: Asymmetric proprioceptive sensory loss without weakness |
| Consider causes of a sensory neuronopathy (ganglionopathy): |
| Cancer (paraneoplastic) |
| Sjögren's syndrome |
| Idiopathic sensory neuronopathy (possible GBS variant) |
| Cisplatin and other chemotherapeutic agents |
| Vitamin B6 toxicity |
| HIV-related sensory neuronopathy |
| Pattern 9: Autonomic symptoms and signs |
| Consider neuropathies associated with prominent autonomic dysfunction: |
| Hereditary sensory and autonomic neuropathy |
| Amyloidosis (familial and acquired) |
| Diabetes mellitus |
| Idiopathic pandysautonomia (may be a variant of Guillain-Barré syndrome) |
| Porphyria |
| HIV-related autonomic neuropathy |
| Vincristine and other chemotherapeutic agents |
Abbreviations: CIDP, chronic inflammatory demyelinating polyneuropathy; CMT, Charcot-Marie-Tooth disease; GBS, Guillain-Barré syndrome; HNA, hereditary neuralgic amyotrophy; HNPP, hereditary neuropathy with liability to pressure palsies; HSAN, hereditary sensory and autonomic neuropathy; SMA, spinal muscular atrophy.