Patient Complaint: ? Neuropathy

Evaluation of other disorder or reassurance and follow-up

EDx

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)

Consider vasculitis or other multifocal process

Consider multifocal form of CIDP

Possible nerve biopsy

Test for paraprotein, HIV, Lyme disease

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

Test for paraprotein, if negative

Treatment appropriate for specific diagnosis

If tests are negative, consider treatment for CIDP

Treatment appropriate for specific diagnosis

Review family history; examine family members; genetic testing

Treatment for CIDP; see Ch. 439, HPIM-20

IVIg or plasmapheresis; supportive care including respiratory assistance

Genetic counseling if appropriate

End

History and examination compatible with neuropathy?

Yes

No

Mononeuropathy

Mononeuropathy multiplex

Polyneuropathy

EDx

Axonal

Demyelinating with focal conduction block

EDx

Axonal

Demyelinating

Subacute course (months)

Chronic course (years)

If chronic or subacute: CIDP

If acute: GBS

Uniform slowing, chronic

Nonuniform slowing, conduction block

CIDP, chronic inflammatory demyelinating polyradiculoneuropathy; EDx, electrodiagnostic; GBS, Guillain-Barré syndrome; IVIg, intravenous immunoglobulin.