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Distal symmetric polyneuropathy

Background

Overview

Definition
Distal symmetric polyneuropathy is diffuse length-dependent peripheral neuropathy characterized by numbness, tingling, pain, and/or weakness that typically starts in the toes and spreads proximally.
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Pathophysiology
Distal symmetric polyneuropathy is most commonly caused due to diabetes (32-53%), idiopathic reasons (24-27%), alcohol, vitamin B 12 deficiency, chemotherapy, CKD, paraproteinemia, and inherited conditions (hammertoes, high arches, Charcot Marie Tooth). Other causes include pre-diabetes, infections, inflammation, toxins, autoimmunity, neoplasms, and paraneoplasms.
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Disease course
Clinical manifestations of distal symmetrical polyneuropathy include numbness, tingling, pain, starting in the toes with proximal spread, decreased pinprick and vibration sensation in a stocking-glove distribution, decreased reflexes starting at the ankles, weakness of toe extension, or trouble walking on heels. Progression may lead to weakness, the involvement of fingertips, balance issues resulting in falls and fractures, risk of ulcerations and amputations.
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Prognosis and risk of recurrence
Lower extremity amputations are associated with early postoperative mortality of up to 22%.
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Guidelines

Key sources

The following summarized guidelines for the evaluation of distal symmetric polyneuropathy are prepared by our editorial team based on guidelines from the American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM/AAN 2009). ...
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Diagnostic investigations

Laboratory assessment
As per AAN/AANEM 2009 guidelines:
Consider screening laboratory tests (e.g., blood glucose, serum B12 and serum protein electrophoresis) in all patients with polyneuropathy.
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Consider testing for impaired glucose tolerance in patients with distal symmetric sensory polyneuropathy in whom there is no evidence of diabetes mellitus.
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