Peripheral neuropathy differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]

Overview

Peripheral neuropathy must be differentiated from other diseases that cause , sensorineural, motor, autonomic and balance problems, such as spinal cord lesions and brain lesions. Peripheral neuropathy usually causes lower motor nerve damage, while lesions in brain and spinal cord usually cause lower motor neuron damage. The difference between upper and lower motor neuron symptoms and signs may be very helpful to differentiate peripheral neuropathy from brain and spinal cord lesions. Lower motor neuron signs and symptoms in peripheral neuropathy typically present with diminished deep tendon reflexes, flaccid paralysis, severe muscle atrophy, negative babinski reflex andfasciculation whereas upper motor neuron signs and symptoms in brain and spinal cord lesions typically present with hyperactive deep tendon reflexes, spastic paralysis, no muscle atrophy, positive babinski reflex and no fasciculation.

Differentiating peripheral neuropathy from other diseases

• Peripheral neuropathy must be differentiated from other diseases that cause , sensorineural, motor, autonomic and balance problems, such as spinal cord lesions and brain lesions.

• Peripheral neuropathy usually causes lower motor nerve damage, while lesions in brain and spinal cord usually cause lower motor neuron damage.

• The difference between upper and lower motor neuron symptoms and signs may be very helpful to differentiate peripheral neuropathy from brain and spinal cord lesions.

• Lower motor neuron signs and symptoms in peripheral neuropathy typically present with diminished deep tendon reflexes, flaccid paralysis, severe muscle atrophy, negative babinski reflex andfasciculation whereas upper motor neuron signs and symptoms in brain and spinal cord lesions typically present with hyperactive deep tendon reflexes, spastic paralysis, no muscle atrophy, positive babinski reflex and no fasciculation.

Diseases	Clinical manifestations			Additional findings
	Physical examination
					Deep tendon reflexes	Type of paralysis	Muscular atrophy
	Peripheral neuropathy	Diminished	Flaccid paralysis		Severe muscle atrophy	Negative babinski reflex, fasciculation
Brain lesion and most spinal cord lesions	Hyperactive	Spastic paralysis	No muscle atrophy	Positive babinski reflex, no fasciculation