Clinical Approach to Peripheral Neuropathy: Anatomic Localization and Diagnostic Testing

@article{Alport2012ClinicalAT,
  title={Clinical Approach to Peripheral Neuropathy: Anatomic Localization and Diagnostic Testing},
  author={Adina R Alport and Howard W. Sander},
  journal={CONTINUUM: Lifelong Learning in Neurology},
  year={2012},
  volume={18},
  pages={13–38}
}
PURPOSE OF REVIEW This article provides a clinical approach to peripheral neuropathy based on anatomic localization and diagnostic testing. [] Key Method Diagnostic testing may include serologic and CSF evaluation, electrodiagnosis, skin biopsy, quantitative sensory testing, autonomic testing, nerve biopsy, confocal corneal microscopy, and laser Doppler imager flare.
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43 Citations
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References

SHOWING 1-10 OF 54 REFERENCES

Utility of Skin Biopsy to Evaluate Peripheral Neuropathy

  • A. Hays
  • Medicine
    Current neurology and neuroscience reports
  • 2010
Skin biopsy for epidermal nerve fiber analysis provides an important objective test for the diagnosis of peripheral neuropathy, particularly small fiber sensory neuropathy (SFSN), and is reliable, with high diagnostic specificity and good sensitivity.

Painful sensory neuropathy

Patients presenting with painful feet are heterogeneous, consisting of both large and small fiber sensory neuropathies, and a limited battery of blood tests facilitated diagnosis, but serum antinerve antibodies were not helpful.

Skin Biopsy for Diagnosis of Small Fiber Neuropathy: A Critically Appraised Topic

Investigating the diagnostic utility of skin biopsy with intraepidermal nerve fiber density in patients with suspected small fiber neuropathy found it to have greater diagnostic utility than the neurologic examination and quantitative sensory testing, both of which rely heavily on subjective patient perception.

The diagnostic criteria for small fibre neuropathy: from symptoms to neuropathology

Patients with pure SFN were identified using a new diagnostic ‘gold standard’, based on the presence of at least two abnormal results at clinical, QST and skin biopsy examination, and a significant inverse correlation between IENF density and both cold and warm thresholds at the leg was found.

Assessment of Epidermal Nerve Fibers: A New Diagnostic and Predictive Tool for Peripheral Neuropathies

The state of current research and clinical practice in the use of skin biopsies and epidermal nerve densities is reviewed to lead to early detection of many common peripheral nerve diseases and an enhanced understanding of disease onset and progression.

Noninvasive and minimally invasive detection and monitoring of peripheral neuropathies

  • D. Herrmann
  • Medicine, Biology
    Expert review of neurotherapeutics
  • 2008
Biopsy evaluation of epidermal innervation and emerging noninvasive imaging approaches hold promise as surrogate markers that are complementary to traditional DSP measures.

Practice Parameter: Evaluation of distal symmetric polyneuropathy: Role of autonomic testing, nerve biopsy, and skin biopsy (an evidence-based review)

There is a need for additional prospective studies to define more exact guidelines regarding the role of autonomic testing, nerve biopsy, and skin biopsy for the assessment of polyneuropathy.

Detection of small‐fiber neuropathy by sudomotor testing

The symptoms of burning sensation affecting the feet, thought to be due to a distal small‐fiber neuropathy (DSFN) affecting somatic unmyelinated fibers, are usually accompanied by vasomotor or sudomotor changes suggestive of involvement of autonomic fibers, and Sudomotor examination is thus a highly sensitive detection tool in DSFN.

An Update on Nerve Biopsy

Nerve biopsy is still of value in specific circumstances when it is performed by trained physicians and examined in a laboratory with expertise in nerve pathology, as well as in some cases of monoclonal dysglobulinemia.

Celiac neuropathy

CD is commonly associated with sensory neuropathy and should be considered even in the absence of gastrointestinal symptoms, particularly in patients with neuropathy.
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