The detailed descriptions about clinical features and management of the different types of peripheral neuropathy are beyond the scope of this article. It may be appropriate here to outline general aspects of clinical features and classification of peripheral neuropathies. The clinical history and the abnormalities revealed by physical examination may either suggest the diagnosis or narrow down the diagnostic possibilities, facilitating subsequent investigation. Nerve conduction studies can provide crucial information and are best performed at initial examination. In general, the first broad determination should be made whether the patient has symmetrical polyneuropathy or focal, or multifocal neuropathies. The range of diagnostic possibilities differs between symmetrical polymeuropathy and mutifocal neuropathy. For those patients with symmetrical polyneuropathy, the clinical pattern (that is, whether it is motor, sensory, or mixed, or whether it has proximal or distal distribution) can provide useful information, as well as the rapidity of onset and previous clinical course in established cases. Managements of peripheral neuropathy and planning of its treatment mostly depend on the confirmative diagnosis of peripheral neuropathy. Thus, the best knowledge and understanding of basic principles of peripheral neuropathies are required for facilitating the diagnosis of peripheral neuropathies.
Classification ; Diagnosis* ; Humans ; Neural Conduction ; Peripheral Nervous System Diseases* ; Physical Examination ; Polyneuropathies

In recent years, the sural nerve biopsy has become a commonly performed procedure in the diagnostic work-up of patients with peripheral neuropathy. This paper reviews the diagnostic usefulness and limitations of this procedure. Based on 385 sural nerve biopsies, we found clinically helpful or relevant information in 45% of cases. In 24% of cases, specific diagnoses were obtained, among which vasculitic neuropathy was most common.
Biopsy/methods/standards ; Evaluation Studies ; Histological Techniques ; Human ; Peripheral Nervous System Diseases/classification/*diagnosis ; Spinal Nerves/*pathology ; Sural Nerve/*pathology

The aim of this study was to compare the current perception threshold (CPT) with a nerve conduction study (NCS) to evaluate the usefulness of CPT in the diagnosis of diabetic Peripheral Neuropathy (DPN). CPT measurement is quantitative method for assessment of peripheral sensory nerve function using electrical impulse. Enrolled in this study were 142 patients with type 2 diabetes who underwent both CPT testing and NCS between January 2013 and April 2016. DPN was diagnosed by NCS. CPT was performed on the right index finger and great toe of each patient. Patients with burning, tingling sensation and with longer history of diabetes tended to have a higher prevalence of DPN. In all frequencies tested (2000, 250, 5 Hz), CPT values of the DPN group were higher than the normal group. After classification in either the normoesthesia or hypoesthesia group according to CPT, the DPN group had a significantly higher prevalence of hypoesthesia than normal group. The receiver operating characteristics curve analysis showed that CPT had a high area under curve value for predicting the presence of DPN. In conclusion, CPT measurement is clinically valuable in detecting nerve dysfunction in patients with type 2 diabetes.
Area Under Curve ; Burns ; Classification ; Diabetic Neuropathies ; Diagnosis ; Fingers ; Humans ; Hypesthesia ; Methods ; Neural Conduction ; Peripheral Nervous System Diseases* ; Prevalence ; ROC Curve ; Sensation ; Toes

Dominantly inherited spinocerebellar ataxias (SCAs) are a group of the heterogenous neurodegenerative diseases that are characterized by chronic progressive cerebellar ataxia associated with various combinations of other neurological signs. Clinical classification is difficult because of the phenotypic overlap. With the evolution of molecular genetics, the loci and mutations for many of the ataxias have been identified, allowing more definitive molecular classification. We experienced 42 years-old man who presented with progressive both lower leg weakness, dysarthria, ataxia, ophthalmoplegia, and nystagmus. The family history was remarkably suspicious. We could not observe the upper extremity weakness, definite evidences of peripheral neuropathy and myopathy in electrodiagnosis. No abnormal findings in blood chemistry and brain MRI. We performed polymerase chain reaction (PCR) and polyacrylamide gel electrophoresis (PAGE) analysis, found that his gene contained expanded CAG repeats (CAG repeat number was 72). Although no effective treatment exists for most the ataxic syndromes, the accurate diagnosis and the genetic counseling are often important to the patient's family for prognostication.
Adult ; Ataxia ; Brain ; Cerebellar Ataxia ; Chemistry ; Classification ; Diagnosis ; Dysarthria ; Electrodiagnosis ; Electrophoresis, Polyacrylamide Gel ; Genetic Counseling ; Humans ; Leg ; Machado-Joseph Disease* ; Magnetic Resonance Imaging ; Molecular Biology ; Muscular Diseases ; Neurodegenerative Diseases ; Ophthalmoplegia ; Peripheral Nervous System Diseases ; Polymerase Chain Reaction ; Spinocerebellar Ataxias* ; Upper Extremity