Review Article Address correspondence to Dr Howard W. Sander, Clinical Approach to New York University School of Medicine, 400 E. 34th St, RR-311, New York, NY 10016, Peripheral Neuropathy:
[email protected]. Relationship Disclosure: Dr Alport reports no Anatomic Localization disclosure. Dr Sander serves on the speakers’ bureau for Grifols and Walgreens and has been an independent peer and Diagnostic Testing reviewer for IPRO and IMEDECS. Dr Sander has also Adina R. Alport, MD; Howard W. Sander, MD served as an expert witness. Unlabeled Use of Products/Investigational Use Disclosure: ABSTRACT Dr Alport reports no disclosure. Purpose of Review: This article provides a clinical approach to peripheral neuropathy Dr Sander discusses the based on anatomic localization and diagnostic testing. unlabeled use of steroids and plasmapheresis for the Recent Findings: Advances have been made in the evaluation of small fiber neu- treatment of chronic ropathy and in the known genetic causes of neuropathy. inflammatory demyelinating Summary: History and physical examination remain the most useful tools for evaluating polyradiculoneuropathy. Copyright * 2012, peripheral neuropathy. Characterization of a neuropathy aids in limiting the differential American Academy diagnosis and includes consideration of temporal profile (tempo of onset and duration), of Neurology. All rights heredity, and anatomic classification. Anatomic classification involves (1) fiber type reserved. (motor versus sensory, large versus small, somatic versus autonomic), (2) portion of fiber affected (axon versus myelin), and (3) gross distribution of nerves affected (eg, length- dependent, length-independent, multifocal). Diagnostic testing may include serologic and CSF evaluation, electrodiagnosis, skin biopsy, quantitative sensory testing, auto- nomic testing, nerve biopsy, confocal corneal microscopy, and laser Doppler imager flare.