Neuropathies: Clinical Presentation

Mononeuropathies

  • typically present with weakness and wasting within the innervation pattern of a single peripheral nerve
  • The pattern of sensory loss should fit a cutaneous nerve distribution
  • eg Ulnar nerve damage presents with weakness of the abductor of the fifth finger and adductor of the thumb, together with a blunted pinprick of the fourth and fifth fingers and adjacent palm

 

Polyneuropathies

  • Motor polyneuropathies produce weakness and wasting (must be distinguished from myopathy)
  • weakness is most marked distally
  • weakness may ascend from the legs upward
  • tendon reflexes are lost by the time the weakness is moderate, unlike myopathies which are lost late, if at all.

Sensory polyneuropathies are identified by the more or less symmetrical “stocking and glove” blunting to touch and pinprick. Reflexes are often dcreased or absent.

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