Differential Diagnosis for Progressive Sensory Motor Subacute Painful Polyneuropathy
Single Most Likely Diagnosis
- Guillain-Barré Syndrome (GBS): Although GBS typically presents with elevated protein in the cerebrospinal fluid (CSF), some variants, especially the axonal forms, can have normal protein levels. The mild elevation of white blood cells (WBC) could be seen in some cases, and the subacute progression fits this diagnosis.
Other Likely Diagnoses
- Chronic Inflammatory Demyelinating Polyneuropathy (CIDP): CIDP can present with a subacute onset and may have mild CSF pleocytosis (elevated WBC). It's a condition that affects the peripheral nerves, leading to sensory and motor symptoms.
- Vasculitic Neuropathy: This condition, often associated with systemic vasculitis, can cause a painful polyneuropathy. The CSF findings can be variable, and while not typical, mild elevation of WBC with normal protein could be seen in some cases.
- Diabetic Amyotrophy: Although typically associated with diabetes, this condition can cause a painful, subacute polyneuropathy. CSF findings are usually normal, but mild WBC elevation could occasionally be seen.
Do Not Miss Diagnoses
- Lyme Neuroborreliosis: Caused by Borrelia burgdorferi, this infection can lead to a variety of neurological manifestations, including polyneuropathy. The CSF typically shows lymphocytic pleocytosis, which could be mild, and normal or slightly elevated protein.
- HIV-Related Neuropathy: HIV can cause various forms of neuropathy, including a distal symmetric polyneuropathy that can be painful. Early in the course of HIV infection, CSF might show a mild increase in WBC.
- Neurosarcoidosis: Sarcoidosis can affect the peripheral nerves, leading to a polyneuropathy. CSF findings can include a mild increase in WBC, and while protein is often elevated, it can be normal in some cases.
Rare Diagnoses
- Sjögren's Syndrome-Associated Neuropathy: This autoimmune disorder can cause a variety of neuropathies, including a painful sensory neuropathy. CSF findings are usually normal but could occasionally show mild abnormalities.
- Paraproteinemic Neuropathy: Associated with monoclonal gammopathies, these neuropathies can be demyelinating or axonal. CSF protein is often elevated due to the paraprotein, but in early or mild cases, it might be normal, with a mild increase in WBC.
- Toxic Neuropathy: Certain toxins (e.g., heavy metals, some drugs) can cause a subacute painful polyneuropathy. CSF findings are typically normal, but mild WBC elevation could be seen in some cases.