Differential Diagnosis for Acute Painful Polyneuropathy
Single Most Likely Diagnosis
- Guillain-Barré Syndrome (GBS): This is the most likely diagnosis due to its relatively high incidence among acute polyneuropathies and its characteristic presentation of rapidly progressive, symmetrical muscle weakness, and pain, often following a minor infection.
Other Likely Diagnoses
- Diabetic Neuropathy: Although typically more chronic, diabetic neuropathy can present acutely, especially in the context of significant glucose fluctuations. Pain is a common symptom, along with sensory deficits.
- Alcoholic Neuropathy: This condition can cause acute painful polyneuropathy, particularly in individuals with a history of chronic alcohol abuse, due to nutritional deficiencies and direct toxic effects of alcohol on nerves.
- Vasculitic Neuropathy: Conditions like polyarteritis nodosa or rheumatoid arthritis can cause an acute painful polyneuropathy due to inflammation of blood vessel walls, leading to nerve ischemia.
Do Not Miss Diagnoses
- Porphyria: A group of disorders that can lead to acute, severe, and potentially life-threatening neuropathy. Early recognition is crucial due to the availability of specific treatments.
- Heavy Metal Poisoning (e.g., Lead, Arsenic): Exposure to certain heavy metals can cause acute polyneuropathy. Identifying and removing the source of exposure is critical.
- Lyme Disease: Neuroborreliosis, particularly in its early disseminated stage, can present with acute painful polyneuropathy, among other neurological manifestations.
Rare Diagnoses
- Sjögren's Syndrome: An autoimmune disorder that can cause a variety of neurological manifestations, including acute painful polyneuropathy, though this is less common.
- Amyloidosis: A condition characterized by the deposition of amyloid proteins in various tissues, including nerves, leading to neuropathy. The presentation can be acute, especially in the primary form associated with plasma cell dyscrasias.
- Paraneoplastic Syndromes: Rarely, acute painful polyneuropathy can be a paraneoplastic manifestation of an underlying cancer, such as small cell lung cancer or lymphoma.