What are the symptoms of neuritis?

Symptoms of Neuritis

The most common symptoms of neuritis include sensory loss, paresthesias, numbness, cramps, burning sensations, and tingling in the affected areas, with symptoms often presenting in a distal, symmetric pattern. 1

Types of Neuritis and Their Specific Symptoms

Peripheral Neuritis

• Sensory Symptoms:

  • Sensory loss in affected areas
  • Paresthesias (abnormal sensations)
  • Numbness and tingling
  • Burning sensations, particularly in the feet ("burning feet")
  • Pain that may be sharp, stabbing, or shooting in nature 1

• Motor Symptoms:

  • Muscle weakness, which may be symmetric or asymmetric
  • Muscle cramps
  • In severe cases, asymmetric mononeuritis with significant sensory-motor manifestations 1

• Autonomic Symptoms:

  • Blood pressure fluctuations
  • Temperature control issues
  • Digestive problems (constipation or nausea)
  • Urinary dysfunction
  • Sexual difficulties
  • Sweating abnormalities 1

Cranial Neuritis

Facial Nerve Neuritis (Bell's Palsy)

• Weakness or paralysis of facial expression muscles
• Tinnitus
• Hearing loss (conductive or sensorineural)
• Hemifacial spasm 1

Optic Neuritis

• Eye pain, particularly with eye movement
• Vision loss (often subacute)
• Color vision defects (dyschromatopsia)
• Visual field defects
• Weakened direct pupillary light reflex in the affected eye
• Mild optic disc edema in approximately one-third of cases 2, 3

Glossopharyngeal Neuritis

• Palate weakness
• Oropharyngeal pain 1

Vagus Nerve Neuritis

• Vocal cord paralysis
• Difficulty swallowing
• Hoarseness 1

Clinical Presentation Patterns

Acute Painful Diabetic Peripheral Neuropathy

• Severe sensory symptoms with few neurological signs on examination
• Weight loss
• Depression
• Erectile dysfunction in men
• Often follows rapid changes in glycemic control 1

Immune Checkpoint Inhibitor-Related Neuritis

• May present as Guillain-Barré-like syndrome with:
  • Bilateral proximal weakness
  • Ataxia
  • Distal sensory disturbances
  • Autonomic dysfunction
  • Cranial nerve involvement 1

Diagnostic Considerations

When evaluating a patient with suspected neuritis, consider these key findings:

• Timing of symptoms: Acute, subacute, or chronic onset
• Distribution pattern: Distal, symmetric, or asymmetric
• Associated symptoms: Presence of systemic symptoms that may suggest underlying causes
• Exacerbating factors: Symptoms often worsen at night 1

Potential Causes and Associations

Neuritis may be associated with:

• Hepatitis C infection 1
• Immune checkpoint inhibitor therapy 1
• Diabetes 1
• Multiple sclerosis 1
• Inflammatory bowel disease 1
• Infections (Lyme disease, syphilis) 1
• Autoimmune conditions 1

Diagnostic Evaluation

For peripheral nerve involvement:

• Electromyography
• Peripheral nerve neurophysiological tests
• Histological peripheral nerve examination (when appropriate)
• Intraepidermal nerve fiber density assessment 1

For cranial nerve involvement:

• MRI is the preferred imaging modality for evaluating both intracranial and extracranial portions of affected nerves 1

Pitfalls and Caveats

1. Misdiagnosis risk: Neuritis symptoms can be confused with other conditions like stroke, vestibular disorders, or mechanical nerve compression.

2. Overlooked causes: Always consider potentially treatable causes such as vitamin deficiencies, micronutrient deficiencies, and medication side effects (particularly metronidazole) 1.

3. Delayed diagnosis: Many patients (up to 12.5% in one study) never report their neuropathic symptoms to their doctors, leading to undertreatment 1.

4. Symptom variability: Patients may use vague descriptions like "dizziness" rather than specific terms like "vertigo," which can complicate diagnosis 1.

5. Mental health impact: Painful neuritis can cause significant psychological distress, including depression, anxiety, and sleep disturbances, which should be addressed as part of comprehensive management 1.