Differential Diagnosis for Peripheral Neuropathy
The following differential diagnosis is organized into categories to help guide the thought process:
Single Most Likely Diagnosis
- Diabetes Mellitus: This is the most common cause of peripheral neuropathy, particularly in patients with a history of poorly controlled blood sugar levels. The symptoms of diabetic neuropathy can include numbness, tingling, and pain in the hands and feet.
Other Likely Diagnoses
- Vitamin B12 Deficiency: A deficiency in vitamin B12 can cause peripheral neuropathy, characterized by numbness, weakness, and gait disturbances. This condition is often seen in patients with malabsorption or those who follow a strict vegan diet.
- Hypothyroidism: Some patients with hypothyroidism may experience peripheral neuropathy, which can manifest as numbness, tingling, or burning sensations in the hands and feet.
- Alcohol Abuse: Chronic alcohol abuse can lead to peripheral neuropathy, likely due to nutritional deficiencies and the toxic effects of alcohol on the nerves.
- Rheumatoid Arthritis: This autoimmune disorder can cause peripheral neuropathy, particularly in patients with long-standing disease or those who have been treated with certain medications.
Do Not Miss Diagnoses
- Guillain-Barré Syndrome: This rare autoimmune disorder can cause rapid onset of peripheral neuropathy, leading to ascending paralysis and potentially life-threatening respiratory failure if not promptly recognized and treated.
- Lyme Disease: In some cases, Lyme disease can cause peripheral neuropathy, particularly in patients with late-stage disease. It is essential to consider this diagnosis in patients with a history of tick exposure or residence in endemic areas.
- Sarcoidosis: This multisystem disorder can cause peripheral neuropathy, often in conjunction with other systemic symptoms such as lung disease or skin lesions.
- Amyloidosis: This rare condition involves the deposition of abnormal proteins in various tissues, including the nerves, leading to peripheral neuropathy.
Rare Diagnoses
- Charcot-Marie-Tooth Disease: This group of inherited disorders affects the peripheral nerves, causing progressive weakness, atrophy, and sensory loss.
- Fabry Disease: A rare genetic disorder that can cause peripheral neuropathy, often accompanied by other systemic symptoms such as skin lesions and cardiac disease.
- Porphyria: A group of rare genetic disorders that can cause peripheral neuropathy, often in conjunction with abdominal pain, psychiatric symptoms, and other systemic manifestations.
- Tangier Disease: A rare genetic disorder characterized by severe high-density lipoprotein deficiency, which can cause peripheral neuropathy among other systemic symptoms.