Differential Diagnoses for Bilateral and Symmetric Sensorimotor Peripheral Neuropathy

Single Most Likely Diagnosis

• Diabetic Neuropathy: This is the most common cause of bilateral and symmetric sensorimotor peripheral neuropathy, especially in patients with a history of diabetes mellitus. The high prevalence of diabetes and the frequent occurrence of neuropathy in diabetic patients make this diagnosis the most likely.

Other Likely Diagnoses

• Alcoholic Neuropathy: Chronic alcohol abuse can lead to bilateral and symmetric sensorimotor peripheral neuropathy due to nutritional deficiencies and the toxic effects of alcohol on peripheral nerves.
• Vitamin B12 Deficiency: A deficiency in vitamin B12 can cause demyelination and axonal degeneration in peripheral nerves, leading to bilateral and symmetric sensorimotor peripheral neuropathy.
• Idiopathic Neuropathy: Some cases of bilateral and symmetric sensorimotor peripheral neuropathy remain idiopathic, meaning the cause is unknown, but they can still be managed symptomatically.

Do Not Miss Diagnoses

• Amyloidosis: Although rare, amyloidosis can cause bilateral and symmetric sensorimotor peripheral neuropathy. Missing this diagnosis can be fatal due to the potential for systemic involvement and the availability of specific treatments.
• Heavy Metal Poisoning (e.g., Lead, Mercury): Exposure to heavy metals can cause peripheral neuropathy. Identifying and removing the source of exposure is crucial to prevent further damage.
• Vasculitis (e.g., Rheumatoid Arthritis, Lupus): Systemic vasculitis can cause peripheral neuropathy due to inflammation of blood vessels supplying nerves. Early diagnosis and treatment can significantly improve outcomes.

Rare Diagnoses

• Charcot-Marie-Tooth Disease: A group of inherited disorders that affect the peripheral nerves, leading to bilateral and symmetric sensorimotor peripheral neuropathy. It is less common than acquired causes but important to consider in younger patients or those with a family history.
• Tangier Disease: A rare genetic disorder characterized by severe reduction in HDL cholesterol, leading to peripheral neuropathy among other symptoms.
• Fabry Disease: An X-linked genetic disorder due to deficiency of alpha-Galactosidase A, leading to accumulation of globotriaosylceramide in various cells, including peripheral nerves, causing neuropathy.