Differential Diagnosis for Localised and Diffuse Nerve Thickening
Single Most Likely Diagnosis
- Leprosy (Hansen's Disease): This is a leading cause of peripheral neuropathy worldwide, characterized by localized and diffuse nerve thickening due to the infection of peripheral nerves by Mycobacterium leprae. The disease presents with a wide range of clinical manifestations, including skin lesions, nerve thickening, and sensory or motor deficits.
Other Likely Diagnoses
- Diabetic Neuropathy: A common complication of diabetes, leading to nerve damage and thickening, particularly in the peripheral nerves. It can cause a variety of symptoms, including pain, numbness, and weakness, typically in a symmetrical pattern.
- Chronic Inflammatory Demyelinating Polyneuropathy (CIDP): An autoimmune disorder that causes nerve root damage and can lead to nerve thickening. It presents with progressive weakness and impaired sensory function, often affecting both sides of the body.
- Hereditary Neuropathies (e.g., Charcot-Marie-Tooth Disease): A group of inherited disorders that affect the peripheral nerves, leading to nerve thickening and degeneration. Symptoms include progressive muscle weakness and atrophy, particularly in the distal limbs.
Do Not Miss Diagnoses
- Sarcoidosis: A systemic granulomatous disease that can affect any organ, including the nervous system. Neurosarcoidosis can cause nerve thickening and presents with a wide range of neurological symptoms. Missing this diagnosis could lead to significant morbidity due to delayed treatment.
- Lymphoma or Leukemia Involvement: Certain types of cancer, such as lymphoma or leukemia, can infiltrate nerves, leading to thickening. Early detection is crucial for effective treatment and prognosis.
- Amyloidosis: A condition characterized by the deposition of amyloid proteins in various tissues, including nerves, leading to nerve thickening and dysfunction. It can be associated with systemic diseases or be localized to the nerves.
Rare Diagnoses
- Neurofibromatosis: A genetic disorder that can cause nerve thickening due to the growth of neurofibromas along nerves. It is characterized by multiple cafe-au-lait spots, neurofibromas, and other systemic manifestations.
- Refsum's Disease: A rare genetic disorder affecting the metabolism of a specific fatty acid, leading to peripheral neuropathy and nerve thickening. It is characterized by retinitis pigmentosa, peripheral neuropathy, and elevated levels of very-long-chain fatty acids.
- Tangier Disease: A rare inherited disorder affecting lipid metabolism, which can lead to peripheral neuropathy and nerve thickening. It is characterized by significantly reduced levels of high-density lipoprotein (HDL) cholesterol and the accumulation of cholesterol in various tissues.