Peripheral Neuropathy: A Practical Guide for Internists

Diagnosing peripheral neuropathy is essential for the majority of clinical specialties, as it often reveals systemic underlying diseases that are rarely purely neurological. The patient’s history and thorough clinical examination represent the foundation of an early diagnosis. For internal medicine practitioners, it is important to consider common causes at first and search for diabetes, alcoholism or vitamin B12 deficiency, whilst following a diagnosis algorithm that encompasses cues to less popular aetiologies such as systemic vasculitis or paraproteinemia. Prior to requesting nerve conduction studies or further investigations, a few characteristics of peripheral neuropathy should be sought: onset, symmetry, distribution and function impairment (either sensory or motor). Given its interdisciplinary nature, peripheral neuropathies are managed via tight collaboration between the specialist and the internist. Although symptomatic treatment for painful neuropathy is available, treating the underlying disease is fundamental.