Polyneuropathies: Symptoms, Complaints, Signs

The following symptoms and complaints may indicate polyneuropathy:

Sensory insensitivity

  • Formication
  • Burning
  • Lack of sensation of heat or cold
  • Gait insecurity → risk of falling or falls.
  • Tingling
  • Swelling sensation
  • Stinging
  • Feeling numb and furry

Motor symptoms

  • Muscle spasms
  • Muscle weakness
  • Muscle twitching/fasciculations
  • Pain*

* Ca. 50% of all polyneuropathies are associated with pain. Autonomic symptoms

  • Blinding sensation
  • Skin and hair
    • Skin lesions (e.g. trophic disorders such as chronic wound).
    • Xeroderma (dry skin)/hypo- or anhidrosis – decreased ability to sweat to inability to sweat.
    • Loss of body hair
  • Gastrointestinal symptoms: Diarrhea (diarrhea), gastroparesis (paralysis of gastric peristalsis).
  • Palpitations (e.g., resting tachycardia: > 100 beats/min).
  • Urogential symptoms
    • Micturition disorders (bladder emptying disorders):
      • Frequency of micturition, residual urine, urinary tract infections, urinary stream attenuation, need for abdominal squeezing, urinary incontinence.
    • Erectile dysfunction (ED; erectile dysfunction).

Other notes

  • Polyneuropathy most commonly presents as a distally symmetric sensorimotor syndrome. DD: Polyradiculoneuropathies with proximal and distal involvement with trunk as well as cranial nerve involvement.
  • Distal symmetric polyneuropathy:
    • History: patients usually complain of numbness at onset, starting in the toes and slowly ascending, usually over years (sock- or stocking-shaped)
    • Complaints – symptoms: paresthesias (insensations; walking as if on absorbent cotton or on pebbles); gait insecurity → risk of falling or falls.
    • Clinical findings: failed Achilles tendon reflexes, decreased sensation of touch, pain and temperature; distal decreased sensation of vibration.
  • Diabetic polyneuropathy
    • An early onset of neuropathic pain is suggestive of a diabetic etiology.
    • Early gait disturbances, involvement of the arms, or marked asymmetry tend to argue against a diabetic genesis.
    • Sensory and motor disturbances (= sensorimotor diabetic polyneuropathy) usually occur uniformly on both legs and / or hands, they are therefore symmetrical.
    • Note: In a quarter of patients with peripheral sensorimotor diabetic polyneuropathy (synonym: diabetic sensorimotor polyneuropathy, DSPN), it is completely painless.

Warning signs (red flags)

  • Medical history
    • Acute or subacute onset → think of:
      • Chronic inflammatory demyelinating PNP (CIDP).
      • Guillain-Barré syndrome (GBS)
      • Collagenosis (connective tissue disease caused by autoimmune processes).
    • rapid deterioration → think of:
      • CIDP
      • Distal acquired demyelinating sensory neuropathy (DADS).
      • GBS
      • Toxic polyneuropathy
    • Early involvement of the hands/arms → think of: Vitamin B12 deficiency; toxic PNP (see below drugs and “environmental stresses – intoxications”),
  • Asymmetric distribution → think of: proximal diabetic neuropathy, collagenosis.
  • Motor symptoms in the foreground → think of: CIDP, GBS, Charcot-Marie-Tooth diseases, CMT, types 1 and 3, some toxic forms).
  • Multifocal pattern → think of: multifocal motor neuropathy (MMN), collagenosis.
  • Severe autonomic disorders → think of: Amyloidosis, Fabry disease (X-linked inherited lysosomal storage disease based on a defect in the gene for the enzyme alpha-galactosidase A), small-fiber neuropathy (SFN; subgroup of neuropathies in which primarily the so-called “small fibers” are affected).