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).
- Micturition disorders (bladder emptying disorders):
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”),
- Acute or subacute onset → think of:
- 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).