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Diabetic Neuropathy Differential Diagnoses

  • Author: Dianna Quan, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
 
Updated: Jul 06, 2016
 
 

Diagnostic Considerations

Establishing the diagnosis of diabetic neuropathy requires careful evaluation, because in 10-26% of diabetic patients with neuropathy, the neuropathy may have another cause.[29, 54, 55, 56, 57]

The differential diagnoses to consider vary with the presentation.

Cranial mononeuropathy includes the following:

  • Intracranial aneurysms
  • Bell palsy

Thoracoabdominal neuropathy includes the following:

  • Herpes zoster
  • Spinal tumors
  • Myocardial infarction
  • Acute cholecystitis
  • Acute appendicitis
  • Diverticulitis

Lumbosacral radiculoplexopathy includes the following:

  • Anterior disk protrusion
  • Spinal cord tumors
  • Malignant nerve root infiltrations
  • Inflammatory neuropathies

Peripheral neuropathy includes the following:

  • Pernicious anemia
  • Vitamin B-6 intoxication
  • Alcoholism
  • Uremia
  • Chemical toxins
  • Nerve entrapment and compression of benign etiology
  • Hepatitis
  • Idiopathic
  • Congenital (various hereditary sensory motor neuropathies)
  • Paraneoplastic syndrome
  • Syphilis
  • HIV/AIDS
  • Medication (eg, chemotherapy, isoniazid)
  • Spine disease (eg, radiculopathy, stenosis, arteriovenous [AV] fistula)

Cardiovascular autonomic neuropathy (in addition to some listed above) includes the following:

  • Myocardial infarction
  • Neuropathic arrhythmias (eg, Wolff-Parkinson–White syndrome, sick sinus syndrome)
  • Volume depletion
  • Drugs

Gastrointestinal neuropathy includes the following:

  • Gastrointestinal malignancy
  • Peptic ulcer disease
  • Postsurgical vagotomy
  • Electrolyte imbalance

Bladder dysfunction includes the following:

  • Bladder outlet obstruction
  • Prostate cancer
  • Spinal cauda equine syndrome

Mononeuropathy includes the following:

  • Vasculitides
  • Acromegaly
  • Coagulopathies
  • Hypothyroidism

For more information, see Diabetic Lumbosacral Plexopathy.

Differential Diagnoses

 
 
Contributor Information and Disclosures
Author

Dianna Quan, MD Professor of Neurology, Director of Electromyography Laboratory, University of Colorado School of Medicine

Dianna Quan, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American Neurological Association

Disclosure: Nothing to disclose.

Coauthor(s)

Helen C Lin, MD Assistant Professor of Neurology, Medical College of Wisconsin

Helen C Lin, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine

Disclosure: Nothing to disclose.

Chief Editor

Romesh Khardori, MD, PhD, FACP Professor of Endocrinology, Director of Training Program, Division of Endocrinology, Diabetes and Metabolism, Strelitz Diabetes and Endocrine Disorders Institute, Department of Internal Medicine, Eastern Virginia Medical School

Romesh Khardori, MD, PhD, FACP is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians, American Diabetes Association, Endocrine Society

Disclosure: Nothing to disclose.

Acknowledgements

Neil A Busis, MD Chief, Division of Neurology, Department of Medicine, Head, Clinical Neurophysiology Laboratory, University of Pittsburgh Medical Center-Shadyside

Neil A Busis, MD is a member of the following medical societies: American Academy of Neurology and American Association of Neuromuscular and Electrodiagnostic Medicine

Disclosure: Nothing to disclose.

Milind J Kothari, DO Professor and Vice-Chair, Department of Neurology, Pennsylvania State University College of Medicine; Consulting Staff, Department of Neurology, Penn State Milton S Hershey Medical Center

Milind J Kothari, DO is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, and American Neurological Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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Table. Subdivisions of Sensory Neurons
Fiber Type Size Modality Myelination
A-alpha (I)13-20 micrometersLimb proprioceptionYes
A-beta (II)6-12 micrometersLimb proprioception, vibration, pressureYes
A-delta (III)1-5 micrometersMechanical sharp painYes
C (IV)0.2-1.5 micrometersThermal pain, mechanical burning painNo
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