Diabetic Neuropathy Differential Diagnoses

  • Author: Helen C Lin, MD; Chief Editor: Nicholas Lorenzo, MD   more...
 
Updated: Nov 1, 2011
 
 

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.[27, 51, 52, 53, 54]

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

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

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

Helen C Lin, 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.

Coauthor(s)

Dianna Quan, MD  Associate Professor of Neurology, Director, 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, and Phi Beta Kappa

Disclosure: e-medicine Honoraria Other

Specialty Editor Board

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

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.

Chief Editor

Nicholas Lorenzo, MD  Consulting Staff, Neurology Specialists and Consultants

Nicholas Lorenzo, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, and American College of Physician Executives

Disclosure: Nothing to disclose.

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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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