Diabetic Neuropathy Differential Diagnoses

Updated: Jul 23, 2019
  • Author: Dianna Quan, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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DDx

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. [33, 60, 61, 62, 63]

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