Sections

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.^{[38, 66, 67, 68, 69]}

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

Alcohol (Ethanol) Related Neuropathy
Amyloid polyneuropathy
Chronic Inflammatory Demyelinating Polyradiculoneuropathy
Chronic Myelogenous Leukemia (CML)
Neurosarcoidosis
Nutritional Neuropathy
Spinal Cord Tumors
Toxic Neuropathy
Uremic Neuropathy
Vasculitic Neuropathy
Vitamin B-12 deficiency

Workup

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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: Received research grant from: Alnylam; Pfizer; Ionis; Cytokinetics; Apellis; Momenta; Alexion; Viela Bio; .

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

Fiber Type	Size	Modality	Myelination
A-alpha (I)	13-20 micrometers	Limb proprioception	Yes
A-beta (II)	6-12 micrometers	Limb proprioception, vibration, pressure	Yes
A-delta (III)	1-5 micrometers	Mechanical sharp pain	Yes
C (IV)	0.2-1.5 micrometers	Thermal pain, mechanical burning pain	No

Diabetic Neuropathy Differential Diagnoses

Diagnostic Considerations

Differential Diagnoses

References

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