EpistemisHypesthesia in glove and sock
Specialty: Neurology.
Why it occurs
- Symmetrical distal diabetic polyneuropathy (most common distal sensory neuropathy)
- Alcoholic-nutritional polyneuropathy (deficiency of thiamine and other B vitamins)
- Chronic inflammatory demyelinating polyneuropathy (CIDP)
- Chemotherapy-induced neuropathy
- Systemic vasculitis with involvement of vasa nervorum (confluent mononeuritis multiplex)
- Uremic or hypothyroid neuropathy
Initial workup
Electromyography (EMG) with sensory and motor nerve conduction velocity of the four limbs; determination of blood glucose, HbA1c, vitamin B12, thyroid profile, antinuclear antibodies (ANA), rheumatoid factor and immunofixation in serum.
red flags
Loss of sensitivity with very rapid upward progression (days) associated with inability to climb stairs or raise arms, or loss of strength to swallow and ineffective cough, suggestive of acute inflammatory polyradiculoneuropathy.
Standard management
- Thioctic acid — 600 mg/day on an empty stomach
- Duloxetine (60 mg/day) or Pregabalin (150-300 mg/day) if neuropathic pain is associated
- Intravenous immunoglobulin or corticosteroids if CIDP is confirmed.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Neurology
- Listed causes
- 6
- Treatment options
- 3