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Diseases » Diabetic neuropathy » Diagnosis

Diagnosis of Diabetic neuropathy

Diabetic neuropathy Diagnosis: Book Excerpts

Differential Overview - Peripheral Neuropathy

Tests and diagnosis discussion for Diabetic neuropathy:

A doctor diagnoses neuropathy based on symptoms and a physical exam. During the exam, the doctor may check muscle strength, reflexes, and sensitivity to position, vibration, temperature, and light touch. Sometimes special tests are also used to help determine the cause of symptoms and to suggest treatment.

A simple screening test to check point sensation in the feet can be done in the doctor's office. The test uses a nylon filament mounted on a small wand. The filament delivers a standardized 10-gram force when touched to areas of the foot. Patients who cannot sense pressure from the filament have lost protective sensation and are at risk for developing neuropathic foot ulcers. Physicians may order the filament (with instructions for use) free from the Lower Extremity Amputation Prevention Program, (LEAP) Bureau of Primary Health Care, Division of Programs for Special Populations, 4350 East West Highway, 9th floor, Bethesda, MD 20814; telephone (301) 594-4424.

Nerve conduction studies check the flow of electrical current through a nerve. With this test, an image of the nerve impulse is projected on a screen as it transmits an electrical signal. Impulses that seem slower or weaker than usual indicate possible damage to the nerve. This test allows the doctor to assess the condition of all the nerves in the arms and legs.

Electromyography (EMG) is used to see how well muscles respond to electrical impulses transmitted by nearby nerves. The electrical activity of the muscle is displayed on a screen. A response that is slower or weaker than usual suggests damage to the nerve or muscle. This test is often done at the same time as nerve conduction studies.

Ultrasound employs sound waves. The sound waves are too high to hear, but they produce an image showing how well the bladder and other parts of the urinary tract are functioning.

Nerve biopsy involves removing a sample of nerve tissue for examination. This test is most often used in research settings.

If your doctor suspects autonomic neuropathy, you may also be referred to a physician who specializes in digestive disorders (gastroenterologist) for additional tests. (Source: excerpt from Diabetic Neuropathy The Nerve Damage of Diabetes: NIDDK)

Diagnosis of Diabetic neuropathy: medical news summaries:

The following medical news items are relevant to diagnosis and misdiagnosis issues for Diabetic neuropathy:

Diagnostic Tests for Diabetic neuropathy: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about diagnostis of Diabetic neuropathy.

Peripheral Neuropathy: Differential Overview
(Field Guide to Bedside Diagnosis)

❑ Diabetes

❑ Alcohol

❑ Vitamin B₁₂ deficiency

❑ Drugs

❑ Carcinomatous

❑ Lead

❑ Guillain-Barré

❑ Tabes dorsalis

❑ Syringomyelia

❑ Polyarteritis nodosa

❑ Amyloidosis

❑ Polymyositis

❑ Pellagra

❑ Arsenic

❑ Porphyria

❑ Wallenberg syndrome

❑ Thalamic lesion

❑ Brown-Sequard syndrome

Diagnostic Approach

Sensory neuropathy symptoms include positive phenomena such as tingling; pins/needles; and burning, cold, or lancinating pain. Physical findings include weakness, fasciculations, atrophy, ataxia, wide-based gait, abnormal sweating, decreased or absent deep tendon reflexes, orthostatic hypotension, hypesthesia surrounded by a zone of hyperesthesia, and vibration or position sense affected before pinprick or temperature sense.

Autonomic neuropathy symptoms include impotence, retrograde ejaculation, diaphoresis, incontinence, urinary retention, constipation, diarrhea, orthostatic dizziness, and flushing. Physical findings include delayed pupillary light response, resting tachycardia, sinus arrhythmia, and orthostatic hypotension.

Sensory loss confined to part of a limb suggests injury to a peripheral nerve, plexus, or spinal root, resulting from trauma, entrapment, or vascular insufficiency. Mononeuropathy multiplex affects multiple nerves over time (e.g., due to diabetes or vasculitis). Polyneuropathy occurs in a stocking-glove distribution starting with the longest nerves, and is due to axonal neuropathy, with a toxic or metabolic origin. Bilaterally symmetrical symptoms are found in polyneuropathy or spinal cord lesions, while unilateral involvement is seen in contralateral disease of the brainstem, thalamus, or cortex.

Injury to large myelinated nerves produces decreased light touch and proprioception with a sensation of “walking on a thick carpet” or imbalance. Injury to medium fibers causes decreased light touch and vibration sense. Injury to small unmyelinated fibers, as occurs in diabetes or amyloidosis, decreases pain and temperature sensation and produces dysesthesias. Disproportionate loss of vibration sense and proprioception compared with pain and temperature sensation occurs with diseases of the dorsal column of the spinal cord (e.g., neurosyphilis, vitamin B ₁₂ deficiency, or multiple sclerosis) and demyelinating polyneuropathy.

Transverse cord lesions produce loss of all modalities below the level of the lesion and a band of hyperalgesia at the level of the lesion. Lateral cord compression is heralded by early sensory changes. Dorsal cord compression affects proprioception and tactile discrimination without pain or temperature loss. Pernicious anemia and tabes dorsalis preferentially affect the dorsal columns.

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Source: Field Guide to Bedside Diagnosis, 2007