Neuropathies in GP

Question 1

What are top 5 causes of periperal neuropathies?

What are relevant investigation to each?

What are top 3 causes Australia? Diabetes Alcohol, Medications.

Acronym: DAM-IT- BITH

Answer 1

• Diabetes - Hba1C, Fasting blood sugar, Glucose tolerance tests.
• Alcohol - Take Alcohol history (important/other substances toxins), FBC- ( Hameoglobin, normal to low Hb, Hct; low platelets low <150/Infection), U/Es- (Hydration, renal impairment?), LFTs- Albumin, GGT, Cloting factors, PT, APPT, Bilirubin, AST, ALT, Alcohol(AST often >2 times ALT), Ca+
• Medications - Chemotherapy agents: Methotrexate/Biological- TNF inhibotrs, (RF, Anti-CCP ANA, ENA)​​
• Inflammatory /Connectives tissues diseases - Ganglions
• Tumour - Multiple Myleoma (Protein electrophoresis) Paraneopatlstic syndrome- (CAncers of Lung, breast , ovaries)
• B12/ B1/ B6, folate deficeincy, Nutritional deficits - Easily tested - Toxins- inhalants- B12 def, B6 increase, anorexia.
• Infection- Covid, EBV
• Trauma - E.g my shoulder- ulnar nerve neuropathy
• Hereditary - (Hereditary motor and sensory neuropathies AKA Charcot-Marie-Tooth (CMT) disease is the most common inherited neurological disorder, affecting 1 in every 2500 people -( Family hx important, PES CAVUS, NCS)