Level 1
Red flag: Jagged edge
When you find a glove and/or stocking sensory loss that has a jagged proximal edge you must consider a mononeuritis multiplex; the latter is a cause of a pseudo glove-and-stocking sensory loss.
Length-dependent sensory loss due to metabolic and toxic neuropathies usually have a sharp edge and are in proportion to each other. The following is a rough guide to proportions:
* when you get length-dependent sensory loss to the level of the thighs you may find sensory loss in the mid abdomen; i.e. the disease process has started to involve the spinal nerves.
Level 2
A mononeuritis multiplex may only involve the superficial cutaneous nerves leaving the deep nerves intact; if this is the case the tendon jerks will be retained and motor involvement will be minimal.
When a mononeuritis multiplex involves the superficial cutaneous nerves only, please consider cryoglobulinaemia in the differential diagnosis. I assume you know how to take blood and process it to detect the latter; if not find out.
Mononeuritis multiplex due to vasculitis is typically very painful.
Red flag: Jagged edge
When you find a glove and/or stocking sensory loss that has a jagged proximal edge you must consider a mononeuritis multiplex; the latter is a cause of a pseudo glove-and-stocking sensory loss.
Length-dependent sensory loss due to metabolic and toxic neuropathies usually have a sharp edge and are in proportion to each other. The following is a rough guide to proportions:
- Foot and ankles = normal hands and arms
- Mid calf = hands
- Knee = mid forearm
- Thigh = upper forearm or elbow*
* when you get length-dependent sensory loss to the level of the thighs you may find sensory loss in the mid abdomen; i.e. the disease process has started to involve the spinal nerves.
Level 2
A mononeuritis multiplex may only involve the superficial cutaneous nerves leaving the deep nerves intact; if this is the case the tendon jerks will be retained and motor involvement will be minimal.
When a mononeuritis multiplex involves the superficial cutaneous nerves only, please consider cryoglobulinaemia in the differential diagnosis. I assume you know how to take blood and process it to detect the latter; if not find out.
Mononeuritis multiplex due to vasculitis is typically very painful.
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