Chronic inflammatory demyelinating polyneuropathy (CIDP) is often misdiagnosed. Of the clinical phenotypes, “atypical CIDP is the most common”. The researchers also found that most people with neuropathy didn't know they had it. There are several conditions that may resemble the symptoms of neuropathy. Vitamin B12 deficiency often causes tingling and numbness that people mistake for neuropathy.
Peripheral neuropathy, a common neurological problem among family physicians, can be clinically classified according to the anatomical pattern of presentation of symptoms and, if indicated, based on the results of electrodiagnostic studies of axonal and demyelinating diseases. The prevalence of peripheral neuropathy in the general population ranges from 1% to 7%, with higher rates among people over 50 years of age. Common identifiable causes include diabetes mellitus, nerve compression or injury, alcohol consumption, exposure to toxins, inherited diseases, and nutritional deficiencies. Peripheral neuropathy is idiopathic in 25% to 46% of cases.
The diagnosis requires a complete medical history, a physical exam, and judicious laboratory tests. Early peripheral neuropathy may present as sensory disorders that are usually progressive, such as loss of sensation, numbness, pain or burning sensation in the extremities shaped like a “stocking and glove”. More advanced stages may include proximal numbness, distal weakness or atrophy. The physical exam should include a comprehensive neurological and musculoskeletal evaluation.
If the peripheral nervous system is identified as the likely source of the patient's symptoms, evaluation of possible underlying etiologies should initially focus on treatable causes. The initial laboratory evaluation includes a complete blood count; a complete metabolic profile; the levels of fasting blood glucose, vitamin B12 and thyroid-stimulating hormone; and serum protein electrophoresis with immunofixation. If the initial evaluation is inconclusive, you should be referred to a neurologist to undergo additional tests (e.g., treatment of peripheral neuropathy focuses on controlling the underlying etiology). There are several classes of medications, such as gabapentinoids and antidepressants, that can help alleviate neuropathic pain.
Peripheral neuropathy affects 25 to 50% of patients with diabetes, depending on factors such as the patient's age, the number of years with diabetes, and the level of diabetes control. 6,7 Peripheral neuropathy is idiopathic in 25 to 46% of cases, and this is more common as the patient's age increases, 8.9.Distal CIDP is easy to confuse with the most common length-dependent axonal neuropathies or genetically determined neuropathies. Signs of long-lasting neuropathy, such as calf atrophy, hammertoes, and hollow foot, should cause concern about inherited neuropathies. Motor CIDP mimics include multifocal motor neuropathy and motor neuron disorder, while sensory CIDP can be confused with a number of neuropathic and non-neuropathic conditions that have altered skin sensitivity. Peripheral neuropathy is likely if the medical history and physical examination reveal the corresponding neuropathic findings.
Although these conditions have different clinical characteristics, the initial stages of inflammatory neuropathies may be similar in their onset and trajectory, especially during weeks 4 to 8 and 6.
