neuropathy

Diabetes Stroke Guillan-barre Vasculitis Toxins (heavy metals)

Fabry’s disease (x linked recessive) Amyloidosis Lyme disease Leprosy HIV

vasculitis; hereditary neuropathy with liability to pressure palsies (HNPP);

ompressive mononeuropathy and radiculopathy Consider: polyradiculopathy or plexopathy due to diabetes mellitus; meningeal carcinomatosis or lymphomatosis; idiopathic; hereditary (HNPP, familial)

Biopsy is indicated in: Vasculitis * Sarcoidosis Amyloidosis-acquired Chronic inflammatory demyelinating polyneuropathy Neuropathy with IgM monoclonal and myelin-associated glycoprotein antibodies Leprosy Tumor infiltration * Charcot-Marie-Tooth disease types 1A, 1B, and 3 Hereditary neuropathy with liability to pressure palsies (tomaculous neuropathy) Amyloidosis—hereditary Giant axonal neuropathy Metachromatic leukodystrophy * Polyglucosan body neuropathy * Refsum's disease

Spinal tap Nerve conduction study

OBTAINED IN MOST PATIENTS REFERRED FOR NEUROPATHY OF UNKNOWN ETIOLOGY CBC and erythrocyte sedimentation rate •	SMA 20 (Albumin: 3.9 to 5.0 g/dl •	Alkaline phosphatase: 44 to 147 IU/L •	ALT (alanine transaminase): 6 to 59 IU/L •	AST (aspartate aminotransferase): 10 to 34 IU/L •	BUN (blood urea nitrogen): 7 to 20 mg/dl •	Calcium - serum: 8.5 to 10.9 mg/dl •	Serum chloride: 101 to 111 mmol/L •	CO2 (carbon dioxide): 20 to 29 mmol/L •	Creatinine: 0.8 to 1.4 mg/dl •	Direct bilirubin: 0.0 to 0.3 mg/dl •	Gamma-GT (gamma-glutamyl transpeptidase): 0 to 51 IU/L •	Glucose test: 64 to 128 mg/dl •	LDH (lactate dehydrogenase): 105 to 333 IU/L •	Phosphorus - serum: 2.4 to 4.1 mg/dl •	Potassium test: 3.7 to 5.2 mEq/L •	Serum sodium: 136 to 144 mEq/L •	Total bilirubin: 0.2 to 1.9 mg/dl •	Total cholesterol: 100 to 240 mg/dl •	Total protein: 6.3 to 7.9 g/dl •	Uric acid: 4.1 to 8.8 mg/dl ) Serum protin electrophoresis and immune fixation electrophoresis Vitamin B12 level OBTAINED IN SELECTIVE PATIENTS WHEN CLINICALLY INDICATED Glucose tolerance test Methylmalonic acid and homocysteine Anti-intrinsic factor/parietal cell antibodies Serum gastrin Hemoglobin A1C VDRL (or RPR) and FTA-ABS (or MHA-TP) Thyroid function tests Creatine kinase * Parathyroid hormone * Antinuclear antibodies (including SS-A and SS-B) Rheumatoid factor Anti-neuronal nuclear antibody type I (ANNA-1 or anti-Hu) Lyme antibody HIV antibody Myelin-associated glycoprotein (MAG) antibody GMI antibody, GQ1b antibody Blood (and urine) for heavy metals Molecular genetic analysis for CMT 1A and 1B, hereditary neuropathy with liability for pressure palsy (HNPP), and the familial amyloid polyneuropathies