Examine this patient's legs.

Carry out a neurological examination of this patient's legs.



· Progressive and symmetrical numbness in the hands and feet which spreads proximally in a glove and stocking distribution.

· Distal weakness, which also ascends.

· History of diabetes, alcohol, connective tissue disorder, malignancy.


Bilateral symmetrical sensory loss for all modalities with or without motor weakness.

Proceed as follows:

· Look for evidence of the following:

-Diabetes mellitus (diabetic chart, insulin injection sites, insulin pump).

- Alcoholic liver disease (palmar erythema, spider naevi, tender liver).

- Drug history.

- Rheumatoid arthritis.

- Uraemia.

-Malignancy. (Mnemonic: DAD, RUM)

· Palpate for thickened nerves and look for Charcot's joints.

· Tell the examiner that you would like to do the following: -Look for anaemia and jaundice (vitamin Bi2 deficiency). -Check urine

for sugar.

-Take a history of alcohol consumption and a drug history.


This patient has symmetrical, bilateral sensory loss for touch and pain (lesion) due to diabetes mellitus (aetiology).


Mention a few causes of thickened nerves.

· Amyloidosis.

· Charcot-Marie-Tooth disease.

· Leprosy.

· Refsum's disease (retinitis pigmentosa, deafness and cerebellar damage).

· D5j5rine-Sottas disease (hypertrophic peripheral neuropathy).

What are the causes of motor neuropathy?

· Guillain-Barrd syndrome.

· Peroneal muscular atrophy.

· Lead toxicity.

· Porphyria.

· Dapsone toxicity.

· Organophosphorous poisoning.

What are the causes of mononeuritis multiplex?

Mononeuritis multiplex is a neuropathy affecting several nerves; causes include:

· Wegener's granulomatosis.

· Amyloidosis.

· Rheumatoid arthritis.

· Diabetes mellitus.

· SLE.

· Polyarteritis nodosa.

· Leprosy.

· Carcinomatosis, Churg-Strauss syndrome. (Mnemonic: WARDS, PLC).

Mention a few causes of predominantly sensory neuropathy.

· Diabetes mellitus.

· Alcoholism.

· Deficiency of vitamins Bi2 and Bi.

· Chronic renal failure.

· Leprosy.

What are the types of neuropathy described in diabetes mellitus?

· Symmetrical, mainly sensory, polyneuropathy.

· Asymmetrical, mainly motor, polyneuropathy (diabetic amyotrophy).

· Mononeuropathy.

· Autonomic neuropathy.

What drugs are used for painful peripheral neuropathy of diabetes?

Tricyclic antidepressants, phenytoin, carbamazepine and topical capsaicin.


What are the other effects of alcohol on the central nervous system?

· Wernicke's encephalopathy (ophthalmoplegia, nystagmus, confusion and neuropathy).

· Korsakoff's psychosis (recent memory loss and confabulation).

· Cerebellar degeneration.

· Marchiafava-Bignami disease (symmetrical demyelination of corpus callosum).

· Central pontine myelinolysis.

· Amblyopia.

· Epilepsy.

· Myopathy and rhabdomyolysis.

K. Wernicke (1848-1904) worked in Poland.

S.S. Korsakoff (1853-1900), a Russian neuropsychiatrist.

J. Churg (b. 1910) qualified in Poland and was Professor of Pathology in New York.

L. Strauss, a pathologist in New York.