Peripheral neuropathy diagnosis is often difficult as there are lots of possible causes. With 20% of patients the cause cannot be diagnosed. (called Idiopathic).

Early diagnosis is very important because in many cases it gets worse unnoticed, stealthily damaging nerves. 11% of patients with diabetic neuropathy have pain. nearly 90% just have numbness.

Up to half of people with PN,don’t know they already have it e.g.numbness creeping in unseen. There may be signs of PN that canbe noticed, however, such as numbing foot injuriesand reduced ankle reflexes.

Visiting Your Doctor

The most important step in treating neuropathy is finding the cause. Often the cause is a disease like diabetes which blood tests can detect. Blood tests can also find liver or kidney dysfunction, vitamin deficiencies, other metabolic disorders, & immune system problems. Please see our page on Causes of Peripheral Neuropathy for more information.

Your doctor will also ask about any accidents, exposure to toxins, environment at work, any past or present alcoholism, neurological disease in the family, and risk of infectious disease.


The doctor will test for what sort of nerves are involved (sensory, autonomic, motor) & for damage & dysfunction, such as by testing reflexes like the http://en.wikipedia.org/wiki/Ankle_jerk_reflex.

They will also test muscle strength & signs of cramps or muscle twitches show whether the nerve fibers that control movement, the motor nerves, are involved.

Your ability to notice light touch, vibration, body position, temperature and pain shows if sensory nerves are damaged and may point to large or small sensory nerves.


Your doctor may want to perform deeper scans and other tests to help diagnose.

  • Spinal fluid tests (Lumbar puncture)
  • Muscle strength tests
  • Tests of the ability to detect vibrations
  • CT scan
  • MRI scan
  • Nerve biopsy – removal of a small bit of tissue for examination under a microscope.
  • Skin biopsy

Consultant Referral

Your doctor could send you to a nerve specialist for an electrodiagnostic assessment (Edx), two tests:

  • Needle Electromyography (EMG)
  • Nerve conduction velocity (NCV) tests

Other cardiovascular or blood diseases, connective tissue disorders, or malignancies may be revealed by more specialised tests.

Notes on Scans and Tests

CT scans, or Computed tomography, produces two-dimensional images, or “slices”, of internal organs, bones, and tissues like muscles. X-rays are passed through the body and are measured by a scanner. The scans show views in cross-section of the internal structure of the body or organ.

CT scans can detect many possible causes of neuropathy.

These include problems with the bone structure, the veins and arteries, growths like tumours and cysts in the brain, herniated disks, encephalitis, spinal stenosis (narrowing of the spinal canal) and other disorders.

MRI scan, or Magnetic resonance imaging,shows the muscles, their size and condition, and if there is compression to a nerve. MRI puts a strong magnetic field around the body through which radio waves are then passed to create a pattern that can be seen from different angles within the body. A computer then processes this resonance into either a 3D picture or a 2D “slice” of the scanned area.

Electromyography (EMG) measures the amount of electrical activity present when muscles are at rest and when they contract. It usesa very fine needle electrode, that transmits and detects electrical signals, inserted into a muscle. The activity of the muscle is recorded and displayed as an electromyogram that your doctor will explain to you. EMG tests can show whether it is a muscle disorder, nerve disorder or a problem with nerve-to-muscle communication.

For more on EMG and NCV including how to prepare for your test please see/

Nerve conduction velocity (NCV), also called nerve conduction study(NCS), tests measure the speed of nerve signal conduction. Small electrodepatches are tapedto the surface of the skin, usually over the nerve or muscle being studied, and short painless pulses of electricity are sent to the patch to stimulate a muscle’s nerve fiber. The test shows the signal speed along the nerve, called the nerve conduction velocity, and so how much damage there is, and which parts of the nerve are affected. Obstructed impulses orslow feedback indicates breakdown of the protective myelin sheath, while weakened responses suggest disruption of the axon itself. [LINK to pic].

Skin biopsy is a test that removes a thin sample of skin to examine the endings of the nerve fibers.

Skin biopsy has the advantage over NCV tests and nerve biopsy that, unlike NCV, it can discover damage in smaller fibers and that it is safer and easier than nerve biopsy.

Nerve biopsyis the taking of a very small sample of nerve tissue for examination, usually from the lower leg. It is an invasive and difficult surgical procedure that can cause neuropathic side effects itself. This test can provide valuable information about the degree of nerve damage but many experts do not think that a biopsy is absolutelynecessary. We do not recommend it.

Nerve conduction test, small metal discs called electrodes are placed on your skin. The electrodes release small electric shocks that stimulate your nerves. The speed and strength of the nerve signal is measured. An unusually slow or weak signal could indicate peripheral neuropathy.

Some types of peripheral neuropathy cause a distinctive change in the pattern of electrical activity, which can be detected using electromyography (EMG).


Sensory examination includes response to light touch, temperature, painful stimulus, vibration and proprioception. Compare both sides and grade as normal, decreased or increased. Motor testing includes tone, strength, reflexes and coordination. Also look for autonomic changes in colour, temperature, sweating and swelling.

Routine blood tests to exclude differential diagnoses include full blood count (FBC), erythrocyte sedimentation rate (ESR), glucose, creatinine, alanine transaminase (ALT), vitamin B12, serum protein immunoelectrophoresis and thyroid function. Assessing glycaemic control with an HbA1c is useful in patients who are diabetic. A glucose tolerance test may be helpful if diabetic status is not known.


Initial tests include:

  • Urine: glucose, protein.
  • Haematology: FBC, erythrocyte sedimentation rate (ESR), vitamin B12, folate.
  • Biochemistry: fasting glucose, renal function, liver function and thyroid function.

Further investigations will depend on the outcome of clinical assessment and initial investigation results:

  • Neurophysiology testing with assessment of distal and proximal nerve stimulation; electrophysiological procedures are helpful in determining the pathological process which may be either an axonopathy, a myelinopathy or a neuronopathy.[2][3]
  • Biochemistry: serum protein electrophoresis, serum angiotensin-converting enzyme.
  • Immunology: antinuclear factor, anti-extractable nuclear antigen antibodies (anti-Ro, anti-La), antineutrophil cytoplasmic antigen antibodies .
  • Urine: Bence-Jones’ protein.
  • Cerebrospinal fluid: cells, protein, immunoglobulin oligoclonal bands.
  • Immunology: anti-HIV antibodies, antineuronal antibodies (Hu, Yo), antigliadin antibodies, serum angiotensin-converting enzyme, antiganglioside antibodies, antimyelin associated glycoprotein antibodies.
  • Search for carcinoma, lymphoma, or solitary myeloma.
  • Molecular genetic tests, eg for Charcot-Marie-Tooth syndrome.
  • Nerve biopsy may be required.



A recent study found that some people with celiac disease had neuropathic symptoms before the gastrointestinal symptoms of celiac disease appeared. The results of this study, and the fact that 10 percent of people with celiac disease suffer from an associated neurological condition (usually peripheral neuropathy or ataxia – a condition characterized by jerky, uncoordinated movements and gait), indicates that patients with neuropathy of an unknown cause should be tested for celiac disease.

In fact, a 2003 study found that 5% of patients with peripheral neuropathy have celiac disease. The most common symptoms for celiacs to experience are sever burning, stinging and electric shock-type pains, adherence to a gluten-free diet lessens and/or eliminates almost all patients’ symptoms.


PN is Caused by :





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