Symptoms of Polyneuropathies.

Intro
Acute (few hours to days), Subacute (within 4 weeks) or
Chronic (over months and years)

Sensory symptoms may appear in two different ways.

• Positive sensory symptoms occur when aberrant
sensation occurs in the absence of normal stimulation.
• Negative symptoms occur when adequate stimuli fail to
produce a sensory response.

Positive symptoms Distal paraesthesias initially at toes

that ascend up to ankle and leg symmetrically on both
sides.
Negative symptoms Disturbances of tactile and
proprioceptive sensations.
 Symptoms
• Ankle jerk is lost very early
• Muscular weakness
• Muscle wasting
• Autonomic involvement orthostatic
hypotension, heat intolerance and localised
excessive sweating in unaffected areas.
 Small fibre involvement
• Burning pain, numbness, tingling in the feet that extends
proximally in a stocking-glove distribution

• Allodynia (perception of non-painful stimuli as being

painful), hyperalgesia (perception of painful stimuli as being
more painful than expected) or reduced pinprick and
thermal sensation in the affected area.

• Vibratory sensation reduced at the toes. Motor strength,

tendon reflexes and proprioception is preserved (because
they are functions of large nerve fibres).

• Autonomic features maybe present.

 Additional systemic findings
• Signs of nutritional deficiency.

• Systemic signs of toxicity of drugs and toxins.

• Presence of malignancy or connective tissue

disorder.

• Presence of skeletal (pes cavus, hammer toes and

kyphoscoliosis), visual or auditory involvement in
hereditary neuropathies.