How is Neuropathy diagnosed?

by Waden E. Emery III MD FAAN, – Neuromuscular Neurologist
Board Certified in Neurology, Asst Clinical Professor in Neurology
Miller School of Medicine University of Miami

Diagnosing Neuropathy - How is Neuropathy diagnosed?

Diagnosing neuropathy is based primarily on the patient’s report of symptoms, medical history, and standard physical examination by a Neuromuscular Neurologist trained to clinically diagnose neuropathy.  There are a number of tests available to help properly diagnose, some of which are listed below:

    • Blood work to test for nutritional / vitamin deficiencies or cancer are important,
    • MRI or an X-Ray may be important tools to determine if there may be an entrapment neuropathy, but only if indicated,
    • Other tests that are used to determine IF damage has been done to the nerves or axon, would include the Nerve Conduct Test, EMG, for large fiber damage,
Diagnosing Neuropathy

Skin Biopsy

  • A Skin Biopsy can be beneficial in diagnosing for small fiber damage,
  • In some types of neuropathy a spinal tap to inspect the protein can be very diagnostic,
  • Also in some cases a nerve / muscle biopsy can be diagnostic but it is rarely needed.

Reflexes unfortunately can be diminished, absent or not affected at all in neuropathy, so is by itself not a absolute standard for diagnosing neuropathy.

No one test will diagnose a neuropathy and you can have neuropathy symptoms long before there is damage to the nerve or axon.

A Diagnosis of neuropathy is more an art than a science and is one place where the practice of good patient focused caring medicine can either shine or dim a patient’s hope for help.

Reference: “How to Diagnose Peripheral Neuropathy: Experts Offer some Guiding Principles”, Neurology Today, March 15, 2012 by Mark Moran