![]() Therefore, in a neuropathy with significant asymmetry, polyradicular, or mononeuritis multiplex presentation, other etiologies should be explored further, even in the setting of documented toxicity or vitamin deficiency.Ĭauses of vitamin B 12 deficiency can be organized by where the absorption defect occurs. Most toxic and vitamin deficiency–related neuropathies present in a length-dependent fashion with axonal pathology (apart from some notable exceptions detailed below). For example, a patient with more sensory loss on examination than expected from considering his or her history, combined with high arches and hammertoes, may reflect a long-standing hereditary neuropathy that has finally become symptomatic (especially in the setting of a positive family history of neuropathy). It is also important to recognize that other causes of neuropathy may mimic what is suspected to arise from a toxic source or a vitamin deficiency. It is important to take a complete review of systems to determine whether a multisystem syndrome is present as this may lead to a correct diagnosis. While most forms of malnutrition no longer plague developed societies, a history of gastric surgery, chronic malabsorption, or alcoholism may predict the presence of vitamin deficiencies. ![]() In particular, asking about recent changes in exposures may provide useful information, as many of the toxic exposures result from new day-to-day habits. Careful attention must be paid to occupational and home exposures. ![]() As with most types of peripheral neuropathies, acquiring a detailed history is crucial to the diagnosis of neuropathies caused by toxic agents and vitamin deficiencies. ![]()
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