Peripheral neuropathies can be classified as typical or atypical. This article describes two cases to illustrate the appropriate diagnostic workup of patients with typical (symmetrical, starting distally, i.e., in the feet and moving towards the knees before beginning in the hands) or atypical neuropathy.
Typical peripheral neuropathies are much more common than atypical peripheral neuropathies. The diagnostic evaluation can be quite extensive for atypical peripheral neuropathies but should be limited for those with typical peripheral neuropathies. All patients require a complete history, neurologic examination, and simple laboratory tests, with more extensive testing, such as electrodiagnostic tests and MRIs, reserved for atypical presentations or special situations. Costs, including patient out-of-pocket costs, should be considered to ensure maximum value in the diagnostic evaluation of peripheral neuropathy.