Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
Am J Med. 2018 Sep;131(9):1010-1016. doi: 10.1016/j.amjmed.2017.12.042. Epub 2018 Feb 2.
Peripheral neuropathy is commonly encountered in the primary care setting and is associated with significant morbidity, including neuropathic pain, falls, and disability. The clinical presentation of neuropathy is diverse, with possible symptoms including weakness, sensory abnormalities, and autonomic dysfunction. Accordingly, the primary care clinician must be comfortable using the neurologic examination-including the assessment of motor function, multiple sensory modalities, and deep tendon reflexes-to recognize and characterize neuropathy. Although the causes of peripheral neuropathy are numerous and diverse, careful review of the medical and family history coupled with limited, select laboratory testing can often efficiently lead to an etiologic diagnosis. This review offers an approach for evaluating suspected neuropathy in the primary care setting. It will describe the most common causes, suggest an evidence-based workup to aid in diagnosis, and highlight recent evidence that allows for selection of symptomatic treatment of patients with neuropathy.
周围神经病变在基层医疗机构中较为常见，与多种发病率相关，包括神经病理性疼痛、跌倒和残疾。神经病变的临床表现多种多样，可能出现的症状包括无力、感觉异常和自主神经功能障碍。因此，基层医疗机构的临床医生必须能够熟练运用神经检查，包括运动功能、多种感觉模式和深腱反射的评估，以识别和描述神经病变。尽管周围神经病变的原因众多且多样，但仔细审查病史，包括个人史和家族史，结合有限的、有针对性的实验室检查，通常可以有效地确定病因诊断。本文介绍了一种在基层医疗机构中评估疑似周围神经病变的方法。文中将描述最常见的病因，并提出基于循证的检查方法以协助诊断，同时还将重点介绍近期相关证据，为神经病变患者的对症治疗提供选择。
