Mackin G A
Department of Neurology, University of Colorado Health Sciences Center, Denver.
Clin Podiatr Med Surg. 1994 Oct;11(4):545-69.
Podiatrists have a unique opportunity to detect neuropathies at stages where specific treatment and measures to limit progression may be most beneficial. This article reviews neuropathic symptoms and signs that call for timely neurologic evaluation and intervention and outlines the essentials of a focused evaluation. The detailed clinical history and examination are still the mainstays for determining the specific diagnosis of most neuropathies and for distinguishing other neurologic disorders that may mimic neuropathies. Whenever the cause, severity, or very presence of a neuropathy remains uncertain, electromyography and nerve conduction studies performed by a well-trained physician experienced with neuromuscular diseases should be the mandatory next steps. Clinicians should expect electrophysiologic studies to define the specific pattern of neuropathy (fiber-length dependent versus multifocal) and the predominant pathologic process (axon loss versus demyelination), enabling them to restrict diagnostic tests to a rational, necessary, cost-effective, and productive minimum.
足病医生有独特的机会在特定治疗和限制病情进展的措施可能最有益的阶段检测出神经病变。本文回顾了需要及时进行神经学评估和干预的神经病变症状和体征，并概述了重点评估的要点。详细的临床病史和检查仍然是确定大多数神经病变的具体诊断以及区分可能模仿神经病变的其他神经疾病的主要方法。每当神经病变的病因、严重程度或是否存在仍不确定时，由训练有素、有神经肌肉疾病经验的医生进行肌电图和神经传导研究应是接下来的必要步骤。临床医生应期望电生理研究能确定神经病变的具体模式（纤维长度依赖性与多灶性）和主要病理过程（轴突丧失与脱髓鞘），使他们能够将诊断测试限制在合理、必要、具有成本效益且高效的最低限度。
