Neurological Examinations
Before diagnosing peripheral neuropathy, your physician will review your medical history and conduct a physical exam and neurological evaluation.
A neurological evaluation, which consists of a number of simple and painless tests, is usually performed to diagnose peripheral neuropathy. Depending on your symptoms and outcome of the neurological evaluation, you may encounter other tests that can determine what type of peripheral neuropathy you have.
What is a Neurological Exam?
A neurological exam helps doctors to diagnose peripheral neuropathy and may include the following:
- The history: questions concerning your symptoms and condition
- An evaluation of neurological function
- Diagnostic tests
- Electrodiagnostic tests
- Blood tests
- Other common tests
Neurology Exam Questions from Your Doctor
You should be prepared to discuss your symptoms in detail with your doctor. Your doctor will ask you to describe your symptoms, when you experience them, how long the episodes last and the amount of discomfort or pain you experience. The more specific you can be about the tingling, numbness, weakness or other symptoms you are experiencing, the easier it will be for your doctor to understand your condition.
Your doctor may also ask you general health questions that may seem unrelated to your symptoms, but are, in fact, important. These questions could be about whether or not you feel faint, nauseated or tired. The doctor may also ask if your bladder control and sexual function are normal. You will also be asked if you are suffering from any other illnesses and if you are taking medications.
The physician will then perform a physical exam to test for loss of vibratory sensation. He or she will test ankle jerks and other reflexes. Sensations in the feet and hands will be evaluated with a pin.
Since some neuropathies are hereditary, your doctor will ask if other members of your family have suffered from any type of neuropathy or neurological disorder.
Neurological Examination Tests
A neurological evaluation consists of a physical exam and a number of simple and painless tests. The purpose of these tests is to assess your neurological function, including your muscle strength, how your autonomic nerves are functioning, and your ability to feel different sensations.
Diagnostic testing
The neurologist may recommend certain diagnostic tests, depending on the patient’s symptoms, medical history and physical examination.
Frequently the neurologist will recommend electrodiagnostic testing to measure the electrical activity of muscles and nerves. If necessary, the neurologist may also recommend a nerve biopsy, a spinal tap or magnetic resonance imaging (MRI). However, for some patients with longstanding neuropathy, the cause may not be found in spite of extensive tests and examinations.
Electrodiagnostic test
Electrodiagnostic tests measure the electrical activity of muscles and nerves. By measuring the electrical activity they are able to determine if there is nerve damage, the extent of the damage and potentially the cause of the damage. Frequently the neurologist will recommend common, non-invasive neurological evaluations such as electromyography (EMG) and nerve conduction velocity (NCV) testing.
Blood tests
Blood tests are commonly employed to check for vitamin deficiencies, toxic elements and evidence of an abnormal immune response.
Depending on your individual situation, your doctor may request certain laboratory tests to identify potentially treatable causes for neuropathy. These include tests for:
- Vitamin B12 and folate levels
- Thyroid, liver and kidney functions
- Vasculitis evaluation
- Oral glucose tolerance test
- Antibodies to nerve components (e.g., anti-MAG antibody)
- Antibodies related to celiac disease
- Lyme disease
- HIV/AIDS
- Hepatitis C and B
Other common tests
If your doctor suspects that you have a specific type of neuropathy, an advanced case of neuropathy, or an entirely different condition, it may be suggested that you undergo additional testing. Your doctor may recommend quantitative sensory testing (QST) and autonomic testing, or other tests to diagnose a specific disorder.
Evaluation + Tests
Autonomic Testing
Evaluation of how the systems in the body controlled by the autonomic nerves respond to stimulation.
Lumbar Puncture
Method of collecting a sample of a patient’s spinal fluid to identify the presence of an autoimmune disorder.
Nerve, Skin, Muscle, Tissue Biopsy
Samples of nerves, skin, muscle or other tissues are examined to identify and diagnose various disorders.
 nerve skin muscle tissue biopsy
Imaging
These tests create images of the body and its organs that may be used in the diagnosis or exclusion of disorders with similar symptoms.
Electrodiagnostic Testing
Measures the electrical activity of muscles and nerves to determine if there is nerve damage.
Quantitative Sensory Testing (QST)
Quantitative Sensory Testing (QST)
Used to diagnose and assess the severity of nerve damage, especially in the small nerve endings.
