Before diagnosing peripheral neuropathy, your physician will review your medical history and conduct a neurological examination and order additional tests.
A neurological examination, 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 examination, you may be referred to undergo other tests that can determine what type of peripheral neuropathy you have.
What is a Neurological Evaluation?
A thorough neurological evaluation helps doctors to diagnose peripheral neuropathy. Your doctor will obtain your history and you will be asked questions about your symptoms and associated medical conditions. Then, the physician will perform a neurological examination by testing your neurological function in different domains including your cranial nerves, strength, sensation, and deep tendon reflexes…Depending on the results of your history and neurological examination, you may be referred for additional tests as outlined below.
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.
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.
Among the items your physician will evaluate to get relevant clues on your conditions, these are the commonly used ones:
- test for loss of vibratory sensation at limb extremities: a tuning fork will be place on some reference spots (usually a bony protuberance as at the ankle bone) and you will be asked to say if/when if you the instrument vibrate;
- test for skin sensation in the feet and hands: a pin or a cotton swab will be gently placed on the limb to examined and you will be asked to say what/if you fell it;
- test for muscle strength: you will be asked to perform some simple gestures, such as bending your forearm, and the examiner will rate your strength;
- deep tendon reflex testing: the physician will use a neurological hammer to gently tap over some specific tendons to see if an involuntary muscle twitch/movement can be obtained.
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 blood tests, a nerve biopsy, a skin biopsy, a spinal tap or magnetic resonance imaging (MRI). These tests usually lead to identifying the underlying cause of the peripheral neuropathy the majority of the time. However, for some patients with longstanding neuropathy, the cause may not be found despite extensive tests and examinations.
Electrodiagnostic tests measure the electrical activity of muscles and nerves. By measuring the electrical activity, they can determine if there is nerve damage, the extent of the damage and potentially the cause of the damage. The electrodiagnostic test is comprised of nerve conduction studies (NCS) and needle electromyography (EMG).
Blood tests are commonly employed to check for infections, 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 of 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
- 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
Evaluation of how the systems in the body controlled by the autonomic nerves respond to stimulation.
Method of collecting a sample of a patient’s spinal fluid to identify the presence of an autoimmune disorder or infection.
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
These tests create images of the body and its organs that may be used in the diagnosis or exclusion of disorders with similar symptoms.
Measures the electrical activity of muscles and nerves to determine if there is nerve damage.
Learn more about electrodiagnostic testingabout electrodiagnostic testing
Quantitative Sensory Testing (QST)
Quantitative Sensory Testing (QST)
Used to diagnose and assess the severity of nerve damage, especially in the small nerve endings.