polyneuropatia

Polyneuropatia, also known as polyneuropathy, is a disorder involving multiple peripheral nerves. It commonly presents with symmetrical distal sensory symptoms—numbness, tingling, or burning in the feet and hands—often with later weakness as motor fibers are affected. The pattern is typically stocking-glove.

Most cases are length-dependent and may be axonal or demyelinating. Small-fiber involvement causes pain and temperature loss, while large-fiber impairment affects vibration, proprioception, and reflexes. It can be acute, subacute, or chronic and may be sensory, motor, autonomic, or mixed.

Common causes include diabetes and prediabetes, alcohol or toxin exposure, nutritional deficiencies (notably B12 and thiamine), autoimmune or inflammatory neuropathies (CIDP, Guillain-Barré spectrum), infections (HIV, hepatitis C), hereditary disorders (Charcot-Marie-Tooth), kidney failure, thyroid disease, and certain drugs or chemotherapy.

Diagnosis relies on clinical assessment supported by nerve conduction studies and electromyography to distinguish axonal versus demyelinating types. Laboratory workup targets glucose control, vitamin levels, thyroid and renal function, liver tests, inflammatory markers, and infectious etiologies; genetic testing or lumbar puncture may be used in select cases.

Management focuses on treating the underlying cause and relieving symptoms. This may include glycemic control, vitamin replacement, withdrawal of neurotoxic medications, and immunotherapy for inflammatory forms. Neuropathic pain is treated with medications such as gabapentinoids, SNRIs, or TCAs. Physical therapy, foot care, and fall prevention are important.

Prognosis varies with cause and treatment timeliness. Some patients stabilize or improve; others have persistent symptoms. Polyneuropathy is a common complication of diabetes and other chronic diseases and is more prevalent with advancing age.