Polyradiculopathy

Synonyms:

Polyradiculoneuropathy

Diagnosis:

The diagnosis is clinical supported by electrophysiological studies (NCS/EMG)

Clinical features:

A syndrome with involvement of multiple nerve roots and peripheral nerves. Usually equal proximal and distal weakness with reduced reflexes

Findings on investigations:

+NCS:

  • Symmetrical i.e. <50% difference between sides
  • Decreased SNAP
  • Decreased CMAP
  • Motor conduction velocities: mild decrease (remaining >75% of lower limit of normal),
  • Distal latencies: normal or <25% increase
  • F-waves: normal or <25% increase

+EMG:

  • Denervation in paraspinal muscles and distally,

Investigations to consider:

  • NCS/EMG
  • MRI L-spine: lumbar spinal stenosis, compression in cauda equina syndrome
  • CSF analysis including cytology: Guillain-Barre syndrome, CIDP, carcinomatous meningitis
  • HIV testing
  • Lyme serology
  • CMV serology
  • Anti-ganglioside antibodies

 

Causes of polyradiculopathy:

Immune:

Neoplastic:

Infectious:

  • CMV polyradiculitis
  • Lyme disease polyradiculitis

Compressive:

Others:

Related articles: