• neuropathy
• chronic inflammatory demyelinating polyradiculoneuropathy
• Charcot-Marie-Tooth
• Guillain-Barré syndrome

The assessment and investigation of a possible neuropathy is one of the most common clinical problems facing the general neurologist. Studies of the prevalence of neuropathy in the community are rare but suggest a figure of between 2–8%,¹ making peripheral neuropathy at least as common as stroke. Despite this high prevalence of neuropathy, it is only a small proportion of patients with neuropathies who are referred for detailed evaluation, principally those individuals with disabling disease, or with none of the obvious risk factors such as diabetes or alcoholism.

A logical approach to the assessment of such patients is essential and can be organised into a number of basic questions. The neurologist faced with a patient with a neuropathy has to deal with literally thousands of possible causes, many extremely uncommon, and these can only be simplified by defining the neuropathy by other features that lead to the select few of most likely diagnoses. This is in part a process of pattern recognition but can be helped by a stepwise approach. Several algorithms² and review articles³ have been published to aid this process and a typical one has been constructed here (fig 1).

The approach adopted in this article is to present the evaluation as a list of commonly asked questions that, if correctly addressed and answered, are likely to yield diagnostically important information, and hence direct appropriate management. This is not intended as an exhaustive account of neuropathy but is a personal view, illustrative of a diagnostic process that is commonly adopted.