Peripheral neuropathy is diagnosed from the pattern of symptoms and examination findings, confirmed and characterised by nerve conduction studies with electromyography, alongside blood tests to identify a treatable cause. The commonest pattern is symmetrical and length-dependent, beginning in both feet and progressing slowly upward. Blood tests look for a treatable cause such as diabetes, vitamin B12 deficiency or thyroid disease.
Peripheral neuropathy is diagnosed from the pattern of symptoms and examination findings, confirmed and characterised by nerve conduction studies with electromyography, alongside blood tests to identify a treatable cause. The commonest pattern is symmetrical and length-dependent, beginning in both feet and progressing slowly upward. Blood tests look for a treatable cause such as diabetes, vitamin B12 deficiency or thyroid disease.
The commonest form is length-dependent and symmetrical: it begins in both feet, progresses slowly upward, and reaches the hands only once it has advanced. Examination tests sensation to light touch, vibration and temperature, checks ankle reflexes, and assesses strength. Reduced vibration sense at the great toe and absent ankle reflexes are often the earliest measurable findings. A pattern that is asymmetrical, predominantly motor, rapidly progressing, or affecting the hands first is atypical and changes the differential considerably.
Electrodiagnostic testing confirms a neuropathy is present, grades its severity, and characterises it as predominantly demyelinating or axonal, which meaningfully narrows the cause. It also distinguishes a generalised neuropathy from a single compressed nerve or a nerve root problem, which can present similarly and are treated differently. One limitation matters: these studies assess large fibres only, so a small fibre neuropathy causing genuine burning pain can produce an entirely normal study. Both CNS offices perform and interpret them.
This is the part that changes outcomes. Blood tests routinely include glucose and HbA1c, vitamin B12, thyroid function, kidney function and a full blood count, with protein studies where indicated. Alcohol history matters. So does a complete medication review, since several chemotherapy agents and other drugs cause neuropathy, and metformin can lower B12. A proportion of neuropathies remain idiopathic after thorough assessment, and saying so honestly is better than attributing it to the most convenient candidate.
Clinical Neurology Specialists has been physician-owned since 1998, when Leo Germin, M.D., FAANEM founded it. Five board-certified neurologists and four advanced practice providers see patients at the Las Vegas and Henderson offices, each with its own AANEM-accredited electrodiagnostic laboratory.
Clinical Neurology Specialists is an adult outpatient neurology practice for patients 18 and older. The practice performs no surgery and operates no imaging suite, infusion suite or interventional pain programme, and provides no emergency or inpatient care.
Physician-reviewed. Reviewed by the physicians of Clinical Neurology Specialists — board-certified neurologists, AANEM-accredited electrodiagnostic laboratories, physician-owned since 1998. Reviewed 1 August 2026. This article is general education for adults 18 and older and is not a substitute for a consultation.
Adults 18 and older, at the Las Vegas and Henderson offices. Call 702-804-1212 or request an appointment online.