--that annoy the living c%$p out of me. (And the dead c%$p, too.)

Fact is, MRI's are only going to be useful with very specific types of neuropathy--compressive ones, usually radiculopathies of the spinal nerve roots--anyway. While these are common, especially as people suffer the arthritic changes of age, they are only one broad area of neural symptom causes.

There are hundreds of KNOWN causes of neuropathy, and likely a great many unknown ones (toxic, genetic, iatrogenic). The easy things to check for are diabetic/glucose intolerance, vitamin deficiency, collagen-connective tissue--vascular (anti-nuclear antibody) autoimmunites. But how many doctors know about deficiencies beyond B12 (if they even know that)? How many know about NON-ANA autoimmunites, such as gluten, monoclonal antibodies, antibodies specific to components of peripheral nerve, sarcoid? How many take a history of possible work or drug toxicities? (At least most seem to know that many chemotherapeutic agents are neurotoxic.) How many look well for infectious agents, such as West Nile, cytomegalovirus, Lyme?

It is true that the work-up for neuropathy isn't standardized--UNLESS one is at a specialty center. At places like Washington University St. Louis, Jacksonville Shands, Cornell Weill, Jack Miller in Chicago, University of California San Francisco, Massachusetts General, and Johns Hopkins, the protocols are very similar, with variations made depending on symptom location and presentation. But all use a close analogue of the Latov/Quest serological protocol:

http://www.questdiagnostics.com/hcp/...eralNeurop.htm

and the Poncelet algorithms:

http://www.aafp.org/afp/1998/0215/p755.html


The fact that neuropathy causes are so varied and often hard to diagnose--at least a quarter of cases, even with these tests, remain stubbornly "idiopathic"--makes me think that a little more continuing education is in order.