Stocking-glove distribution is most characteristic of which condition?

• A. Guillain-Barré syndrome
• B. Bell palsy
• C. Meningitis
• D. Diabetic peripheral neuropathy

Answer: (D)

Stocking-glove distribution describes a length-dependent, symmetric loss of sensation that starts in the longest nerves, typically in the feet and then the hands. This pattern is classic for diabetic peripheral neuropathy, where chronic hyperglycemia and microvascular damage cause axonal degeneration in distal nerves. Patients usually notice numbness, tingling, or burning pain in the toes and feet first, with later involvement of the hands, and exam may show reduced vibration sense and diminished ankle reflexes.

Other conditions don’t fit this pattern as neatly. Guillain-Barré syndrome tends to present with rapid, ascending weakness and areflexia, not a gradual distal sensory loss pattern confined to feet and hands. Bell palsy is a focal facial nerve problem, not a symmetric distal polyneuropathy. Meningitis presents with fever, headache, neck stiffness, and meningeal signs rather than a chronic distal sensory loss pattern.