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Small Fiber neuropathy Part-2 by: M.C |JUNE 29, 2020
Overview by M.C.& modification by I.K. USA SMALL FIBER NERVE TYPE LINK
Symptoms of pain, burning, numbness, and autonomic dysfunction (lack of sweating) in the hands and feet in a stocking-glove distribution. Strength is not affected. Tendon reflexes are normal, as are nerve conduction studies.Screening and diagnosis: Small Fiber Neuropathy can be tested by a skin biopsy.
EMG.NCV is important test for small fiber neuropathy if A waves, F waves and Compound action potential is carefully looked into. The CAP waveform will become wide a phenomena called temporal dispersion. A waves will appear and F waves will become prolonged. We have seen low amplitudes and conduction block in NCV.
SSEP: somatosensory evoked responses can be abnormal.Because autonomic neuropathy isn't a single disease, it can be difficult to diagnose. Often, determining the diagnosis is a matter of ruling out other causes of the symptoms. Your doctor is likely to take a medical history, ask for a thorough description of your symptoms and do a physical exam.
Your doctor also may use a number of tests to aid in diagnosis. These may include:
- Autonomic tests. These tests measure what happens to your heart rate and blood pressure and how much you sweat in response to certain maneuvers. Electrocardiogram. This test can measure the electrical impulses of your heart while you exhale forcibly into an instrument (Valsalva maneuver). This maneuver increases the pressure in the blood vessels in your head.Tilt-table test. This test monitors your blood pressure and heart rate as you lie flat on a table that is tilted to raise the upper part of your body. The tilting places stress on your autonomic nervous system, which regulates your blood pressure and heart rate. Your doctor can see how you respond to a situation that's similar to what occurs when you stand up from lying down. Normally, your body compensates for the drop in blood pressure that occurs when you stand up by narrowing your blood vessels and increasing your heart rate. However, this process may not occur properly in autonomic neuropathy. Quantitative sudomotor axon reflex test (QSART). A small electrical current passes through four capsules placed on your forearm, foot and leg to activate the nerves that supply your sweat glands. You'll feel a slight burning sensation during this testcalled QSART,Thermoregulatory sweat test. During this test, you're coated with a powder that changes color when you sweat. You then enter a chamber with slowly increasing temperature. It causes your body temperature to increase 1 to 1.5 degrees Celsius, which makes most people sweat. Digital photos document the results. Your sweat pattern may help confirm a diagnosis of autonomic neuropathy or other causes for decreased sweating.Ultrasound. For those with bladder symptoms, high-frequency sound waves create an image of the bladder and other parts of the urinary tract, which your doctor can check for abnormalities. Complications
The possible complications of autonomic neuropathy are many. They may include:Injuries from falls caused by lowered blood pressure when you stand. Mental and physical fatigue due to low blood pressureMalnutrition and weight loss from digestive system difficultiesFluid or electrolyte imbalance from excessive vomiting or diarrhea, a condition in which your body loses minerals you need Relationship problems due to sexual dysfunctionUrinary tract infections Cardiovascular complications, such as irregular heartbeat (arrhythmia)Kidney failure from bladder problems that aren't treated properly For treatment of small fiber Neuropathy continue to next page
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