Idiopathic neuropathies

After a careful diagnostic work up, a cause can be found in the majority of neuropathies. However, in a proportion of cases, no cause can be found, despite extensive investigations. Such cases constitute a heterogeneous group of disorders. Some of them have small-fiber sensory neuropathy and suffer from burning pain, restricted initially to the feet and toes but extending more proximally to involve legs and hands with time. Most patients present with slowly progressive symptoms. Foot ulceration is uncommon in these patients, even though small fibers are involved. Rarely, the presentation can be acute with generalized small-fiber dysfunction. Pathologically, widespread loss of small fibers from the epidermis has been demonstrated.56 Some patients resemble those with erythromelalgia.

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