Sensory Loss

Like motor function, sensation is affected symmetrically and in distal segments in polyneuropathies. As the neuropathy worsens, sensory loss may spread from distal to proximal parts. In most polyneuropathies, all sensory modalities are impaired (pain and temperature, indicating small-fiber involvement; joint position and vibration sense, suggesting large-fiber dysfunction). Occasionally, selective damage to large or small fibers predominates. In polyneuropathy affecting mainly small nerve fibers, patients often present with burning, painful dysesthesiae, alteration of pinprick and temperature sensation, and autonomic dysfunction. Motor function, balance, and tendon jerks may be preserved. Some cases of amyloid and early distal diabetic polyneuropathies fall into this group. Large-fiber neuropathy, in contrast, is characterized by loss of joint position and vibration sense, ataxia, areflexia, and variable but often severe loss of motor function. In sensory neuronopathies (primary involvement of dorsal root ganglion), there is usually no motor loss.

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