Smallfiber Neuropathy

Patients present with distal burning pain in the extremities and have cutaneous hyperesthesiae and autonomic dysfunction as a prominent feature. They have loss of pain and temperature sensation, but preservation of large-fiber modalities, including tendon reflexes. Small-fiber loss has been demonstrated in nerve biopsies.19 Such patients are believed to have small-fiber neuropathy. Small-fiber involvement is an early consistent feature in diabetic polyneuropathy to varying degrees.17

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