Case 58: Small Fiber Neuropathy and Orthostatic Cerebral Hypoperfusion Syndrome with Positive Autoantibodies to N-type Calcium Channel

2019 ◽  
pp. 312-315
Author(s):  
Peter Novak
Keyword(s):  
Calcium Channel ◽  
Small Fiber Neuropathy ◽  
Cerebral Hypoperfusion ◽  
Small Fiber

Small fiber neuropathy, mixed, length-dependent, is associated with antibodies against the N-type calcium channel. Tilt showed hypocapnic cerebral hypoperfusion.

Case 57: Small Fiber Neuropathy and Hypocapnic Cerebral Hypoperfusion with Elevated Antibodies to N-type Calcium Channel

2019 ◽  
pp. 308-311
Author(s):  
Peter Novak
Keyword(s):  
Calcium Channel ◽  
Clinical Significance ◽  
Small Fiber Neuropathy ◽  
Cerebral Hypoperfusion ◽  
Autonomic Testing ◽  
Small Fiber

Autonomic testing revealed severe small fiber neuropathy and severe hypocapnic cerebral hypoperfusion (HYCH). Both findings are relevant to patient symptoms. The dysautonomia was mild and of questionable clinical significance.

Case 77: Painful Small Fiber Neuropathy in Posttreatment Lyme Disease Syndrome

2019 ◽  
pp. 390-393
Author(s):  
Peter Novak
Keyword(s):  
Lyme Disease ◽  
Orthostatic Hypotension ◽  
Autonomic Failure ◽  
Small Fiber Neuropathy ◽  
Cerebral Hypoperfusion ◽  
Supine Hypertension ◽  
Autonomic Testing ◽  
Small Fiber ◽  
Immune Globulins ◽  
Sensory Fibers

This case illustrates autonomic failure in painful post-Lyme disease syndrome. Autonomic testing has shown supine hypertension, orthostatic hypotension, and hypocapnic cerebral hypoperfusion (HYCH). Small fiber neuropathy was painful, affecting sensory fibers. Patient noted improvement in the pain by about 40% after 12 month of intravenous immune globulins.

Case 69: Small Fiber Neuropathy, Hypocapnic Cerebral Hypoperfusion, and Generalized Hypermobility Spectrum Disorder

2019 ◽  
pp. 357-360
Author(s):  
Peter Novak
Keyword(s):  
Orthostatic Intolerance ◽  
Small Fiber Neuropathy ◽  
Spectrum Disorder ◽  
Cerebral Hypoperfusion ◽  
Autonomic Testing ◽  
Small Fiber ◽  
Generalized Hypermobility

Autonomic testing showed mixed small fiber neuropathy, which can be responsible for both sensory complaints and dysautonomia. Dysautonomia was generalized, but mild and was associated with mild orthostatic intolerance. The patient has generalized hypermobility spectrum disorder (GHSD).

Case 61: Small Fiber Neuropathy, Patchy, with Elevated Voltage-Gated Potassium Channel Antibodies

2019 ◽  
pp. 324-327
Author(s):  
Peter Novak
Keyword(s):  
Chronic Pain ◽  
Lyme Disease ◽  
Potassium Channel ◽  
Chronic Fatigue ◽  
Small Fiber Neuropathy ◽  
Cerebral Hypoperfusion ◽  
Sensory Threshold ◽  
Voltage Gated ◽  
Small Fiber ◽  
History Of

This patient presents with disabling pain in the feet for several years, chronic fatigue, and a history of Lyme disease. Neuropathy workup revealed autoimmune small fiber neuropathy with patchy distribution, associated with voltage-gated potassium channel antibodies (VGKC) antibodies. VGKCs modulate the nociceptive sensory threshold. Severe hypocapnic hyperventilation in this patient may be related to chronic pain and cerebral hypoperfusion.

Case 41: Atypical Parkinsonism

2019 ◽  
pp. 237-240
Author(s):  
Peter Novak
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Multiple System Atrophy ◽  
Small Fiber Neuropathy ◽  
Cerebral Hypoperfusion ◽  
Vitamin B ◽  
Atypical Parkinsonism ◽  
Small Fiber

The testing for this patient showed minimal dysautonomia, small fiber neuropathy, and orthostatic cerebral hypoperfusion syndrome (OCHOS). Small fiber neuropathy can be due to vitamin B12 deficiency. Mild dysautonomia is not suggestive of Parkinson’s disease or multiple system atrophy.

Case 83: Small Fiber Neuropathy and Preload Failure

2019 ◽  
pp. 419-422
Author(s):  
Peter Novak
Keyword(s):  
Small Fiber Neuropathy ◽  
Cerebral Hypoperfusion ◽  
Small Fiber

Preload failure can be associated with small fiber neuropathy, hypocapnic cerebral hypoperfusion, and dysautonomia.

Case 76: Small Fiber Neuropathy, Hypocapnic Cerebral Hypoperfusion, and Posttreatment Lyme Disease Syndrome

2019 ◽  
pp. 386-389
Author(s):  
Peter Novak
Keyword(s):  
Lyme Disease ◽  
Small Fiber Neuropathy ◽  
Cerebral Hypoperfusion ◽  
Small Fiber

This chapter describes posttreatment Lyme disease syndrome (PLDS) that can be associated with mild adrenergic failure, small fiber neuropathy, and hypocapnic cerebral hypoperfusion during the tilt.

Case 33: Hypocapnic Cerebral Hypoperfusion with Cholinergic Small Fiber Neuropathy

2019 ◽  
pp. 202-205
Author(s):  
Peter Novak
Keyword(s):  
Heart Rate ◽  
Orthostatic Intolerance ◽  
Small Fiber Neuropathy ◽  
Cerebral Hypoperfusion ◽  
Normal Heart ◽  
Small Fiber ◽  
Normal Heart Rate

Patient experienced symptoms of orthostatic intolerance, most likely due to mild cerebral hypoperfusion due to hypocapnic hyperventilation and normal heart rate responses, which is typical for hypocapnic cerebral hypoperfusion (HYCH). In addition, there was significant small fiber cholinergic neuropathy affecting predominantly autonomic fibers, biopsy-proven.

Case 79: Small Fiber Neuropathy and Abnormal Cerebral Blood Flow

2019 ◽  
pp. 399-402
Author(s):  
Peter Novak
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Orthostatic Hypotension ◽  
Flow Velocity ◽  
Blood Flow Velocity ◽  
Cerebral Blood Flow Velocity ◽  
Small Fiber Neuropathy ◽  
Cerebral Hypoperfusion ◽  
Small Fiber ◽  
Receptor Antibodies

This patient exhibited tilt-induced orthostatic hypotension and reduced orthostatic cerebral blood flow velocity due to combined hypocapnic cerebral hypoperfusion (HYCH) and orthostatic cerebral hypoperfusion syndrome (OCHOS). The patient had small fiber neuropathy, and clinical workup revealed elevated acetylcholine receptor antibodies.

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