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 70: Small Fiber Neuropathy and Generalized Hypermobility Spectrum Disorder

2019 ◽  
pp. 361-364
Author(s):  
Peter Novak
Keyword(s):  
Small Fiber Neuropathy ◽  
Spectrum Disorder ◽  
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. The patient has generalized hypermobility spectrum disorder (GHSD).

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 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 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 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 51: Small Fiber Neuropathy and Transient Orthostatic Hypotension in Diabetes

2019 ◽  
pp. 283-286
Author(s):  
Peter Novak
Keyword(s):  
Diabetes Mellitus ◽  
Orthostatic Hypotension ◽  
Autonomic Failure ◽  
Small Fiber Neuropathy ◽  
Autonomic Testing ◽  
Small Fiber

This patient is an example of a typical autonomic failure associated with diabetes mellitus. Autonomic testing showed generalized autonomic failure with orthostatic hypotension and severe small fiber neuropathy affecting both sensory and autonomic fibers.

Case 62: Small Fiber Neuropathy with Symptomatic Improvement on Immune Globulins

2019 ◽  
pp. 328-331
Author(s):  
Peter Novak
Keyword(s):  
Symptomatic Improvement ◽  
Small Fiber Neuropathy ◽  
Fiber Density ◽  
Autonomic Testing ◽  
Small Fiber ◽  
Epidermal Nerve Fiber Density ◽  
Immune Globulins ◽  
Sensory Fibers ◽  
Nerve Fiber Density ◽  
Epidermal Nerve Fiber

Autonomic testing revealed length-dependent small fiber neuropathy affecting sensory fibers. Repeated titer of acetylcholine ganglionic antibody was negative, but repeated epidermal nerve fiber density testing showed progressive deterioration. Symptoms improved with intravenous immune globulin therapy.

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.

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