Case 75: Small Fiber Neuropathy, Cerebral Autoregulatory Failure, and Posttreatment Lyme Disease Syndrome

2019 ◽  
pp. 382-385
Author(s):  
Peter Novak
Keyword(s):  
Lyme Disease ◽  
Small Fiber Neuropathy ◽  
Autonomic Testing ◽  
Small Fiber ◽  
History Of

This patient has a history of Lyme disease with persistent cognitive and sensory symptoms, and he may have posttreatment Lyme disease syndrome (PLDS). The autonomic testing showed small fiber neuropathy and cerebral autoregulatory failure.

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 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 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 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.

Small fiber neuropathy following vaccination for rabies, varicella or Lyme disease

Vaccine ◽  
2009 ◽  
Vol 27 (52) ◽  
pp. 7322-7325 ◽  
Author(s):  
Nizar Souayah ◽  
Senda Ajroud-Driss ◽  
Howard W. Sander ◽  
Thomas H. Brannagan ◽  
Arthur P. Hays ◽  
...  
Keyword(s):  
Lyme Disease ◽  
Small Fiber Neuropathy ◽  
Small Fiber

Case 74: Small Fiber Neuropathy and Lyme Disease

2019 ◽  
pp. 378-381
Author(s):  
Peter Novak
Keyword(s):  
Lyme Disease ◽  
Small Fiber Neuropathy ◽  
Small Fiber

Dizziness, numbness, and pain can be associated with small fiber neuropathy and hypocapnic hyperventilation. Lyme disease can be the underlying cause.

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 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 99: Mixed Tilt Patterns in Rheumatoid Arthritis

2019 ◽  
pp. 497-501
Author(s):  
Peter Novak
Keyword(s):  
Rheumatoid Arthritis ◽  
Orthostatic Hypotension ◽  
Small Fiber Neuropathy ◽  
Volume Depletion ◽  
Autonomic Testing ◽  
Small Fiber ◽  
Initial Orthostatic Hypotension

Autonomic testing may reveal combined initial orthostatic hypotension and orthostatic hypotension due to a combination of volume depletion and adrenergic failure, presyncope with prominent vasodepressor component, and small fiber neuropathy.

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.

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