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 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 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 50: Small Fiber Neuropathy and Severe Autonomic Failure in Diabetes

2019 ◽  
pp. 279-282
Author(s):  
Peter Novak
Keyword(s):  
Diabetes Mellitus ◽  
Orthostatic Hypotension ◽  
Autonomic Failure ◽  
Small Fiber Neuropathy ◽  
Autonomic Testing ◽  
Small Fiber

This 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 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 55: Small Fiber Neuropathy with Autonomic Failure

2019 ◽  
pp. 298-302
Author(s):  
Peter Novak
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Orthostatic Hypotension ◽  
Flow Velocity ◽  
Blood Flow Velocity ◽  
Cerebral Blood Flow Velocity ◽  
Autonomic Failure ◽  
Small Fiber Neuropathy ◽  
Small Fiber ◽  
Adrenergic Fibers

This case demonstrates severe autonomic failure with orthostatic hypotension affecting cardiovagal and sympathetic adrenergic fibers and associated with small fiber neuropathy. Small fiber neuropathy is severe, mixed, and affecting sensory and autonomic fibers, non–length-dependent. Orthostatic cerebral blood flow velocity was reduced throughout the tilt, indicative of autoregulation failure.

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 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.

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 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.

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