Small nerve fiber pathology in critical illness.

<h4>Background</h4>Degeneration of intraepidermal nerve fibers (IENF) is a hallmark of small fiber neuropathy of different etiology, whose clinical picture is dominated by neuropathic pain. It is unknown if critical illness can affect IENF.<h4>Methods</h4>We enrolled 14 adult...

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Autores principales:	Nicola Latronico, Massimiliano Filosto, Nazzareno Fagoni, Laura Gheza, Bruno Guarneri, Alice Todeschini, Raffaella Lombardi, Alessandro Padovani, Giuseppe Lauria
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2013
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/7632c70c57e4455ab358dbaffd937cde
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spelling	oai:doaj.org-article:7632c70c57e4455ab358dbaffd937cde2021-11-18T08:53:12ZSmall nerve fiber pathology in critical illness.1932-620310.1371/journal.pone.0075696https://doaj.org/article/7632c70c57e4455ab358dbaffd937cde2013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24098716/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Degeneration of intraepidermal nerve fibers (IENF) is a hallmark of small fiber neuropathy of different etiology, whose clinical picture is dominated by neuropathic pain. It is unknown if critical illness can affect IENF.<h4>Methods</h4>We enrolled 14 adult neurocritical care patients with prolonged intensive care unit (ICU) stay and artificial ventilation (≥ 3 days), and no previous history or risk factors for neuromuscular disease. All patients underwent neurological examination including evaluation of consciousness, sensory functions, muscle strength, nerve conduction study and needle electromyography, autonomic dysfunction using the finger wrinkling test, and skin biopsy for quantification of IENF and sweat gland innervation density during ICU stay and at follow-up visit. Development of infection, sepsis and multiple organ failure was recorded throughout the ICU stay.<h4>Results</h4>Of the 14 patients recruited, 13 (93%) had infections, sepsis or multiple organ failure. All had severe and non-length dependent loss of IENF. Sweat gland innervation was reduced in all except one patient. Of the 7 patients available for follow-up visit, three complained of diffuse sensory loss and burning pain, and another three showed clinical dysautonomia.<h4>Conclusions</h4>Small fiber pathology can develop in the acute phase of critical illness and may explain chronic sensory impairment and pain in neurocritical care survivors. Its impact on long term disability warrants further studies involving also non-neurologic critical care patients.Nicola LatronicoMassimiliano FilostoNazzareno FagoniLaura GhezaBruno GuarneriAlice TodeschiniRaffaella LombardiAlessandro PadovaniGiuseppe LauriaPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 8, Iss 9, p e75696 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Nicola Latronico Massimiliano Filosto Nazzareno Fagoni Laura Gheza Bruno Guarneri Alice Todeschini Raffaella Lombardi Alessandro Padovani Giuseppe Lauria Small nerve fiber pathology in critical illness.
description	<h4>Background</h4>Degeneration of intraepidermal nerve fibers (IENF) is a hallmark of small fiber neuropathy of different etiology, whose clinical picture is dominated by neuropathic pain. It is unknown if critical illness can affect IENF.<h4>Methods</h4>We enrolled 14 adult neurocritical care patients with prolonged intensive care unit (ICU) stay and artificial ventilation (≥ 3 days), and no previous history or risk factors for neuromuscular disease. All patients underwent neurological examination including evaluation of consciousness, sensory functions, muscle strength, nerve conduction study and needle electromyography, autonomic dysfunction using the finger wrinkling test, and skin biopsy for quantification of IENF and sweat gland innervation density during ICU stay and at follow-up visit. Development of infection, sepsis and multiple organ failure was recorded throughout the ICU stay.<h4>Results</h4>Of the 14 patients recruited, 13 (93%) had infections, sepsis or multiple organ failure. All had severe and non-length dependent loss of IENF. Sweat gland innervation was reduced in all except one patient. Of the 7 patients available for follow-up visit, three complained of diffuse sensory loss and burning pain, and another three showed clinical dysautonomia.<h4>Conclusions</h4>Small fiber pathology can develop in the acute phase of critical illness and may explain chronic sensory impairment and pain in neurocritical care survivors. Its impact on long term disability warrants further studies involving also non-neurologic critical care patients.
format	article
author	Nicola Latronico Massimiliano Filosto Nazzareno Fagoni Laura Gheza Bruno Guarneri Alice Todeschini Raffaella Lombardi Alessandro Padovani Giuseppe Lauria
author_facet	Nicola Latronico Massimiliano Filosto Nazzareno Fagoni Laura Gheza Bruno Guarneri Alice Todeschini Raffaella Lombardi Alessandro Padovani Giuseppe Lauria
author_sort	Nicola Latronico
title	Small nerve fiber pathology in critical illness.
title_short	Small nerve fiber pathology in critical illness.
title_full	Small nerve fiber pathology in critical illness.
title_fullStr	Small nerve fiber pathology in critical illness.
title_full_unstemmed	Small nerve fiber pathology in critical illness.
title_sort	small nerve fiber pathology in critical illness.
publisher	Public Library of Science (PLoS)
publishDate	2013
url	https://doaj.org/article/7632c70c57e4455ab358dbaffd937cde
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Small nerve fiber pathology in critical illness.

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