Diagnosing PN, neuro exams
 

I am not dx'd with anything yet. My neuro says I show signs of both a CNS and PNS disorder. I'm just wondering if those with PN can have nearly normal neuro exams.

I have a mildly positive Rhomberg, brisk reflexes in lower extremities and reduced in upper, reduced sensation with the pin prick testing, I cannot stand from a kneeling position. And, after kneeling I have severe muscle pain.

Anyway, I just wonder if I had more abnormalities on exam if more testing might be done. I keep having repeated MRI's, but not much else. I had an EMG and nerve conduction testing done a few years ago (for the second time), but this has never been repeated. I've been reading about the skin biopsy and I wonder if this might help lead me to a dx. Although I have a good relationship with my neuro, I am hesitant to bring it up. I've been burned by so many neuros and I don't want go there again. Yet I know something is wrong and I need to advocate for myself. Any suggestions on how to handle this?

Thanks for any help.

One of the distinguishing aspects of small-fiber neuropathy--
 

--that is, nerve dmage to the small, unmyelinated fibers that subsume the sensations of pain and temperature, as well as most autonomic functions, is that most "standard" blood tests will not show a probable cause of it (unless it is diabetic in nature), and current nerve condcution study technology cannot detect it, as these can only grossly measure the function of larger, myelinated nerves.

This is why specialized testing, such as quantitative sensory testing, sudomotor axon reflex testing, or skin biopsy might be in order. Recently, too, a new technique is coming into play--microscopic examination under flourescence of Meisner corpucles.

So, in essence, yes, many with small-fiber neuropathy will shoe as "normal" on standard examination and testing. Marc Triehaft really makes a pointof this in his article about small-fiber neuropathies:

http://www.thecni.org/reviews/13-2-p07-treihaft.htm

Thank you so much for taking the time to respond to my post. The article was very interesting. I'm wondering how many small fiber patients are labeled as idiopathic, fibro patients, or mentally ill? It seems highly possible. Maybe having a diagnosis doesn't really affect the treatment, but it sure does help to put a name to something. And, I'm sure in many cases, depending on what the illness is, there is a treatment available.

I feel as if the small fiber neuropathy is something my neuro and I need to explore. I am curious though, I do seem to have the tingling and numbness as seen in the large fiber neuropathy, would this rule out the small fiber neuropathy? I do get sharp stabbing pains, usually in the sole of my left foot, from time to time. I have the tight, banding feelings too. And, honestly at times I do have severe pain that is hard to describe.

I was reading through the stickies and was directed to the Neurpathy Association and found out that my neuro has a support group for neurpathy!! Imagine that. Now, I feel as if maybe I can approach her with the idea. Luckily, she is easy to talk to.

I'm rambling now. Thanks again for your help.

Shalynn

Well, thre's nothing that says--
 

--you can't have a mixed type; there are plenty of people who have symptoms indicative that both large and small fibers may be affected. When that happens, one usually thinks of metabolic, toxic, or sometimes autoimmune causes.

small fiber & large fiber
 

Hi Shalynn, I was just at the neuro, thurs. and he said I have small and some large fiber neuropathy the way I tested. I am sort of lost, I have idiopathic sensory motor mild pn, possible pre diabetes relationship, Can't it be small and large fiber, really confused? I have burning tingles, sharp paines throughout, have all the symptoms Lynn