Small Fiber Neuropathy Symptoms Diagnosis and Treatment
Small fiber neuropathy is really an interestingcondition because it consists typically of just burning, numbness, pain of the feet,sometimes the hands later on without necessarily having any abnormalities on your EMG or nerveconduction study. So what I tell patients and actually residents or students who trainunder us is that a normal nerve conduction study does not exclude a neuropathy. And wewill confirm this by doing additional testing, specifically the nervous the the examinationat the bedside asking patients about their symptoms, for example, loss of sensation tocool or or hot temperatures, loss of pain sensation and also doing skin biopsies wherewe look at nerve densities in the skin both
from the calf and the thigh as well as doinga special test that looks at sweat function both in your foot in in the legs as well asthe feet to gauge the level of small fiber nerve damage. Small fiber neuropathy typicallywill progress unless the underlying cause is identified and reversed. Diabetes of coursebeing the most common cause is always screened for. But once the more common causes are excludedand the focus becomes on excluding any underlying secondary disease process but also controllingpain because if patients' symptoms of pain are generally controlled they tend to do prettywell and really have no other major functional deficits. I've really become interested overthe years is how interconnected neurology
and rheumatology are and one thing I oftendo on patients who have unexplained small fiber even autonomic neuropathy is have themsee rheumatology or get evaluated for connective tissue disorders like lupus or Sjogren's orsarcoid and sometimes even if we are not directly involved in treating the patients, this canbe the first sign of an underlying connective tissue disorder that can then be brought tothe attention of rheumatology and addressed from their standpoint.
What Is Vertigo Why Do We Get It
You might think vertigo is a problem thatpeople have when they're afraid of heights.or are Jimmy Stewart. Nope! Vertigo is all inyour head.specifically, your ears. Hey guys, Lissette here for Dnews. Vertigois one of the four main categories of dizziness it's a subjective experience that makesyou feel like you've lost a sense of your surroundings. But there are some very realcauses behind it in some cases, vertigo can even lead to nausea, vomiting and youreyes to twitch from side to side. There are two types of vertigo: peripheralvertigo and central vertigo. Central vertigo is a neurological problem usually in thebrain stem or cerebellum which can be caused
things like multiple sclerosis, stroke, andtumors. But the most common by far, and what we'll be focusing on here, is peripheralvertigo. Because, as a 2002 study in The British Journal of General Practice reports, at least93% of patients with vertigo, are those with peripheral vertigo.which has a lot to dowith problems in your ears. Your ears are super important for keepingyour balance and navigating the world. They help you orient yourself in it. In your innerear, there are these tiny hairs called stereocilia, that line a pouchlike structure called thesaccule. And interspersed between these hairs, is a sticky goop called glycoprotein thatholds tiny crystals in place. These guys are
made up of calcium carbonate, and move wheneverwe move, which causes them to bang up against the hairs in our ear. When the hairs sensethe crystals moving, they send signals through nerves in our ears to our brain that giveit information about our vertical and horizontal movement essentially, these crystals tellour brains where the heck we're going and help us keep our balance. On top of these nerves, crystals, and hairs,we also have fluid in our ears. Like the crystals, the fluid moves when we move and that'spicked up by our hairs which send information to our brain. Our brain uses the informationcoming from both ears to figure out whether
we're stationary or moving, and how we areoriented! Vertigo occurs when something in this systemgoes wrong. The spinning sensation or dizziness is your brain trying to figure out what theheck is going on. It's getting cues that don't make sense. And a number of differentconditions can cause this. In the cases of vestibular neuritis and labyrinthitis, partsof your ear become inflamed, usually because of a viral or bacterial infection. When oneof your two ears is inflamed particularly the ear's nerves it causes your brainto get imbalanced information so you can end up with vertigo. Meniere's disease, althoughit's not well understood, it's thought
to be caused by too much liquid in your ear,which causes the same dizzying symptoms. And researchers think migraines can cause vertigobecause they cause changes in our vascular and nervous systems, which affect parts ofour ears. Finally, one of the most common causes of vertigo benign paroxysmal positionalvertigo has to do with the crystals. Sometimes these crystals fall out of place possiblydue to a head injury or because the goop that holds them in place in the inner ear becomestoo weak. When they fall off, these crystals can end up in places where they don't belong,like the middle ear, and cause our brain to receive signals that don't make sense toit. They throw everything off!
Luckily, this one can often be fixed by simplyfollowing a set of head movements that move the crystals out of where they don't belong.Invented by John Epley in the 1980's, this noninvasive procedure can be effectivein up to 90% of these vertigo cases. Other causes of vertigo can be treated with medication,although in more extreme cases surgery may be necessary. As nasty as that sounds, some people do undergothese procedures, because vertigo can be horrible. It can last anywhere from hours to monthsat a time and can be debilitating. On top of that, just moments of Vertigo can causea lot of harm. If we lose our balance and