Small‐nerve‐fiber pathology in critical illness documented by serial skin biopsies |
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| Authors: | Miroslav Skorna MD Roman Kopacik MD Eva Vlckova MD PhD Blanka Adamova MD PhD Milena Kostalova PhD Josef Bednarik MD PhD |
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| Institution: | 1. Department of Neurology, University Hospital Brno, Czech Republic;2. Central European Institute of Technology, Masaryk University, Brno, Czech Republic |
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| Abstract: | Introduction: Small‐fiber pathology can develop in the acute phase of critical illness and may explain chronic sensory impairment and pain in critical care survivors. Methods: Eleven adult ischemic stroke patients in a neurocritical care unit were enrolled in an observational cohort study. Intraepidermal nerve fiber density (IENFD) in the distal leg was assessed on admission to the intensive care unit and 10–14 days later, together with electrophysiological testing. Results: Of the 11 patients recruited, 9 (82%) had sepsis or multiple‐organ failure. Median IENFD on admission (5.05 fibers/mm) decreased significantly to 2.18 fibers/mm (P < 0.001), and abnormal IENFD was found in 6 patients (54.5%). Electrodiagnostic signs of large‐fiber neuropathy and/or myopathy were found in 6 patients (54.5%), and autonomic dysfunction was found in 2 patients (18.2%). Conclusion: Serial IENFD measurements confirmed the development of small‐fiber sensory involvement in the acute phase of critical illness. Muscle Nerve 52 : 28–33, 2015 |
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| Keywords: | critical illness small fibers polyneuropathy myopathy skin biopsy |
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