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A 63-year-old man presents to the clinic for burning pain in both feet, causing discomfort while walking. He also feels as if something is stuck in his shoe at times. He complains of tenderness to palpation of his feet. His deep tendon reflexes are normal. Which of the following is not true regarding the most likely diagnosis?
Explanation
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The given symptoms suggest small fiber neuropathy (myelinated A and unmyelinated C-fibers). Typically, proprioception and light touch are normal.<br><br>There are many causes of small-fiber neuropathy, but diabetes and insulin resistance are the most frequent causes. Other conditions include human immunodeficiency virus, Guillain-Barr syndrome, hepatitis C, complex regional pain syndrome type 1, paraproteinemias, lupus, Sjgren syndrome, amyloidosis, and paraneoplastic syndromes. The diagnosis is frequently made with a skin biopsy, which shows a reduction in the nerve fiber density. Electromyography and nerve conduction studies are normal, as these tests detect large-fiber pathology
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Reference
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Bradleys NiCP, 7th edn,Ch. 30
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Option 1
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Is Correct (Option 1):
The diagnosis is often made on skin biopsy.
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Option 2
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Is Correct (Option 2):
Nerve conduction studies are usually normal.
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Option 3
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Is Correct (Option 3):
Disorders of glucose dysregulation cause the majority of cases.
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Option 4
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Is Correct (Option 4):
Examination usually shows impaired proprioception and light touch.
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