Mainpoints to consider when evaluating a small fiber
#neuropathy:
1️⃣. Is it likely the result of a self limited process (post-infectious, toxic exposure, transient metabolic derangement etc.)? ➡️ You probably won’t find an etiology and have to mainly manage symptoms.
2️⃣. Is it of a recent onset & with a relatively rapid progression? ➡️ R/o connective tissue disorder, paraneoplastic, autoimmune, amyloid, vitamin deficiency, toxic, metabolic (e.g rapid drop in A1c, hypothyroidism)…❓Empiric treatment trial if no etiology found and significant/rapidly progressive deficit❓
3️⃣. Chronic/slowly progressive: idiopathic vs diabetic are the most common. Mostly symptom management diabetes control. Metabolic syndrome is also a risk factor.
These rules also apply to any peripheral neuropathy but to limit the differential, I mainly address
#small_fiber PN here.