Department of Neurology and Neurophysiology, University Hospital of North Norway, 9038 Tromsø, Norway.
Clin Neurophysiol. 2013 May;124(5):1019-24. doi: 10.1016/j.clinph.2012.11.002. Epub 2012 Dec 7.
To report follow-up data in the evaluation of peripheral neuropathy in a 29-year old female after accidental deep hypothermia (13.7°C) in 1999.
Nerve conduction studies (NCS) and electromyography (EMG) were performed 20 days after the accident and again after 5 months and 1, 3, 5 and 11 years. Macro EMG was performed after 3, 5 and 11 years. To evaluate small fiber function, RR-interval, sympathetic skin response, quantitative sensory testing and skin biopsy for quantification of intra-epidermal nerve fiber density were performed in 2009.
In the intensive care unit sensory and motor responses were absent except for the tibial nerves, and EMG showed profuse denervation. Improvement of amplitudes and conduction velocities was seen during the first 5 years. Muscular atrophy of hand muscles persisted. Large fibers were involved more extensively than small fibers.
A severe axonal sensorimotor polyneuropathy developed in the intensive care unit following severe hypothermia. The mechanism was most likely cold injury to peripheral nerves.
The clinical picture and the laboratory findings indicate that even multi-organ dysfunction and, of specific interest in this study, a severe axonal degeneration may come to a good restitution after long time.
报告一名 29 岁女性在 1999 年意外深度低温（13.7°C）后评估周围神经病的随访数据。
事故后 20 天、5 个月后、1 年、3 年、5 年和 11 年分别进行神经传导研究（NCS）和肌电图（EMG）。3 年、5 年和 11 年后进行宏观 EMG。为了评估小纤维功能，在 2009 年进行了 RR 间隔、交感皮肤反应、定量感觉测试和皮肤活检以定量评估表皮内神经纤维密度。
在重症监护室中，除胫神经外，感觉和运动反应均不存在，EMG 显示广泛失神经支配。在最初的 5 年内，振幅和传导速度有所改善。手部肌肉的肌肉萎缩持续存在。大纤维比小纤维受累更广泛。
在严重低温后，重症监护病房中发生了严重的轴索性感觉运动多发性神经病。其机制很可能是周围神经的冷损伤。
临床表现和实验室发现表明，即使是多器官功能障碍，特别是在本研究中，严重的轴索性变性也可能在很长时间后得到很好的恢复。
