Campero Mario, Campero Sebastián
Facultad de Medicina, Alemana-Universidad del Desarrollo, Chile.
Rev Med Chil. 2012 Nov;140(11):1383-90. doi: 10.4067/S0034-98872012001100002.
Painful polyneuropathy may result from selective impairment of small diameter nerve fibers, while tactile and motor functions are preserved. In these patients clinical and electrophysiological assessment is usually unrevealing. We report three patients with a pure painful polyneuropathy. One of them had neurogenic pruritus additionally. Quantitative sensory analysis disclosed a slight warm hypoesthesia (3/3) and paradoxical hot sensation (2/3) in the feet. Intraneural recordings from the peroneal nerve demonstrated abnormal spontaneous activity in 8 of 17 nociceptive afferents. One of them displayed double firing reflecting impulse multiplication. These results support the notion that patients with pain or pruritus with a distal distribution similar to a polyneuropathy, could have small diameter afferent fiber damage, despite normal function of large diameter fibers.
疼痛性多发性神经病可能源于小直径神经纤维的选择性损伤，而触觉和运动功能则得以保留。在这些患者中，临床和电生理评估通常并无异常发现。我们报告了3例患有单纯疼痛性多发性神经病的患者。其中1例还伴有神经源性瘙痒。定量感觉分析显示足部存在轻微的温热感觉减退（3/3）和反常热感觉（2/3）。腓总神经的神经内记录显示，17条伤害性传入神经中有8条存在异常自发放电。其中1条表现出双发放，反映了冲动倍增。这些结果支持了这样一种观点，即疼痛或瘙痒且分布于远端类似于多发性神经病的患者，尽管大直径纤维功能正常，但可能存在小直径传入纤维损伤。
