title: Small-nerve-fiber pathology in critical illness documented by serial skin biopsies.
abstract: BACKGROUND
  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%).
  
  
  CONCLUSIONS
  Serial IENFD measurements confirmed the development of small-fiber sensory involvement in the acute phase of critical illness.
authors.affiliation: Department of Neurology, University Hospital Brno, Brno, Czech Republic.
authors.forename: Miroslav
authors.initials: M
authors.lastname: Skorna
authors.affiliation: Department of Neurology, University Hospital Brno, Brno, Czech Republic.
authors.forename: Roman
authors.initials: R
authors.lastname: Kopacik
authors.affiliation: Central European Institute of Technology, Masaryk University, Kamenice 5, 62500, Brno, Czech Republic.
authors.forename: Eva
authors.initials: E
authors.lastname: Vlckova
authors.affiliation: Central European Institute of Technology, Masaryk University, Kamenice 5, 62500, Brno, Czech Republic.
authors.forename: Blanka
authors.initials: B
authors.lastname: Adamova
authors.affiliation: Central European Institute of Technology, Masaryk University, Kamenice 5, 62500, Brno, Czech Republic.
authors.forename: Milena
authors.initials: M
authors.lastname: Kostalova
authors.affiliation: Central European Institute of Technology, Masaryk University, Kamenice 5, 62500, Brno, Czech Republic.
authors.forename: Josef
authors.initials: J
authors.lastname: Bednarik
mesh_terms: D000368:Aged; D001706:Biopsy / Q000379:methods*; D016638:Critical Illness; D004576:Electromyography; D004916:Erythromelalgia / Q000175:diagnosis* / Q000503:physiopathology*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009431:Neural Conduction / Q000502:physiology; D009460:Neurologic Examination; D012867:Skin / Q000473:pathology*
keywords: critical illness; myopathy; polyneuropathy; skin biopsy; small fibers