Presentation
When present, autonomic disturbances manifest as hypohydrosis. [avensonline.org]
Multiple scars and superficial erosions were present over the legs and dorsa of both hands [Figure 3] and [Figure 4]. The skin over palms and soles was mildly hyperkeratotic. Her hairs and nails were normal and no joint deformities were present. [ijpd.in]
Sequencing of MFN2 should be considered in all patients presenting with late-onset HSAN. [ncbi.nlm.nih.gov]
Oral manifestations may be the presenting complaint. Thus, it is important for the clinicians to be familiar with the condition. The present article provides a brief review of the condition and its insinuation in dentistry. [indianjpain.org]
Deep nontender ulcer of 3´3cm size with hyperkeratotic edges was present on the plantar aspect of right sole at the base of second toe and great toe. [e-ijd.org]
Entire Body System
- Difficulty Walking
Muscle weakness can cause weak ankles and eventually progress to difficulty walking (gait disturbances). Some older affected individuals (e.g. those in their 60s or 70s) may eventually require a wheelchair. [rarediseases.org]
Loss of sensation in the feet and legs, which usually begins in adolescence or early adulthood in people with HSAN IE and worsens over time, can cause difficulty walking. [ghr.nlm.nih.gov]
walking, and foot deformity are important indicators of a potential inherited neuropathy. [annalsofian.org]
- Localized Pain
[…] on palpation of the anteromedial (or posteromedial) area of tibial crest No pain during activity or exercise 2 Pain after activity or exercise No pain during activity or exercise 3 Pain during activity or exercise Pain after activity or exercise 4 Pain [medical-dictionary.thefreedictionary.com]
- Intermittent Claudication
claudication chronic compartment syndrome; CCS; chronic exertional compartment syndrome exercise-induced fascial compartment pain; caused by compromised circulation and relative ischaemia of intracompartmental tissues, with long-term muscle and nerve [medical-dictionary.thefreedictionary.com]
- Acute Intermittent Porphyria
Nerve pathology demonstrates loss of both small myelinated and unmyelinated fibers. [7] Acute intermittent porphyria and variegate porphyria Acute intermittent porphyria and variegate porphyria can both have forms of peripheral neuropathy. [emedicine.medscape.com]
Cardiovascular
- Orthostatic Hypotension
Postural orthostatic tachycardia syndrome: the Mayo clinic experience. Mayo Clin Proc. 2007 Mar. 82(3):308-13. [Medline]. Freeman R. Current pharmacologic treatment for orthostatic hypotension. Clin Auton Res. 2008 Mar. 18 Suppl 1:14-8. [Medline]. [emedicine.medscape.com]
In the cardiovascular system, postural hypotension, orthostatic hypotension and syncopal episodes are common. Dehydration azotemia and progressive loss of renal function occur. [ijaweb.org]
The individual with familial dysautonomia commonly experiences orthostatic hypotension without a compensatory tachycardia, as well as episodic and supine hypertension [ 22, 27 ]. [ojrd.biomedcentral.com]
In these disorders, a variety of autonomic symptoms may be present, although certainly the most dramatic and incapacitating is orthostatic hypotension, which causes postural light- headedness, syncope, or both. [clevelandclinicmeded.com]
Severe autonomic dysfunctions occur: alacrymia (loss of tear secretion), dysphagia, hypothermia, orthostatic hypotension, loss of fungiform papillas on tongue. [tankonyvtar.hu]
- Palpitations
A somatic neuropathy is often coexistent. [15] Postural orthostatic tachycardia syndrome: Postural orthostatic tachycardia syndrome (POTS) is a syndrome most common in young females with orthostatic intolerance characterized by palpitations with excessive [emedicine.medscape.com]
Skin
- Flushing
[…] complaints are: (motor symptoms) atrophy of calf muscles, pain, muscle cramps, weakness in foot dorsiflexion, foot jams during walk, frequent falls, hand weakness, dropping objects; (sensory), “gloves”, “stocking-like” numbness, sensory loss, (vegetative), flushing [tankonyvtar.hu]
Musculoskeletal
- Muscle Weakness
Muscle weakness and muscle wasting can occur in some affected individuals, although these findings are highly variable and usually occur after the sensory symptoms. In rare cases, muscle weakness in the hands and feet can be the initial sign of HSN. [rarediseases.org]
Affected individuals may also experience muscle wasting and weakness as they get older. Weakness in the ankle muscles can make walking difficult. [icdlist.com]
Variable distal muscle weakness and wasting, and chronic skin ulcers are characteristic. Autonomic features (usually sweating disturbances) are invariably observed. [orpha.net]
Charcot-Marie-Tooth neuropathy type 1 (CMT1) is a demyelinating peripheral neuropathy characterized by distal muscle weakness and atrophy, sensory loss, and slow nerve conduction velocity. [bcbst.com]
The degree of motor involvement varies, even within families, and can include tingling sensations, muscle weakness, wasting of foot extensors, and gait issues. Open sores and ulcerations of the feet may occur. [medicalbag.com]
Eyes
- Blurred Vision
They may experience a sharp drop in blood pressure upon standing (orthostatic hypotension), which can cause dizziness, blurred vision, or fainting. [en.wikipedia.org]
Psychiatrical
- Suggestibility
Our findings suggest that mutation in exon 21 of DNMT1 may also produce a HSAN phenotype. [ncbi.nlm.nih.gov]
Some patients may show features suggesting upper neuron involvement. {ECO:0000269 PubMed:21194679}. Note=The disease is caused by mutations affecting the gene represented in this entry. [genecards.org]
Hereditary sensory neuropathy type 1D (HSN ID) Further genetic heterogeneity has been suggested in HSN I [ 19, 34, 35 ]. [ojrd.biomedcentral.com]
X-ray of left upper tibia was suggestive of old malunited fracture with abundant callus formation [Figure 4]. CT scan of left knee joint was suggestive of neuropathic joint disease. MRI scanning of spine showed no evidence of syringomyelia. [e-ijd.org]
In addition, there was a history suggestive of absence of sweating since the child was 4 months old. Even during the episodes of fever, the child used to have no sweating. [ijpd.in]
Urogenital
- Sexual Dysfunction
Sexual dysfunction and abnormally low blood pressure also can occur. [webmd.com]
Neurologic
- Seizure
Some people with HSAN IE also experience recurrent seizures (epilepsy) and sleep problems. The severity of the signs and symptoms of HSAN IE and their age of onset are variable, even among affected members of the same family. [ghr.nlm.nih.gov]
There was no history of feeding problems or seizures in the child. There was no significant family or drug history. The patient was born at full term by normal vaginal delivery, with uneventful antenatal, intranatal, and postnatal periods. [ijpd.in]
Thus the concept has been proposed that the crisis may represent a type of autonomic seizure and that nausea may be the aura [ 52 ]. [ojrd.biomedcentral.com]
In childhood central nervous system signs (attention deficit disorder, hyperactivity and spasticity, blindness, deafness, seizures) and adrenal insufficiency occur. [tankonyvtar.hu]
[…] dizziness, nausea, sedation Topiramate 25-400 mg Sedation, weight loss, nephrolithiasis, myopia, angle closure glaucoma Miscellaneous Mexiletine 150-750 mg Dyspepsia, dizziness, tremor, arrhythmia Tramadol 50-400 mg Dizziness, nausea, constipation, seizures [clevelandclinicmeded.com]
- Motor Symptoms
During an attack, abdominal pain, vomiting begins and subacute motor symptoms (tetraparesis) and vegetative symptoms (tachycardia, hypertension, postural hypotension) develop. [tankonyvtar.hu]
Patients had distal sensory loss usually without foot ulcerations but adult onset of gastro-oesophageal reflux and cough and no motor symptoms. Cough could be triggered by noxious odours and could lead to syncope. [ojrd.biomedcentral.com]
[…] nerves; characterized by vasomotor instability, hyperalgesia and impaired motor function; diagnosed from clinical presentation, symptoms reduction on administration of sympathetic nerve blockade, and intense, focal periarticular uptake of contrast medium [medical-dictionary.thefreedictionary.com]
- Convulsions
[…] characterized by anhidrosis, i.e. absent or markedly decreased sweating. [10], [11], [12], [13] It is the anhidrosis that causes episodic fevers and extreme hyperpyrexia that is usually the earliest sign of the disorder and can cause recurrent febrile convulsions [ijpd.in]
It is the anhidrosis that causes episodic fevers and extreme hyperpyrexia that is usually the earliest sign of the disorder and can cause recurrent febrile convulsions secondary to high environmental temperature [ 1, 12 ]. [ojrd.biomedcentral.com]
- Limb Weakness
Introduction: Hereditary Sensory Autonomic Neuropathy Type 1 (HSAN1) is a severe, autosomal dominant, axonal neuropathy that manifests with marked, small fiber predominant sensory loss, variable degrees of limb weakness, and skin ulceration. [deaterfoundation.org]
In advanced stages, individuals may need powered mobility because of hand/upper limb weakness. Promote strengthening and use of proximal muscle in exercise and recreation. [now.aapmr.org]
Workup
Given these findings, along with prior negative workup, a neurology consult was obtained, and the patient was diagnosed with HSAN. The blisters were unroofed, and local wound care resulted in ultimate improvement of these lesions ( Figure 2 ). [avensonline.org]
Treatment
Because affected individuals cannot feel the pain of these sores, they may not seek immediate treatment. [icdlist.com]
The supportive treatment is generally provided by a multidisciplinary team including neurologists, orthopedic surgeons, physical and occupational therapists; with treatment choices limited to physical therapy, the use of orthotics, surgical treatment [bcbst.com]
(Outcomes/Resolutions) The prognosis of Hereditary Sensory Neuropathy Type II is good with appropriate treatment. It is important to note that early diagnosis and treatment of any injury or wound may help avoid severe complications. [dovemed.com]
Walsh, along with a multi-disciplinary team of contributors guide you through the sweeping developments in diagnosis and treatment of the mother fetus, and neonate. [books.google.com]
The material is in no way intended to replace professional medical care by a qualified specialist and should not be used as a basis for diagnosis or treatment. [orpha.net]
Prognosis
Correct clinical assessment and genetic confirmation of the diagnosis are important for appropriate genetic counselling and prognosis. [orpha.net]
Parents should talk to their own or their children’s physician and medical team about their specific case, associated symptoms and overall prognosis. [rarediseases.org]
[…] reported the following features 9 : acro-osteolysis within the first year of life (100%) limb fractures with prominent periosteal reaction and exuberant callus (100%) osteomyelitis (50%) brain volume loss with mild ventriculomegaly (50%) Treatment and prognosis [radiopaedia.org]
What is the Prognosis of Hereditary Sensory Neuropathy Type II? (Outcomes/Resolutions) The prognosis of Hereditary Sensory Neuropathy Type II is good with appropriate treatment. [dovemed.com]
Prognosis If patients with HSN I receive appropriate counselling and treatment, the prognosis is good. Early treatment of foot infections may avoid serious complications. Also the complications are manageable, allowing an acceptable quality of life. [ojrd.biomedcentral.com]
Etiology
Etiology HSN I is a genetically heterogenous condition with three loci and mutations in two genes ( SPTLC1 and RAB7 ) identified so far. Diagnostic methods Diagnosis is based on the clinical observation and is supported by a family history. [orpha.net]
The etiology and pathogenesis of CIP depends on the specific type of HSAN. For example: HSAN2D (channelopathy-associated congenital insensitivity to pain) : patients have homozygous mutations in the SCN9A gene 4,7. [radiopaedia.org]
With a systematic approach to the evaluation of these disorders, approximately 75% of patients have a specific etiologic diagnosis. [clevelandclinicmeded.com]
Several demyelinating etiologies can produce a “Dejerine-Sottas” phenotype with early onset, palpable nerves, and marked onion-bulb formation. [now.aapmr.org]
(Etiology) The cause of Hereditary Sensory Neuropathy Type II is a recessive mutation in either the WNK1 gene on chromosome 12 (A), the FAM134B gene on chromosome 5 (B), the KIF1A gene on chromosome 2 (C), or in the SCN9A gene on chromosome 2 (D). [dovemed.com]
Epidemiology
Summary Epidemiology The exact prevalence is unknown, but is estimated as very low. Clinical description Disease onset varies between the 2nd and 5th decade of life. [orpha.net]
Relevant External Links for ATL1 Genetic Association Database (GAD) ATL1 Human Genome Epidemiology (HuGE) Navigator ATL1 Atlas of Genetics and Cytogenetics in Oncology and Haematology: ATL1 No data available for Genatlas for ATL1 Gene Mutations in the [genecards.org]
Several epidemiological studies were completed, the prevalence was found between 10.8/100.000 (Japan) and 40/100.000 (USA) (usually 1:2500-5000). [tankonyvtar.hu]
Epidemiology Hereditary sensory neuropathy type I (HSN I) constitutes a clinically and genetically heterogenous group of disorders of low prevalence. No detailed epidemiological data are currently available. [ojrd.biomedcentral.com]
Epidemiology including risk factors and primary prevention HMSN is the most common inherited neuromuscular disease with overall prevalence of approximately 1/2500 and incidence 15/100,000 in the general population. [now.aapmr.org]
Pathophysiology
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test Inherited peripheral neuropathies are a relatively common diverse group of disorders with heterogeneous genetic causes. [mayomedicallaboratories.com]
Pathophysiology The pathophysiology of autonomic neuropathies is variable and depends upon the underlying medical conditions. We have chosen to classify the autonomic neuropathies into hereditary and acquired. [emedicine.medscape.com]
Back to Top Pathophysiology and Natural History Despite the diverse array of medical disorders that cause peripheral neuropathies, peripheral nerves exhibit only a few distinct pathologic reactions to an insult or disease: wallerian degeneration, axonal [clevelandclinicmeded.com]
„New insights into the pathophysiology of pes cavus in Charcot-Marie-Tooth disease type 1A duplication.” J Neurol, 2011;258: 1594-602. Berciano J, Sevilla T, Casasnovas C, Sivera R, Vílchez JJ, Infante J, Ramón C, Pelayo-Negro AL, Illa I. [tankonyvtar.hu]
Prevention
Currently, there are no specific methods or guidelines for the prevention of Hereditary Sensory Neuropathy Type II, since it is a genetic condition Genetic testing of the expecting parents (and related family members) and prenatal diagnosis (molecular [dovemed.com]
Prevention of secondary complications: Regular dental examinations and restriction of sweets to prevent dental caries; early treatment of dental caries and periodontal disease to prevent osteomyelitis of the mandible. [en.wikipedia.org]
After treatment of ulcers, prevention of recurrent fool ulcers with comfortable shoes is most important. [3] We report here two brothers, one 17 years and another 14 years old, who started developing callosities at age of 9-10 years and later developed [ijdvl.com]
Management focuses on lifestyle and education interventions with an aim of preventing further injuries, and in quickly identifying and treating injuries if they do occur 1, 6,7. Promoted articles (advertising) [radiopaedia.org]
The prevention of HNPP manifestations can be accomplished by wearing protective padding (e.g., elbow or knee pads) to prevent trauma to nerves during activity. [bcbst.com]