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Congenital Autosomal Dominant Indifference to Pain

Congenital Autosomal Dominant Analgesia


Presentation

  • There are few conditions that may be confused with CIPA due to pain insensitivity at initial presentation. The congenital indifference to pain presents with loss of pain sensitivity but without dysautonomic symptoms.[apicareonline.com]
  • The nonunion of the proximal right ulna was left alone, as she did not present with any complaints.[ijoonline.com]
  • Rarely, it also can present with features of impaired immune response, proteinuria, renal failure, anemia, hyperkeratosis, dry skin, and early primary tooth loss.[e-ijd.org]
  • 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]
  • The abnormality in skin growth and hydration called ichthyosis may present with symptoms at birth or in early childhood.[medical-dictionary.thefreedictionary.com]
Anemia
  • Stay current on the developments and research surrounding neonatal anemia from the entirely new chapter on Blood and Hematopoietic System highlights.[books.google.com]
  • 1 2 Diamond-Blackfan Anemia 10 2 Diamond-Blackfan Anemia 11 2 Diamond-Blackfan Anemia 12 2 Diamond-Blackfan Anemia 3 2 Diamond-Blackfan Anemia 4 2 Diamond-Blackfan Anemia 5 2 Diamond-Blackfan Anemia 6 2 Diamond-Blackfan Anemia 7 2 Diamond-Blackfan Anemia[preventiongenetics.com]
  • Rarely, it also can present with features of impaired immune response, proteinuria, renal failure, anemia, hyperkeratosis, dry skin, and early primary tooth loss.[e-ijd.org]
  • Adrenomyodystrophy Orofaciodigital syndrome 3 Stiff person syndrome Myoclonus-dystonia Sialuria, French type Hartnup disease Toriello-Carey syndrome Thompson Baraitser syndrome Periodic fever, aphthous stomatitis, pharyngitis and adenitis Sickle cell anemia[checkrare.com]
  • Avoid with a history of seizures, bleeding disorders, eating disorders (such as anorexia or bulimia), or anemia (low levels of iron). Avoid if pregnant or breastfeeding.[livingnaturally.com]
Episodic Pain
  • pain SCN 11A 3p22 Dominant Congenital Absence of pain Hyperhidrosis; GI Δ None Absent pain, Congenital Recessive Congenital, or Early childhood Absence of pain No anhidrosis Aδ VIII: Absent pain, & temperature Congenital PRDM12 9q33 Recessive Congenital[neuromuscular.wustl.edu]
  • Pain Syndrome, Familial, 2 3 Episodic Pain Syndrome, Familial, 3 3 Epstein Syndrome 3 Erythrocytosis, Familial, 2 1 Erythroderma, Ichthyosiform, Congenital Reticular 1 Erythrokeratodermia Variabilis Et Progressiva 1 Erythropoietic Protoporphyria 3 Escobar[preventiongenetics.com]
Camping
  • Panjabrao Deshmukh Memorial Medical College, Amravati, Maharashtra, India Date of Web Publication 10-Jul-2015 Correspondence Address : Yogeshree R Deshmukh Birthday Hall, 5 Keshav Colony, Camp Road, Amravati - 444 602, Maharashtra India Source of Support[ijpd.in]
Cheilitis
  • Oral cavity showed loss of tip of the tongue, many missing teeth and angular cheilitis [Figure 4]. Sensory examination showed complete loss of pain and temperature sensations, but fine touch and vibration were preserved.[e-ijd.org]
Lichenification
  • Cutaneous examination showed multiple ulcers, loss of teeth, loss of tip of the tongue (due to biting), scarring of finger tips, xerosis and lichenification.[e-ijd.org]
  • Anhidrosis also contributes to the thick and calloused appearance of the skin with lichenification of palms, dystrophic nails, and areas of hypotrichosis on the scalp. [ 4 ] Emotional tearing is normal.[edoj.org.eg]
  • It causes the skin to become thick and callused with lichenification of palms, dystrophic nails, and areas of hypotrichosis on the scalp [ 12, 13, 56, 57 ]. Like FD, HSAN IV is associated with decreased sensation and autonomic dysfunction.[ojrd.biomedcentral.com]
Hypopigmented Macule
  • There were no hypopigmented macules or thickened palpable nerves. Investigations revealed hemoglobin on lower side that is, 9 g/dl.[ijpd.in]
Normal Hair
  • Her milestone development was normal. Hair and nails were normal. On neurological examination, deep tendon reflexes were absent. Her tactile sensation is present but pain and temperature absent.[ijpd.in]
Skin Ulcer
  • All these children have self-inflicted injuries in the form of skin ulcers, burns, bone fractures, auto-amputations of the fingertips, and tongue. [11] However, no joint problem was noted in our patient.[e-ijd.org]
Decreased Lacrimation
  • They present with anhidrosis, decreased lacrimation, tongue ulcerations, recurrent gastrointestinal (GI) upset, diminished or absent deep tendon reflexes, poorly controlled temperature, a fluctuating blood pressure and an absent axon reflex.[ijoonline.com]
Emotional Lability
  • Hyperactivity and emotional lability are common. Medical management is supportive.[ijpd.in]
  • We can also find patients with hyperactivity and emotional lability.[flipper.diff.org]
  • Hyperactivity and emotional lability are common [ 1, 3, 12, 56 ]. Figure 5 Charcot joints are demonstrated in this boy with HSAN IV or congenital insensitivity to pain with anhidrosis (CIPA). The left knee and left ankle are enlarged and distorted.[ojrd.biomedcentral.com]
Peripheral Neuropathy
  • Features of Textbook of Peripheral Neuropathy Include : ̈ Practical yet comprehensiveóan accessible ìgo-toî reference for clinicians ̈ Covers all clinically relevant peripheral neuropathies ̈ Clinical Pearls and Key Points are set off from the text for[books.google.de]
  • Investigations ruled out diabetic neuropathy, metabolic disorder neuropathy and other peripheral neuropathies.[ijpd.in]
  • neuropathy-type IV: case series and review of literature D.[indianjpain.org]
  • Congenital insensitivity to pain is considered a form of peripheral neuropathy because it affects the peripheral nervous system, which connects the brain and spinal cord to muscles and to cells that detect sensations such as touch, smell, and pain.[ghr.nlm.nih.gov]
  • Peripheral Neuropathy. Philadelphia: Saunders; 1993: 1065. 3 Thomas PK. Hereditary sensory neuropathies. Brain Pathol. 1993; 3: 157 163. 4 Brofen C, Bensahel H, Teule JG. Orthopedic aspects of congenital insensitivity to pain.[ams.ac.ir]
Polyneuropathy
  • Reviewing the full spectrum of clinically significant neuropathies, the book contains chapterson common and rare forms including mononeuropathy in the upper and lower extremities, mononeuritismultiplex, diffuse and symmetric polyneuropathies, brachial[books.google.de]
  • Nerve conduction studies were suggestive of motor-sensory (sensory motor) mixed (demylinating axonal) polyneuropathy. Due to nonavailability, molecular DNA study was not done.[ijpd.in]
  • […] imperforate anus Spastic paraplegia 7 Spastic paraplegia 26 Trichodental syndrome Spastic paraplegia 5A Wagner syndrome Spasmodic dysphonia Al Gazali syndrome Paroxysmal exertion-induced dyskinesia KCNQ2-Related Disorders Orofaciodigital syndrome 5 Polyneuropathy[checkrare.com]
  • […] form 2 Polyglucosan Body Myopathy 1 with or without Immunodeficiency 2 Polyglucosan Body Myopathy 2 3 Polymicrogyria With Optic Nerve Hypoplasia 1 Polymicrogyria, Asymmetric 2 Polymicrogyria, Bilateral Frontoparietal 1 Polymorphous Corneal Dystrophy 1 Polyneuropathy[preventiongenetics.com]
Febrile Convulsions
  • It is usually the earliest sign of the disorder and can cause recurrent febrile convulsions secondary to high environmental temperature. [1], [4] Like FD, HSAN IV is associated with decreased sensation and autonomic dysfunction.[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]
Mononeuropathy
  • Reviewing the full spectrum of clinically significant neuropathies, the book contains chapterson common and rare forms including mononeuropathy in the upper and lower extremities, mononeuritismultiplex, diffuse and symmetric polyneuropathies, brachial[books.google.de]
Abnormal Gait
  • Gait 3 Mental Retardation-Hypotonic Facies Syndrome X-Linked, 1 4 Merosin Deficient Congenital Muscular Dystrophy 5 Metachondromatosis 1 Metachromatic Leukodystrophy 2 Metaphyseal Anadysplasia 2 1 Metaphyseal Chondrodysplasia, Jansen Type 1 Metaphyseal[preventiongenetics.com]

Treatment

  • 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 textbookprovides an evidence-based approach to testing, differential diagnosis, and treatment, and should serveas a trusted resource for healthcare professionals confronting the many manifestations of peripheralneuropathy in clinical practice.[books.google.de]
  • All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment.[jamaicahospital.org]
  • […] and prognosis No specific treatment is available for CIP 1,7.[radiopaedia.org]
  • Treatment Self treatment : Most simple boils can be treated at home. Ideally, the treatment should begin as soon as a boil is noticed. Early treatment may prevent later complications.[livingnaturally.com]

Prognosis

  • […] 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]
  • The prognosis for independent function depends on the degree of disease expression and the ability to control the secondary clinical problems. Hereditary sensory and autonomic neuropathy type IV is second most common disorder.[ijpd.in]
  • The prognosis for independent function depends on the degree of disease expression and the ability to control the secondary clinical problems. Prognosis and goals There are a number of hereditary and sensory and autonomic neuropathies (HSAN).[ojrd.biomedcentral.com]
  • Further prognosis will be based on increased understanding of specific gene actions that will lead to definitive therapies. Diagnosis and management of HSAN type V is a great challenge to the oral health care provider.[contempclindent.org]
  • Prognosis This condition requires continuous care throughout a lifetime. Properly treated, in most cases it is a cosmetic problem. There are a small number of lethal forms, such as harlequin fetus.[medical-dictionary.thefreedictionary.com]

Etiology

  • 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]
  • […] upper cervical complex or craniovertebral junction at increased risk. 221 The relationship between Down syndrome and congenital laxity of the transverse portion of the cruciate ligament of C1 is well known, and is generally considered to be the primary etiology[radiologykey.com]

Epidemiology

  • Till date only one epidemiological survey has been conducted on HSAN types IV and V in Japan in which questionnaires reported from 105 institutes were evaluated.[contempclindent.org]
  • Epidemiology HSAN IV is extremely rare among most populations with the exception of the Japanese and Israeli-Bedouins. The prevalence is unknown, but it was seen the disorder is more diffused in cultures in which intermarriage is accepted.[flipper.diff.org]
Sex distribution
Age distribution

Pathophysiology

  • Its pathophysiology has not been established. It seems that patients have a life span close to normal although unnoticed visceral problems are a major concern.[link.springer.com]
  • The molecular pathophysiology of CIPA can provide important clues about the biological processes of pain in our species and insights into the mechanisms that underlie persistent or chronic pain syndromes. 2 In conclusion, we presented novel inherited[journals.lww.com]

Prevention

  • Modified bite guard was given to the patient to prevent further self-mutilating injuries to the tongue.[contempclindent.org]
  • As a measure of prevention of further fractures, we advised her to use preventive splints during any vigorous activity. At 1-year follow-up, the patient was perfectly normal with no signs and symptoms around knee and normal physeal growth.[jocr.co.in]
  • Endorphins are molecules in your body that when released, prevent nerve cells from releasing more pain signals.[thetartan.org]
  • Common practices can be: • prevention of self-mutilation by smoothing or extracting teeth; • prevention of debilitating orthopedic problems by daily evaluation for early signs of unrecognized injury; • prevention of neurotrophic keratitis with tarsorrhaphy[flipper.diff.org]
  • Braces may be required on the ankles to prevent injury to these weight bearing joints. Some children will require smoothing of the teeth or extraction to prevent self-mutilation of the tongue and lips.[ijpd.in]

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