A Case of Acute Autonomic and Sensory Neuropathy Accompanied by Respiratory Failure

Acute autonomic and sensory neuropathy (AASN) is a rare neuropathy characterized by the acute onset of autonomic dysfunction and objective sensory disturbances. A 33-year-old woman experienced generalized fatigue, urinary retention, and defecation difficulty with numbness around her mouth followed by a decreased pain sensation over her face and whole body, and respiratory difficulty with aspiration pneumonia. Neurological examination revealed bilaterally dilated fixed pupils, loss of sweating and lacrimation, orthostatic hypotension, and decreased sensation of all modalities with transient mild to moderate motor weaknesses. The muscle weakness may have been responsible for her respiratory failure as her respiratory distress was resolved in conjunction with improved general muscle power. Although the pathogenetic mechanism of AASN has been generally believed to be immune-mediated, the absence of immunoglobulin responsiveness and the negative results to various autoantibody tests in our case, raises questions against its autoimmune etiology. The patient showed slow progress of overcoming her autonomic dysfunction with relatively persistent sensory deficits.

T-reflex Changes in Asymptomatic Diabetics

BACKGROUND: The loss or depression of ankle jerk has been considered one of the earliest physical findings of diabetic polyneuropathy, even in asymptomatic cases. Therefore, the electronic ankle T-reflex test (ATR) could be a sensitive, objective test for the early detection of polyneuropathy among diabetics. METHOD: In order to verify the sensitivity and usefulness of the ATR, the ankle jerk and ATR were studied in 99 legs of 50 patients with diabetes who did not have any symptoms related to neuropathy or peripheral vascular disease at the time of the study. A sensory nerve conduction study (SNCS) of sural and superficial peroneal nerves was also performed and the results were compared with the ATR. RESULTS: The ATR response was abnormal in 42.4% of the legs tested and was more sensitive than the sural SNCS (18.2%) or superficial peroneal SNCS (30.3%) in revealing subclinical abnormalities. Our results confirm that ATR abnormalities in asymptomatic diabetics are more frequent than conventional SNCS abnormalities and are a reliable indicator of peripheral nerve dysfunction in diabetic patients. CONCLUSIONS: The ATR seems to be a sensitive test in detecting subclinical abnormalities in diabetics and would be useful especially in early or equivocal cases of