Selective Fiber Degeneration in the Peripheral Nerve of a Patient With Severe Complex Regional Pain Syndrome.

摘要: Aims: Complex regional pain syndrome (CRPS) is characterized by chronic debilitating disproportional to the inciting event and accompanied motor, sensory, autonomic disturbances. The pathophysiology of CRPS remains elusive. An exceptional case severe leading forearm amputation provided opportunity examine nerve histopathological features peripheral nerves. Methods: A 35-year-old female developed secondary low voltage electrical injury. was refractory medical therapy led functional loss forelimb, repeated cutaneous wound infections hospitalization. Specifically, patient had exhausted a targeted conservative management programme prior amputation. Radial, median, ulnar specimens were obtained from amputated limb analyzed light transmission electron microscopy (TEM). Results: All samples showed selective myelinated fiber degeneration (47-58% fibers) on microscopy. Degenerating fibers significantly larger than healthy (p < 0.05), corresponded Aα (motor/proprioception) whilst smaller Aδ (pain/temperature) spared. Groups small unmyelinated C (Remak bundles) also evidence in all samples. Conclusions: We are first show large using TEM. Degeneration may lead an imbalance signaling, inappropriately triggering fibers, which transmit temperature. These findings suggest play key role CRPS. Improved knowledge pathogenesis will help develop more treatments.