Sensory Changes

Large-fiber and small-fiber neuropathies can often be distinguished clinically by whether they affect proprioception and vibration or pain and temperature. Because processes that affect small fibers cause pain and sensory changes, symptoms may include reduced sensitivity to stimuli (hypoesthesia) or burning and tingling sensations (dysesthesias and paresthesias, respectively). There may also be impaired pain or temperature sensation and autonomic dysfunction. When large fibers are damaged, vibratory sense and proprioception are affected. This can lead to unsteady gait, complaints of coolness in the extremities, or allodynia, in which non-noxious stimuli such as light touch are perceived as pain. In polyneu-ropathies, pain and sensation are commonly affected in a stocking-glove distribution.

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