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A Morphometric Study

Mark J. Brown, MD; John R. Martin, MD; Arthur K. Asbury, MD

Arch Neurol. 1976;33(3):164-171.

Abstract
• We investigated three diabetic patients whose neuropathy was characterized by pain, hypesthesia, and autonomic dysfunction, with preservation of epicritic sensation and muscle-stretch reflexes. Two sural nerves were studied qualitatively and quantitatively, using teased fiber, light, and electron microscopical techniques. The most striking alterations were encountered in unmyelinated and small myelinated fibers. Unmyelinated nerve fiber sprouting was evident. The clinical features, which suggested small-fiber involvement, correlated with the pathological findings in biopsied cutaneous nerve. The balance of evidence indicates that the painful small-fiber neuropathy of diabetes is an axonal disorder.

Author Affiliations
From the Neurology Research Laboratory, San Francisco Veterans Administration Hospital, and the Department of Neurology, University of California, San Francisco. Drs Brown and Asbury are now with the Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia. Dr Martin is presently with the Department of Pathology, College of Physicians and Surgeons, Columbia University, New York.

Footnotes
Accepted for publication March 5, 1975.

Read in part before the annual meeting of the American Association of Neuropathologists, Boston, June 9, 1974.

Reprint requests to Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104 (Dr Brown).

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