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Patterns of neuropathy and autonomic failure in patients with amyloidosis
Mayo Clinic Proceedings, 11/07/08

WANG AK et al. – Physicians should test for symptoms of generalized autonomic failure in patients who have peripheral neuropathy of unknown origin; early recognition may lead to earlier diagnosis and earlier treatment of the underlying pathogenesis of amyloidosis.

Methods

Study to define the clinical patterns of peripheral neuropathy and autonomic testing abnormalities in pts with amyloidosis
A chart review of 65 pts; were required to have neurologic evaluation, autonomic reflex screening, and tissue confirmation of amyloidosis

Results

5 clinical patterns of peripheral neuropathy were identified:
(i) Generalized autonomic failure and polyneuropathy with pain (62%)
(ii) Generalized autonomic failure and polyneuropathy without pain (17%)
(iii) Isolated generalized autonomic failure (11%)
(iv) Polyneuropathy without generalized autonomic failure (6%)
(v) Generalized autonomic failure and small-fiber neuropathy (5%)
Moderately severe generalized autonomic failure was found in all pts, including those w/o clinically manifested autonomic failure
Diagnosis of amyloidosis was delayed in pts who did not have initial symptoms of pain or generalized autonomic failure

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