Die neuropathologische Untersuchung von Hautbiopsien bei Patient*innen nach Fume Event bei Verdacht auf eine Small-Fiber-Neuropathie

Neuropathological examination of skin biopsies in patients after a fume event for suspected small fiber neuropathy

by Kristina Gudrun Decker née Hierold
Doctoral thesis
Date of Examination:2024-05-14
Date of issue:2024-04-29
Advisor:Prof. Dr. Christine Stadelmann-Nessler
Referee:Prof. Dr. Christine Stadelmann-Nessler
Referee:Prof. Dr. Astrid Heutelbeck
Persistent Address: http://dx.doi.org/10.53846/goediss-10473

 

 

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Abstract

English

Small-Fiber-Neuropathy (SFN) is a disease of the thinly myelinated A-delta and unmyelinated C-fibers. This results in a reduction of the intraepidermal nerve fiber density. Affected patients predominantly report acral pain with a burning component, dys- or paraesthesia. In this dissertation, the intraepidermal fiber density of patients with suspected SFN was determined using a three-millimeter punch biopsy. The skin biopsy was taken ten centimeters above the lateral malleolus, stained immunohistochemically and the intraepidermal nerve fibers quantified microscopically. Gender, age and intraepidermal nerve fiber density of three patient cohorts were compared: 1) patients who were exposed to a fume event and subsequently experienced health complaints and consulted a doctor, 2) patients with neurological symptoms who were not exposed to a fume event, and 3) patients with known chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). The results show that a reduced fiber density was found in 31 of 48 patients examined here after a fume event. Morphologically reduced fiber density was found in 64% of women and 65% of men from the cohort with suspected SFN after a fume event. The density of intraepidermal nerve fibers is particularly reduced in patients with known CIDP. The patients in the cohort with suspected SFN after a fume event were significantly younger than the patients in the two comparison cohorts. In summary, the results indicate that fume events may lead to reduced intraepidermal nerve fiber density and thus clinically to SFN. The triggering or protective factors are the subject of current research.
Keywords: Small-Fiber-Neuropathy; Fume Event; intraepidermal nerve fiber density; chronic inflammatory demyelinating polyradiculoneuropathy
Schlagwörter: Small-Fiber-Neuropathie; intraepidermale Nervenfaserdichte; chronisch inflammatorisch demyelinisierende Polyradikuloneuropathie
 
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