My primer for the peripheral neuropathies Neurologists love to use the small and large fiber dichotomy --> this needs to be clarified. See my notes --> defines types of fibers Large fiber disease - Motor --> A alpha fibres --> motor weakness +/- atrophy (if 1° axonal or demyelinating with 2° axonal changes) Sensory - disease of type Ib and II fibers Positive phenomena --> 1. Tingling 2. Cotton wool Negative phenomena --> 1. Numbness 2. Sensory ataxia 3. Pseudoathetosis 4. Washbasin phenomenon 5. Rombergism 6. 'Shower is a Romberg machine' Reflexes - A alpha (efferent) and 1a (afferent) limbs of stretch reflex --> loss of tonic reflexes leads to hypotonia and loss of phasic reflexes leads to areflexia Autonomic - none Small fiber disease - Motor - none Sensory - disease of A delta and C fibers --> positive phenomena is burning and negative phenomena includes numbness Reflexes - preserved Autonomic - disease of type B and type C fibers - both positive and negative sensory phenomena Dictum from Dr Archith Boloor - Large fiber neuropathy is the neuropathy of signs. Small fiber neuropathy is the neuropathy of symptoms. #MedTwitter #NeuroTwitter #Peripheralneuropathies