Premium
Aquadynia. a manifestation of small fiber sensory neuropathy?
Author(s) -
Brindani F,
Gemignani F,
Zinno L,
Marbini A
Publication year - 2004
Publication title -
journal of the peripheral nervous system
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1
H-Index - 67
eISSN - 1529-8027
pISSN - 1085-9489
DOI - 10.1111/j.1085-9489.2004.009209av.x
Subject(s) - medicine , allodynia , electroneuronography , sensation , neurological examination , context (archaeology) , sensory system , polyneuropathy , anesthesia , surgery , physical medicine and rehabilitation , nociception , electromyography , psychology , neuroscience , hyperalgesia , paleontology , receptor , biology
Aquadynia is a rare phenomenon of water‐induced pain through presumed neural mechanisms. We describe two women in whom bathing was regularly followed by pain in the lower limbs, as a unique symptom (case 1) and, respectively, in the clinical context of an axonal polyneuropathy (case 2). Case 1: A 71‐year‐old woman complained, by age 69, of pruritus and pinprick‐like pain in the extremities that lasted about 20 minutes following bathing. Neurological examination and electroneurography were negative, as well as investigations for systemic diseases. Quantitative sensory testing (QST) showed abnormal cold‐pain sensation. Treatment with gabapentin was not effective. Case 2: A 69‐year‐old woman affected with HCV‐related cryoglobulinemia had numbness and aquadynia in the distal lower limbs and restless legs syndrome, in the last few months. Neurological examination showed absent ankle jerks, and decreased touch and vibration sense in the feet. Electroneurography demonstrated an axonal neuropathy. Aquadynia likely represents a manifestation of small fiber neuropathy. It is unclear whether it has to be viewed as a primary sensory phenomenon similar to allodynia, or a type of noradrenergic pain primarily due to autonomic dysfunction. Alteration of QST in case 1, and the association with obvious features of sensory neuropathy in case 2, may favour the sensory hypothesis.