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See Table H-5.

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H-5 Hereditary Sensory and Autonomic Neuropathies (HSAN)
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At a Glance

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Genetic neurodegenerative disorder characterized by a loss of sensations, especially in the lower extremities, leading to perforating skin ulceration and bone destruction as a result of abnormal functioning of the autonomic nervous system.

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Synonyms

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Acrodystrophic Neuropathy; Burning Feet Syndrome; Denny-Brown Syndrome I; Hereditary Sensory Neuropathy type I (HSN I); Hereditary Sensory Radicular Neuropathy; Hick Syndrome; Lumbosacral Syringomyelia; Mutilating Acropathy; Sensory Radicular Neuropathy, type I; Smith-Thévenard Syndrome; Thévenard Disease II; Thévenard Syndrome; Ulcerative and Mutilating Acropathy.

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History

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First reported by Auguste Nélaton, a French physician and surgeon, in 1852.

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Genetic Inheritance

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Autosomal dominant, chromosome 9q22.

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Pathophysiology

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Shorter lifespan of ganglion cells in sacral and lumbar dorsal root ganglia.

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Diagnosis

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Ganglia biopsy showing loss of neuronal cells with sometimes amyloid deposits, mainly around the capillaries. At the beginning, Meissner corpuscles count in skin biopsies are normal. With disease progression, loss of these sensory corpuscles occurs. Sometimes associated with brain atrophy.

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Clinical Aspects

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Onset is between 15 and 40 years of age. Loss of sensitivity in the feet, with painless ulcers, occurs first, followed by shooting pain and lightning pain in the lower legs. Ulcers require years to heal. There is thermal sensory loss of the lower extremities, often extending to the thigh, sometimes thermal loss in the hands, and restless legs and burning sensations in the feet. Shortly thereafter, the patient complains of bilateral neurosensory deafness. Normal sweating. The other cranial nerves are not involved. Normal ocular motility, normal pupils and pupillary reactions, no nystagmus. Disappearance of ankle jerks and knee jerks. Secondary Charcot-type neurotrophic arthropathy and mutilating acropathy. Upper extremities seldom affected. No motor involvement. Deafness is a common feature of the syndrome.

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Precautions before Anesthesia

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Usually patients present with painless cutaneous ulcers for orthopedic procedures. For medicolegal reasons, it is advisable to obtain a neurologic evaluation before and after the procedure. Search for signs of autonomic dysfunction before induction.

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Anesthetic Considerations

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General anesthesia is often preferred, even though regional anesthesia cannot be ...

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