• Miroslav Skorna, Roman Kopacik, Eva Vlckova, Blanka Adamova, Milena Kostalova, and Josef Bednarik.
• Department of Neurology, University Hospital Brno, Brno, Czech Republic.
• Muscle Nerve. 2015 Jul 1;52(1):28-33.

IntroductionSmall-fiber pathology can develop in the acute phase of critical illness and may explain chronic sensory impairment and pain in critical care survivors.MethodsEleven adult ischemic stroke patients in a neurocritical care unit were enrolled in an observational cohort study. Intraepidermal nerve fiber density (IENFD) in the distal leg was assessed on admission to the intensive care unit and 10-14 days later, together with electrophysiological testing.ResultsOf the 11 patients recruited, 9 (82%) had sepsis or multiple-organ failure. Median IENFD on admission (5.05 fibers/mm) decreased significantly to 2.18 fibers/mm (P < 0.001), and abnormal IENFD was found in 6 patients (54.5%). Electrodiagnostic signs of large-fiber neuropathy and/or myopathy were found in 6 patients (54.5%), and autonomic dysfunction was found in 2 patients (18.2%).ConclusionSerial IENFD measurements confirmed the development of small-fiber sensory involvement in the acute phase of critical illness.© 2014 Wiley Periodicals, Inc.

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