Axonal degeneration progresses in a distal-to-proximal pattern, initially affecting small myelinated and unmyelinated nerve fibers associated with paresthesia, dysesthesia, and hyperalgesia in the lower extremities.12
As it progresses, large nerve fibers in the lower limbs become involved, at which time muscle atrophy and weakness and difficulty ambulating are observed.11 Upper extremity involvement is also observed with neuropathic progression similar to that observed in the lower extremities.5
Patients also experience unintentional weight loss.11
Autonomic neuropathy may be evident at disease onset or may develop within 1 to 2 years of initial peripheral nerve involvement.11 Autonomic symptoms may include orthostatic hypotension, alternating constipation and diarrhea, and urogenital symptoms, such as erectile dysfunction.5,10
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