What Does My Biopsy Report Indicate?

Posted on Thu, 3 Aug 2017

Question: I recently had a biopsy for small fiber neuropathy. The report and doctor said the results were normal but look at the attached report. My numbers are very very close to the cutoff point.

Answered by Dr. Dr. Erion Spaho (1 hour later)

Brief Answer:
The test findings are considered normal.

Detailed Answer:
Hello and thanks for being on HealthcareMagic.

I had gone through your question and understand your concerns.

I looked at the report of small fibers nerve biopsy too.

Even if the values are close to cut off point, they are within normal ranges, so the test is considered normal.

This test is done to evaluate small fibers neuropathy, However, in about one-third of the patients with clinically suspected neuropathy normal skin biopsy doesn't exclude small fibers neuropathy.

Repeating the biopsy after six months if clinical suspicion may help understanding better your condition.

Hope this helps.

Let me know if I can assist you further.

Kind regards.

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Dr. Erion Spaho (12 minutes later)

hi. I have also attached qsart test. I have talked to you about this before .. what I am having is vestibular migraines facial numbness and I am having pins and needles throughout my body randomly they kind of seem to go along with the dizziness and migraine type symptoms. With the normal qsart would you say it would be very unlikely to have SNF now with this and the negative biopsy or is there still a chance like you're saying with 1/3 of the patients who dont show + ? do you have any other ideas for the cause of my symptoms. I had a EMG nerve conduction study test on my legs and arms they were normal I also had an EEG which was normal too. I have seen a psychologist for psychiatric evaluation and he does not see anxiety or a disorder like that as the cause of my symptoms. the only test that show some abnormalities or is that I am vitamin D deficient and my cd57 level is 60 which is low

Answered by Dr. Dr. Erion Spaho (12 hours later)

Brief Answer:
QSART test is not uploaded.

Detailed Answer:
Welcome back.

The QSART test was not uploaded, so, if you can please upload it or tell me if it was positive or negative.

Awaiting........

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Dr. Erion Spaho (3 hours later)

sorry it's attached now let me know what you think these symptoms are really bothersome like I said it's either being dizzy facial numbness headaches or pins and needles all over my body

Answered by Dr. Dr. Erion Spaho (8 hours later)

Brief Answer:
QSART test results are normal too.

Detailed Answer:
Hello again. I've reviewed it.

The QSART test resulted normal, so autonomic neuropathy is very unlikely by now.

Small fibers neuropathy cannot be excluded entirely by the nerve biopsy, so, if the symptoms persist repeating the test after six months or one year may be necessary.

Regarding your symptoms, other conditions to consider include multiple sclerosis, low vitamin B12.

If these conditions are or will be excluded, anxiety disorder remains the main suspicious condition.

Hope I helped you.

Take care.

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Dr. Erion Spaho (17 hours later)

You mentioned b12 and M.S. With a normal recent brain MRI and a normal B12 blood test, wouldn't both of those be ruled out?

my only abnormal blood tests have been

- low vitamain D
- low cd57

My doctor thinks what I have is a vestibular migraine condition that may also be causing pins and needles and she suggest that I try nortriptyline 10mg along with verapamil 40 mg x 3 times a day, and to use ativan or a medrol pack for cycle breakers.

Answered by Dr. Dr. Erion Spaho (19 hours later)

Brief Answer:
MRI alone is not sufficient to exclude MS.

Detailed Answer:
Hello again.

Only normal MRI of the brain is not sufficient to exclude MS.

Spinal tap about oligoclonal bands and thoracic-cervical spine MRI may be necessary.

Since vitamin B12 was normal, it is not responsible for your symptoms.

Low vitamin D doesn't cause such symptoms, a CD57 imbalance may point towards chronic viral infections.

You could try nortriptyline and Verapamil for migraines if there is an improvement of facial numbness, pins and needles, then vestibular migraine is the culprit.

Hope I helped you so far.

Take care.

Above answer was peer-reviewed by : Dr. Remy Koshy