Extremely Painful Multifocal Acquired Predominant Axonal Sensorimotor Neuropathy of the Upper Limb

The differential diagnosis of upper extremity mononeuritis multiplex includes neuralgic amyotrophy, vasculitic neuropathy, and Lewis‐Sumner syndrome. We describe 3 patients initially suspected of neuralgic amyotrophy, who had an extremely painful, protracted, progressive disease course, not fitting...

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Bibliographic Details
Published in:Journal of ultrasound in medicine 2018-06, Vol.37 (6), p.1565-1574
Main Authors: Lieba‐Samal, Doris, van Eijk, Jeroen J. J., van Rosmalen, Marieke H. J., van Balken, Irene M. F., Verrips, Aad, Mostert, Jop, Pillen, Sigrid, van Alfen, Nens
Format: Article
Language:English
Subjects:
Aged
Autoimmune Diseases of the Nervous System - complications
Autoimmune Diseases of the Nervous System - diagnosis
Autoimmune Diseases of the Nervous System - drug therapy
brachial plexus
Brachial Plexus Neuritis - complications
Brachial Plexus Neuritis - diagnosis
Brachial Plexus Neuritis - drug therapy
Diagnosis, Differential
Electromyography - methods
Glucocorticoids - therapeutic use
high‐frequency imaging
Humans
Immunoglobulins
inflammatory neuropathy
Lewis‐Sumner syndrome
Male
Middle Aged
musculoskeletal
neuralgic amyotrophy
neuromuscular ultrasound
neurosonology (adult)
Pain - etiology
peripheral nerve
Prednisone - therapeutic use
treatment
Ultrasonography - methods
Upper Extremity - diagnostic imaging
Upper Extremity - innervation
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Summary:The differential diagnosis of upper extremity mononeuritis multiplex includes neuralgic amyotrophy, vasculitic neuropathy, and Lewis‐Sumner syndrome. We describe 3 patients initially suspected of neuralgic amyotrophy, who had an extremely painful, protracted, progressive disease course, not fitting one of these established diagnoses. Nerve ultrasonography showed focal caliber changes of the roots, plexus, and limb nerves. Electromyography showed predominant multifocal axonopathy. Ongoing autoimmune neuropathy was suspected. Steroid treatment provided temporary relief, and intravenous immunoglobulin A sustained pain decrease and functional improvement. These patients appear to have extremely painful axonal inflammatory neuropathy, with a good response to immune‐modulating treatment.
ISSN:0278-4297
1550-9613
DOI:10.1002/jum.14492