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Mononeuropatías , Vasculitis Reumatoide , Cardiomiopatía de Takotsubo , Humanos , Cardiomiopatía de Takotsubo/diagnóstico , Cardiomiopatía de Takotsubo/complicaciones , Cardiomiopatía de Takotsubo/fisiopatología , Femenino , Mononeuropatías/diagnóstico , Mononeuropatías/etiología , Mononeuropatías/tratamiento farmacológico , Vasculitis Reumatoide/diagnóstico , Vasculitis Reumatoide/tratamiento farmacológico , Resultado del Tratamiento , Índice de Severidad de la Enfermedad , Anciano , Persona de Mediana Edad , Electrocardiografía , Antirreumáticos/uso terapéuticoRESUMEN
The expert consensus is aimed to develop an algorithm for the diagnosis and treatment of mononeuropathies for outpatient neurologists. Leading experts in the field of neurology have suggested workup options for certain types of tunnel mononeuropathies based on current data on the effectiveness and safety of various types of conservative and surgical treatment.
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Algoritmos , Humanos , Consenso , Mononeuropatías/diagnóstico , Mononeuropatías/terapia , Síndrome del Túnel Carpiano/diagnóstico , Síndrome del Túnel Carpiano/terapia , Síndrome del Túnel Carpiano/cirugíaAsunto(s)
Mononeuropatías , Factor de Necrosis Tumoral alfa , Humanos , Mononeuropatías/inducido químicamente , Mononeuropatías/diagnóstico , Mononeuropatías/tratamiento farmacológico , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Femenino , Resultado del Tratamiento , Antirreumáticos/efectos adversos , Lupus Eritematoso Sistémico/inducido químicamente , Lupus Eritematoso Sistémico/diagnóstico , Lupus Eritematoso Sistémico/tratamiento farmacológico , Piel/patología , Piel/efectos de los fármacos , Persona de Mediana Edad , Vasculitis/inducido químicamente , Vasculitis/diagnóstico , AdultoRESUMEN
Neuropathic pain in the upper extremity is a serious problem, commonly involving relatively young patients. The pain causes loss of function and productivity, changes a patient's lifestyle and can progress into a chronic pain syndrome with secondary psychosocial co-morbidities. Treating patients with a painful mononeuropathy remains challenging, with a monodisciplinary approach often having limited treatment efficacy. This narrative review discusses how to deal with this challenge in the treatment of patients with peripheral nerve injury pain, addressing the four important pillars: (1) diagnosing a painful mononeuropathy; (2) clinical pain phenotyping; (3) personalized pain treatment; and (4) using a multidisciplinary team approach.
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Mononeuropatías , Neuralgia , Grupo de Atención al Paciente , Extremidad Superior , Humanos , Mononeuropatías/terapia , Mononeuropatías/diagnóstico , Neuralgia/terapia , Neuralgia/diagnóstico , Manejo del Dolor/métodos , Dimensión del DolorRESUMEN
Membranous nephropathy has been associated with demyelinating polyneuropathies and antiglomerular membrane disease; however, an association with vasculitic neuropathy has not been described. This case describes a patient with biopsy-proven idiopathic membranous nephropathy and synchronous mononeuritis multiplex secondary to idiopathic small vessel vasculitis, who presented with lower limb microvascular ischaemia, peripheral neuropathy and active urinary sediment. Her extensive non-invasive screening for immunological disease and radiological investigations for occult malignancy were unremarkable. The patient received intravenous methylprednisolone and intravenous rituximab induction therapy resulting in complete remission of both the idiopathic membranous nephropathy and small vessel vasculitis at 7 months post treatment.
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Glomerulonefritis Membranosa , Mononeuropatías , Neoplasias Primarias Desconocidas , Enfermedades Vasculares Periféricas , Vasculitis , Femenino , Humanos , Glomerulonefritis Membranosa/complicaciones , Glomerulonefritis Membranosa/diagnóstico , Glomerulonefritis Membranosa/tratamiento farmacológico , Vasculitis/complicaciones , Vasculitis/diagnóstico , Vasculitis/tratamiento farmacológico , Mononeuropatías/diagnóstico , Mononeuropatías/tratamiento farmacológico , Mononeuropatías/etiología , Administración IntravenosaRESUMEN
AIMS: To report an exceptional case of nerve infiltration by an otherwise benign chronic B cell leukemia, inducing severe mononeuritis multiplex. METHODS: The patient underwent extensive evaluation, including nerve conduction study and myography, brain and plexus MRI, and nerve biopsy. RESULTS: The clinical and electrophysiological diagnosis was a mononeuritis multiplex with severe motor and sensory involvement; only the nerve biopsy allowed definite diagnosis and introduction of chemotherapy, leading to resolution of sensory deficit and progressive motor improvement. DISCUSSION: Neuroleukemiosis caused by chronic lymphoid leukemia is an exceptional diagnosis. The presence of other possible causes like cryoglobulinemia could induce avoidance of nerve biopsy thus undertreating patient, since steroid treatment is not expected to be efficient on lymphocytic proliferation. Our case stretches the importance of nerve biopsy and raises neuromuscular specialist's awareness of this rare entity.
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Leucemia Linfocítica Crónica de Células B , Mononeuropatías , Humanos , Leucemia Linfocítica Crónica de Células B/complicaciones , Mononeuropatías/diagnóstico , Mononeuropatías/etiología , Mononeuropatías/tratamiento farmacológico , Imagen por Resonancia Magnética , Biopsia/efectos adversos , Estudios de Conducción NerviosaRESUMEN
Neuroleukemiosis describes peripheral nerve involvement secondary to leukemic infiltration, a rare complication of leukemia with various clinical presentations, leading to diagnostic challenges for hematologists and neurologists. We present two cases of painless progressive mononeuritis multiplex secondary to neuroleukemiosis. A literature review of previously reported cases of neuroleukemiosis was undertaken. Neuroleukemiosis may present as a progressive mononeuritis multiplex. The diagnosis of neuroleukemiosis requires a high index of suspicion and be aided by repeated CSF analysis.
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Leucemia Mieloide Aguda , Mononeuropatías , Humanos , Mononeuropatías/complicaciones , Mononeuropatías/diagnóstico , Nervios Periféricos , Infiltración Leucémica/complicaciones , Leucemia Mieloide Aguda/complicacionesRESUMEN
This study characterised the hemidiaphragm elevation on 3-month interval chest X-rays (CXRs) of patients post COVID-19 pneumonia. 467 CXRs were screened; 19 (4.1%) had an elevated hemidiaphragm. There were 15 (3.2%) patients of interest with new hemidiaphragm elevation, persisting on average 7 months post COVID-19 diagnosis. Symptomatic patients underwent diaphragm ultrasound (n=12), pulmonary function test (n=10), muscle function test (n=6) and neurophysiology (n=5), investigating phrenic nerve function. Ultrasound demonstrated reduced/paradoxical diaphragmatic movements in eight; four of eight had reduced thickening fraction. Neurophysiology peripheral limb studies did not support the differential diagnoses of critical illness neuropathy/myopathy. We propose that, in selected patients, COVID-19 may cause phrenic nerve mononeuritis.
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COVID-19 , Mononeuropatías , COVID-19/complicaciones , Prueba de COVID-19 , Diafragma , Humanos , Mononeuropatías/diagnóstico , Mononeuropatías/etiología , Nervio Frénico/fisiologíaRESUMEN
Carpal tunnel syndrome, ulnar neuropathy at the elbow, and peroneal neuropathy are the most common mononeuropathies; however, other individual nerves may also be injured by various processes. These uncommon mononeuropathies may be less readily diagnosed owing to unfamiliarity with the presentations and vague symptoms. Electrodiagnostic studies are essential in the evaluation of uncommon mononeuropathies and can assist in localization and prognostication. However, they can also be challenging; stimulation at the proximal sites is difficult and well-validated reference values are not available. This article reviews the electrodiagnostic assessment of several uncommon upper and lower extremities mononeuropathies.
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Electrodiagnóstico , Mononeuropatías , Humanos , Extremidad Inferior , Mononeuropatías/diagnósticoRESUMEN
OBJECTIVES: COVID-19 is a novel coronavirus that emerged in 2019 and is responsible for a global pandemic. Numerous neurologic manifestations have been described in the literature regarding COVID-19, but most studies are focused on the central nervous system. The authors have noted an association between prior COVID-19 infection and the development of a systemic neuropathy that manifests with asymmetric sensorimotor loss in the peripheral nervous system. We describe 4 cases of mononeuropathy multiplex that were diagnosed after COVID-19 infection. METHODS: All patients included were treated for severe COVID-19 infection at New York Presbyterian Hospital and subsequently referred to the Columbia Peripheral Neuropathy Center for persistent neuropathy. RESULTS: Patient history, COVID-19 disease course, and mononeuropathy multiplex diagnostic evaluation of the 4 patients are recounted. CONCLUSIONS: We postulate a connection between COVID-19 and the development of mononeuropathy multiplex with implications in prognostication, rehabilitation strategies, and future treatments.
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COVID-19/complicaciones , Mononeuropatías/etiología , Anciano , Diabetes Mellitus Tipo 2/complicaciones , Electrodiagnóstico , Electromiografía , Femenino , Humanos , Hipertensión , Masculino , Persona de Mediana Edad , Mononeuropatías/diagnóstico , Conducción Nerviosa , Examen Neurológico , Síndrome de Dificultad Respiratoria/etiología , Síndrome de Dificultad Respiratoria/terapia , Estudios RetrospectivosRESUMEN
INTRODUCTION: Turns-amplitude, number of small segments (NSS)-activity, and envelope-activity clouds are three methods of electromyography (EMG) interference pattern analysis. Our objective was to evaluate the sensitivity and specificity of each individual cloud analysis and combined clouds analysis to compare with that of quantitative motor unit potential (QMUP) analysis. METHODS: A total of 379 muscles from 100 patients were analyzed by both QMUP and clouds analyses. Calculation of sensitivity and specificity was based on the clinical diagnosis as the "gold standard." RESULTS: For discrimination of abnormal vs normal and neuropathic vs non-neuropathic, combined clouds analysis had greater sensitivity than QMUP analysis and any single cloud analysis, but there were no differences in specificity. For discrimination of myopathic vs non-myopathic, combined clouds analysis and single cloud analysis had greater sensitivity than QMUP analysis, but there were no differences in specificity. DISCUSSION: Combined clouds analysis was superior to QMUP and each single cloud analysis for distinguishing normal, myopathic, and neuropathic muscles.
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Electromiografía/métodos , Enfermedad de la Neurona Motora/diagnóstico , Músculo Esquelético/fisiopatología , Enfermedades Musculares/diagnóstico , Enfermedades del Sistema Nervioso Periférico/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Esclerosis Amiotrófica Lateral/diagnóstico , Esclerosis Amiotrófica Lateral/fisiopatología , Dermatomiositis/diagnóstico , Dermatomiositis/fisiopatología , Diagnóstico Diferencial , Electrodiagnóstico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mononeuropatías/diagnóstico , Mononeuropatías/fisiopatología , Enfermedad de la Neurona Motora/fisiopatología , Atrofia Muscular Espinal/diagnóstico , Atrofia Muscular Espinal/fisiopatología , Enfermedades Musculares/fisiopatología , Distrofias Musculares/diagnóstico , Distrofias Musculares/fisiopatología , Miositis/diagnóstico , Miositis/fisiopatología , Enfermedades del Sistema Nervioso Periférico/fisiopatología , Polineuropatías/diagnóstico , Polineuropatías/fisiopatología , Radiculopatía/diagnóstico , Radiculopatía/fisiopatología , Reclutamiento Neurofisiológico , Sensibilidad y Especificidad , Procesamiento de Señales Asistido por Computador , Atrofias Musculares Espinales de la Infancia/diagnóstico , Atrofias Musculares Espinales de la Infancia/fisiopatología , Adulto JovenRESUMEN
INTRODUCTION: In everyday clinical neurophysiology practice, mononeuropathies are evaluated primarily by traditional electrodiagnostic testing. We sought to assess the additional benefit of neuromuscular ultrasound (US) in this scenario. METHODS: All consecutive mononeuropathies undergoing combined US and electrodiagnostic evaluation over a 23-mo period at a single neurophysiology practice were reviewed. Three independent examiners assessed how often US was: (a) "contributory" - enabling a definite diagnosis not made by electrophysiology alone and/or impacting on the therapeutic decision, (b) "confirmatory" of the electrodiagnostic findings, but not adding further diagnostic or therapeutic information, or (c) "negative" - missed the diagnosis. RESULTS: There were 385 studies included. US was "contributory" in 36%, "confirmatory" in 61% and "negative" in 3%. DISCUSSION: In this study of everyday neurophysiology practice, neuromuscular US contributed significant diagnostic or therapeutic information in over 1/3 of the investigations for common mononeuropathies. False negative US studies were uncommon in this setting.
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Mononeuropatías , Neurofisiología , Ultrasonografía , Electrodiagnóstico/métodos , Electrodiagnóstico/normas , Electromiografía/métodos , Guías como Asunto , Humanos , Mononeuropatías/diagnóstico , Mononeuropatías/fisiopatología , Neurofisiología/normas , Ultrasonografía/métodos , Ultrasonografía/normasRESUMEN
BACKGROUND: Multiple mononeuropathy is a rare presentation of primary (AL) amyloidosis and nerve biopsy is usually needed for diagnosis. Conventional imaging is useful to identify proximal nerve involvement but may be inadequate. We report a patient with multiple mononeuropathy whose presentation was suggestive of AL amyloid neuropathy and in whom repeated tissue biopsies were negative for amyloid (including two sensory nerves and one muscle). METHODS: The patient underwent magnetic resonance imaging (MRI) and whole body 18 F-florbetapir positron emission tomography (PET)/MRI. RESULTS: Whole body 18 F-florbetapir PET/MRI revealed abnormal low-level florbetapir uptake in the right proximal tibial and peroneal nerves, which provided a target for a sciatic bifurcation fascicular nerve biopsy that was diagnostic of AL amyloidosis. CONCLUSIONS: 18 F-florbetapir PET/MRI imaging is a promising diagnostic tool for patients with suspected peripheral nerve amyloidosis (including multiple mononeuropathy) in whom conventional imaging and nerve and muscle biopsies miss the pathology.
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Neuropatías Amiloides/patología , Amiloidosis/patología , Compuestos de Anilina/farmacología , Glicoles de Etileno/farmacología , Mononeuropatías/patología , Neuropatías Amiloides/diagnóstico , Amiloidosis/diagnóstico , Biopsia/métodos , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Mononeuropatías/diagnóstico , Procedimientos Neuroquirúrgicos , Tomografía de Emisión de Positrones/métodosRESUMEN
Lyme neuroborreliosis (LNB) typically presents as a painful radiculitis or a cranial mononeuropathy with lymphocytic meningitis (Bannwarth's syndrome). Isolated peripheral mononeuropathy or multiple mononeuropathy is less frequently recognised. A 58-year-old female with a background of IgA nephropathy and chronic kidney disease presented with a painful left ulnar neuropathy followed within 3 months by superficial radial neuropathy. Initial serum and cerebrospinal fluid (CSF) analysis were unremarkable; nerve conduction study was in keeping with a mononeuritis multiplex. A superficial radial nerve biopsy demonstrated inflammation with axonal injury consistent with a pathologically possible vasculitis. Borrelia antibodies were identified using enzyme-linked immunosorbent assay and immunoblot in serum consistent with active recent Lyme borreliosis. A 6-week course of doxycycline was initiated with gradual resolution of pain and improved power. A repeat nerve conduction study demonstrated improvement in sensory and motor responses. This case report identifies a peripheral nerve syndrome of a mononeuritis multiplex secondary to LNB in the absence of CSF pleocytosis with excellent outcome following antibiotic treatment. Peripheral nervous system manifestations of Lyme borreliosis can mimic a vasculitic neuropathy and therefore should be considered in individuals presenting with a painful mononeuritis multiplex.
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Antibacterianos/uso terapéutico , Doxiciclina/uso terapéutico , Neuroborreliosis de Lyme/complicaciones , Mononeuropatías/diagnóstico , Diagnóstico Diferencial , Inglaterra , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Immunoblotting , Persona de Mediana Edad , Mononeuropatías/tratamiento farmacológico , Mononeuropatías/parasitología , Resultado del TratamientoAsunto(s)
Enfermedades de los Nervios Craneales/diagnóstico , Herpes Zóster/diagnóstico , Mononeuropatías/diagnóstico , Enfermedades del Nervio Abducens/diagnóstico , Enfermedades del Nervio Abducens/tratamiento farmacológico , Enfermedades del Nervio Abducens/fisiopatología , Enfermedades del Nervio Abducens/virología , Anciano , Enfermedades de los Nervios Craneales/tratamiento farmacológico , Enfermedades de los Nervios Craneales/fisiopatología , Enfermedades de los Nervios Craneales/virología , Diagnóstico Diferencial , Diplopía/fisiopatología , Dolor de Oído/fisiopatología , Edema/fisiopatología , Enfermedades del Nervio Facial/diagnóstico , Enfermedades del Nervio Facial/tratamiento farmacológico , Enfermedades del Nervio Facial/fisiopatología , Enfermedades del Nervio Facial/virología , Parálisis Facial/fisiopatología , Enfermedades del Nervio Glosofaríngeo/diagnóstico , Enfermedades del Nervio Glosofaríngeo/tratamiento farmacológico , Enfermedades del Nervio Glosofaríngeo/fisiopatología , Enfermedades del Nervio Glosofaríngeo/virología , Glucocorticoides/uso terapéutico , Pérdida Auditiva Sensorineural/diagnóstico , Pérdida Auditiva Sensorineural/tratamiento farmacológico , Pérdida Auditiva Sensorineural/fisiopatología , Pérdida Auditiva Sensorineural/virología , Herpes Zóster/tratamiento farmacológico , Herpes Zóster/fisiopatología , Humanos , Masculino , Mononeuropatías/tratamiento farmacológico , Mononeuropatías/virología , Osteomielitis/diagnóstico , Otitis Externa/diagnóstico , Prednisolona/uso terapéutico , Base del Cráneo , Enfermedades del Nervio Vago/diagnóstico , Enfermedades del Nervio Vago/tratamiento farmacológico , Enfermedades del Nervio Vago/fisiopatología , Enfermedades del Nervio Vago/virología , Enfermedades del Nervio Vestibulococlear/diagnóstico , Enfermedades del Nervio Vestibulococlear/tratamiento farmacológico , Enfermedades del Nervio Vestibulococlear/fisiopatología , Enfermedades del Nervio Vestibulococlear/virología , Activación ViralRESUMEN
A 40-year-old woman presented with painful ulcerations on the bilateral lower extremities. A biopsy confirmed the diagnosis of livedoid vasculopathy (LV). She was treated initially with aspirin and pentoxifylline, and with the addition of dipyridamole she has had no recurrence of her ulcerations to date. Despite this positive response to treatment she reported numbness and paresthesias in her legs. Nerve conduction studies confirmed a diagnosis of mononeuritis multiplex. This case highlights mononeuritis multiplex as a rarely described complication of LV, and suggests that early recognition of symptoms and a multidisciplinary approach are necessary for optimal management of this condition.
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Mononeuropatías/etiología , Enfermedades Cutáneas Vasculares/complicaciones , Úlcera Cutánea/patología , Piel/patología , Adulto , Biopsia , Femenino , Fibrinolíticos/uso terapéutico , Humanos , Mononeuropatías/diagnóstico , Enfermedades Cutáneas Vasculares/tratamiento farmacológico , Enfermedades Cutáneas Vasculares/patología , Úlcera Cutánea/tratamiento farmacológicoRESUMEN
Despite being common, polyneuropathy remains a diagnostic challenge for most clinicians. Mononeuritis multiplex (MM) refers to involvement of several or many peripheral nerves at the same or different points in time by a disease process. This report describes a case of an atypical presentation of Hansen's disease (HD) as mononeuritis multiplex in the left lower limb with corresponding radiographic, electrodiagnostic, and histopathological data that confirmed pure neuritic leprosy (PNL). We reiterate that although the incidence of PNL is exceedingly low characterized by nerve involvement without the characteristic cutaneous stigmata, leprosy is still the commonest cause of MM in the Indian sub-continent.This report underscores the crucial need for a heightened multi-disciplinary awareness of this "forgotten and uncommon" presentation of PNL. It is imperative that the treating physician should also understand the various neurological presentations, both mimics and chameleons, of this treatable disease to prevent permanent neuropathic injury and disability.
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Lepra , Mononeuropatías , Enfermedades del Sistema Nervioso Periférico , Humanos , Lepra/diagnóstico , Mononeuropatías/diagnóstico , Mononeuropatías/etiología , Nervios Periféricos , PielRESUMEN
INTRODUCTION: Mononeuritis multiplex (MM) is an unusual form of peripheral neuropathy involving at least two noncontiguous peripheral nerve trunks. The pure sensory form of MM occurs rarely. Immunoglobulin (Ig)G subclass deficiency is a clinically and genetically heterogeneous disorder. Up to 50% of adults with selective subnormal IgG1 levels or selective IgG1 deficiency have a concomitant autoimmune disorder. Herein, we report the case of a patient with MM and selective IgG1 deficiency who showed remarkable clinical improvement after 2-year combination therapy with the DPP-4 inhibitor sitagliptin plus vitamin D3. CASE REPORT: A 49-year-old man developed numbness in right hand and forearm. After 6 months, the patient developed left forefoot numbness. Approximately 8 years later, the patient started to develop numbness also in the right forefoot, along with symptoms of evening fatigue and occasional orthostatic hypotension. The patient also reported recurrent candidiasis in glans and intergluteal areas since adolescence. Electromyoneurography of lower and upper limbs revealed the presence of multiple mononeuropathies. Protein electrophoresis showed hypogammaglobulinemia and low serum IgG1 levels. Sural nerve biopsy showed the presence of perineuritis. The patient was diagnosed with MM due to perineuritis probably secondary to IgG1 deficiency. We, then, proposed combination therapy with sitagliptin and vitamin D3 in the attempt to achieve immunomodulation. At the last follow-up visit (2 years), the patient showed persistent clinical improvement, increase in IgG1 levels and normalization of protein electrophoresis. CONCLUSIONS: To the best of our knowledge, this is the first case showing a remarkable clinical improvement of MM and selective IgG1 deficiency achieved through a combination therapy with sitagliptin and vitamin D3.