Extremely Painful Multifocal Acquired Predominant Axonal Sensorimotor Neuropathy of the Upper Limb. (21st November 2017)

• Record Type: Journal Article
• 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
• Is Part Of: Journal of ultrasound in medicine. Volume 37:Number 6(2018)
• Page Start: 1565
• Page End: 1574
• Publication Date: 2017-11-21
• Subjects: brachial plexus -- high‐frequency imaging -- inflammatory neuropathy -- Lewis‐Sumner syndrome -- musculoskeletal -- neuralgic amyotrophy -- neuromuscular ultrasound -- neurosonology (adult) -- peripheral nerve -- treatment; Ultrasonics in medicine -- Periodicals; Ultrasonics; Ultrasonography; Ultrasonics in medicine; Electronic journals; Periodicals; Periodicals; 616.07543
• DOI: 10.1002/jum.14492
• Languages: English
• ISSNs: 0278-4297

Abstract

Abstract : 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.