Ischemic monomelic neuropathy
| Ischemic monomelic neuropathy | |
|---|---|
| Other names | IMN |
| Specialty | Cardiology/neurology |
Ischemic monomelic neuropathy (IMN) is an uncommon vascular access complication in hemodialysis patients that manifests as multiple mononeuropathies without clinical ischemia.[1] Ischemic monomelic neuropathy is most likely to affect patients who have had brachiocephalic vascular grafts, and it is characterized by symptoms of acute pain, numbness, and paresthesia in addition to motor weakness.[2] The term "ischemic monomelic neuropathy" was first used in 1983 by Wilbourn, despite the fact that Bolton et al. had originally reported on it in 1979.[3]
Signs and symptoms
[edit]Neurologic symptoms predominate and typically appear right away, even in the absence of a substantial clinical ischemia of the hand. All three of the forearm nerves can cause pain, paresthesias, numbness, and diffuse motor weakness or paralysis as symptoms. These deficiencies are frequently more pronounced distally and less severe proximally. In addition to frequently having a palpable radial pulse or audible Doppler signal, the hand is typically warm.[4]
Causes
[edit]Ischemic monomelic neuropathy is a complication of arteriovenous fistula access for hemodialysis.[4]
Patients with diabetes and women are more likely to experience ischemic monomelic neuropathy.[5][6]
Mechanism
[edit]The precise workings of IMN remain largely unknown. Since the access surgery "steals" blood flow from distal nerve tissue, multiple axonal loss mononeuropathies are caused distally in the limb, IMN is a type of steal phenomenon.[7]
Diagnosis
[edit]This illness is diagnosed clinically. It should be connected to peripheral artery disease and peripheral neuropathy with underlying artery manipulation. Electro-diagnostic studies can help with diagnosis when the results of the clinical neurologic examination are unclear. The diagnosis can be verified with nerve conduction studies and electromyography. Axonal loss, low amplitude or absent responses to sensory and motor nerve stimulation, and comparatively preserved conduction velocities are commonly observed in the electromyogram.[7]
Vascular steal, neurologic consequences of axillary block anesthesia or patient positioning, carpal tunnel syndrome or other peripheral nerve compression, postoperative pain and functional deficit due to surgical trauma or venous hypertension, and postoperative swelling are all included in the differential diagnosis of IMN.[8]
Treatment
[edit]Immediate ischaemia correction by fistula/graft ligation or narrowing placation to lower the blood flow in the shunt is the advised treatment for IMN.[9]
See also
[edit]References
[edit]- ^ Datta, Sorabh; Mahal, Shanan; Govindarajan, Raghav (July 22, 2019). "Ischemic Monomelic Neuropathy after Arteriovenous Fistula Surgery: Clinical Features, Electrodiagnostic Findings, and Treatment". Cureus. 11 (7). Cureus, Inc.: e5191. doi:10.7759/cureus.5191. ISSN 2168-8184. PMC 6758992. PMID 31565598.
- ^ Miles, A (February 1, 1999). "Vascular steal syndrome and ischaemic monomelic neuropathy: two variants of upper limb ischaemia after haemodialysis vascular access surgery". Nephrology Dialysis Transplantation. 14 (2). Oxford University Press (OUP): 297–300. doi:10.1093/ndt/14.2.297. ISSN 1460-2385. PMID 10069179.
- ^ Wilbourn, Asa J.; Furlan, Anthony J.; Hulley, William; Ruschhaupt, William (1983). "Ischemic rnonornelic neuropathy". Neurology. 33 (4): 447–451. doi:10.1212/WNL.33.4.447. ISSN 0028-3878. PMID 6300732. S2CID 32441009.
- ^ a b Sheetal, S; Byju, P; Manoj, P (2017). "Ischemic monomelic neuropathy". Journal of Postgraduate Medicine. 63 (1). Medknow: 42–43. doi:10.4103/0022-3859.194221. ISSN 0022-3859. PMC 5394817. PMID 27853044.
- ^ Ramdon, Andre; Breyre, Amelia; Kalapatapu, Venkat (2017). "A Case of Acute Ischemic Monomelic Neuropathy and Review of the Literature". Annals of Vascular Surgery. 42. Elsevier BV: 301.e1–301.e5. doi:10.1016/j.avsg.2016.11.019. ISSN 0890-5096. PMID 28341506.
- ^ Redfern, Anne B.; Zimmerman, Neal B. (1995). "Neurologic and ischemic complications of upper extremity vascular access for dialysis". The Journal of Hand Surgery. 20 (2). Elsevier BV: 199–204. doi:10.1016/s0363-5023(05)80007-3. ISSN 0363-5023. PMID 7775751.
- ^ a b Thimmisetty, Ravi K.; Pedavally, Swetha; Rossi, Noreen F.; Fernandes, J. Americo M.; Fixley, Joleen (2017). "Ischemic Monomelic Neuropathy: Diagnosis, Pathophysiology, and Management". Kidney International Reports. 2 (1). Elsevier BV: 76–79. doi:10.1016/j.ekir.2016.08.013. ISSN 2468-0249. PMC 5678663. PMID 29142943.
- ^ Miles, Anne Marie (2000). "Upper Limb Ischemia After Vascular Access Surgery: Differential Diagnosis and Management". Seminars in Dialysis. 13 (5). Wiley: 312–315. doi:10.1046/j.1525-139x.2000.00082.x. ISSN 0894-0959. PMID 11014693. S2CID 12959362.
- ^ Awais, M.; Nicholas, J.; Al-Saleh, A.; Dyer, J. (March 13, 2012). "Ischaemic monomelic neuropathy (IMN) following vascular access surgery for haemodialysis: an under-recognized complication in non-diabetics". Clinical Kidney Journal. 5 (2). Oxford University Press (OUP): 140–142. doi:10.1093/ckj/sfs017. ISSN 2048-8505. PMC 5783217. PMID 29497516.
Further reading
[edit]- Sheetal, S; Remadevi, SAthira Vijayan; Mathew, AshnaSara; George, AlnaMerin (2022). "Ischemic monomelic neuropathy". Current Medical Issues. 20 (4). Medknow: 257. doi:10.4103/cmi.cmi_39_22. ISSN 0973-4651.
- Greason, Kevin L.; Murray, Jay D.; Hemp, James R.; Hatter, Douglas G.; Riffenburgh, Robert H. (1998). "Ischemic Monomelic Neuropathy A Case Report and Literature Review". Vascular Surgery. 32 (4): 385–390. doi:10.1177/153857449803200420. ISSN 0042-2835. S2CID 71688168.