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Case-of-the-month: perineuritis presenting as mononeuritis multiplex
Z Simmons1, J W Albers, A A Sima
1Department of Neurology, University of Michigan, Ann Arbor.
Muscle & Nerve
|May 1, 1992
Summary
Perineuritis, inflammation of the nerve sheath, can mimic mononeuritis multiplex. This rare condition, even in diabetic patients, may respond to treatments like prednisone and plasma exchange, suggesting it is a treatable neuropathy.
Area of Science:
- Neurology
- Pathology
Background:
- Perineuritis, inflammation of the nerve sheath, is rarely found without other significant pathological changes.
- Mononeuritis multiplex presents as a clinical picture of multiple individual nerve disorders.
Observation:
- A patient with mild, non-insulin dependent diabetes mellitus presented with symptoms mimicking mononeuritis multiplex.
- Sural nerve biopsy revealed perineuritis but no evidence of occlusive vascular disease.
Findings:
- Focal perineuritis was identified as the cause of the clinical presentation, rather than the patient's diabetes.
- Treatment with prednisone and plasma exchange led to partial improvement in the patient's condition.
Implications:
- This case suggests that perineuritis, even in the context of diabetes, can be the primary cause of neurological symptoms.
- The positive response to treatment indicates that perineuritis may be a distinct and treatable neuropathy, warranting further investigation.