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Utility of Dissociated Intrinsic Hand Muscle Atrophy in the Diagnosis of Amyotrophic Lateral Sclerosis

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Primary amyloidosis presenting as upper limb multiple mononeuropathies.

Jennifer A Tracy¹, Peter J Dyck, P James B Dyck

¹Peripheral Neuropathy Research Laboratory, Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA.

|April 21, 2010

Summary

This summary is machine-generated.

Primary amyloidosis typically causes lower limb neuropathy. This case highlights it can also manifest as progressive upper limb mononeuropathies, expanding diagnostic considerations for this condition.

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Area of Science:

Neurology
Oncology
Pathology

Background:

Primary (AL) amyloidosis commonly presents with peripheral neuropathy, typically affecting lower limbs symmetrically and predominantly small nerve fibers.
This neuropathy is usually length-dependent, impacting sensory and autonomic functions significantly.

Observation:

A unique case of a patient presenting with stepwise progressive, multiple upper limb mononeuropathies is described.
Nerve biopsy confirmed the cause to be primary amyloidosis due to lambda light chain deposition.

Findings:

The patient's presentation deviated from the typical pattern, with no systemic or autonomic involvement observed.
This atypical presentation underscores that primary amyloidosis can manifest as a multiple mononeuropathy.

Implications:

The findings broaden the differential diagnosis for multiple mononeuropathy, particularly in cases without typical systemic signs.
Clinicians should consider light chain amyloidosis in the etiological workup of unusual mononeuropathy patterns.
This case emphasizes the importance of nerve biopsy for accurate diagnosis in complex neuropathic presentations.