[Approach to the diagnosis and therapy of vascular neuropathy]

Peripheral neuropathy is a very common clinical manifestation of vasculitis syndromes which may present as an early sign of such neuropathy or else may be the only such sign as in the case of non-systemic vascular neuropathy. The clinical affectation of the neuropathy depends on the extent and course of the ischaemic changes brought on by vasculitis, with multineuritis being the most usual presenting form of vascular neuropathy. Neurophysiological studies show the extent and severity of the neuropathy and often identify subclinical affectation representing a mixed pattern of affectation with axomal predominance. Nerve biopsy is a prerequisite for diagnosis, noting any infiltration by inflammatory cells and/or necrosis at perivascular and transmural levels together with vessel thrombosis or rechanneling. Using immunofluorescent techniques, immune deposits of IgG, IgM and components may be noted. Vasculitis neuropathy treatment is fundamentally carried out at the expense of corticosteroids and immunosuppressive which may be administered individually or in combination. In vasculitis neuropathy bad prognostic factors would include old age, the presence of kidney disease and delayed diagnosis and treatment.