Ghazaei Fatemeh, Sabet Reza, Raissi Gholam Reza
From the Neuromusculoskeletal Research Center, Department of Physical Medicine and Rehabilitation, Iran University of Medical Sciences, Iran (FG, GRR); and Department of Physical Medicine and Rehabilitation, Jahrom University of Medical Sciences, Iran (RS).
Am J Phys Med Rehabil. 2017 Mar;96(3):e44-e47. doi: 10.1097/PHM.0000000000000562.
Vasculitis is a group of disorders characterized by inflammation and destruction of blood vessels, resulting in ischemic injury to the involved tissue. Sometimes, peripheral neuropathy is one of the first symptoms of systemic vasculitis. Although the classic form of peripheral nervous system vasculitis is mononeuritis multiplex, it can also present as a mononeuritis. In this case report, the patient presented with progressive rapid onset numbness in her right hand for 2 months. She underwent carpal tunnel decompression surgery with initial diagnosis of acute carpal tunnel syndrome but failed to respond to the surgery, and two month later, she presented with foot drop. The final diagnosis was vasculitic mononeuritis multiplex. The present case report demonstrates the importance of identification of median mononeuritis as one of the first presentations of vasculitic disorders and distinction from acute carpal tunnel syndrome. The natural history of many of the systemic vasculitides is rapidly progressive, and they are likely to be fatal without early treatment. In this regard, timely diagnosis of vasculitis is critical because of the vital role of early immunosuppressive therapy in preventing multiorgan damage and decreasing mortality rate.
血管炎是一组以血管炎症和破坏为特征的疾病，可导致受累组织发生缺血性损伤。有时，周围神经病变是系统性血管炎的首发症状之一。虽然周围神经系统血管炎的典型形式是多发性单神经炎，但也可表现为单神经炎。在本病例报告中，患者右手出现进行性快速发作的麻木症状达2个月。她最初被诊断为急性腕管综合征并接受了腕管减压手术，但手术无效，两个月后，她出现了足下垂。最终诊断为血管炎性多发性单神经炎。本病例报告表明，识别正中神经单神经炎作为血管炎性疾病的首发表现之一并与急性腕管综合征相鉴别具有重要意义。许多系统性血管炎的自然病程进展迅速，若不早期治疗可能会致命。在这方面，由于早期免疫抑制治疗在预防多器官损害和降低死亡率方面的关键作用，血管炎的及时诊断至关重要。
