1/
A 42-YO F developed pain & numbness on the dorsum of her left forearm w/ wrist & finger drop over 3 days.
A month later, she developed R foot drop with pain & numbness along the outer surface of her calf.
Not your typical length-dependent sensory neuropathy.
A #ContinuumCase
A 42-YO F developed pain & numbness on the dorsum of her left forearm w/ wrist & finger drop over 3 days.
A month later, she developed R foot drop with pain & numbness along the outer surface of her calf.
Not your typical length-dependent sensory neuropathy.
A #ContinuumCase
2/
I feel that I am becoming an expert on mononeuro(no)pathy multiplex.
We talked last week about Leprosy (Hansen’s) which also caused multiple motor/sensory symptoms with anesthesia:
I feel that I am becoming an expert on mononeuro(no)pathy multiplex.
We talked last week about Leprosy (Hansen’s) which also caused multiple motor/sensory symptoms with anesthesia:
3/
The week before that we discussed sensory neuronopathy 2/2 Sjogrens:
What is different about this case…?
The pain.
This is a red flag🚩🚩🚩🚩🚩!
The week before that we discussed sensory neuronopathy 2/2 Sjogrens:
What is different about this case…?
The pain.
This is a red flag🚩🚩🚩🚩🚩!
4/
I really enjoyed the conversation @AaronLBerkowitz has with the guest editor Kelly Gwathmey on @ContinuumAAN Audio.
She emphasizes that you must think beyond B12, HgbA1c and SPEP with IFE in pts w/
🚩 Rapid progression
🚩Pain
🚩Asymmetry
I really enjoyed the conversation @AaronLBerkowitz has with the guest editor Kelly Gwathmey on @ContinuumAAN Audio.
She emphasizes that you must think beyond B12, HgbA1c and SPEP with IFE in pts w/
🚩 Rapid progression
🚩Pain
🚩Asymmetry
5/
All of these, and particularly pain should really make you think about vasculitis! It hurts when a nerve infarcts!
Broadly its helpful to think of these in 3 buckets:
➡️Primary Systemic vasculitides
➡️Secondary systemic vasculitides
➡️Localized vasculitis
All of these, and particularly pain should really make you think about vasculitis! It hurts when a nerve infarcts!
Broadly its helpful to think of these in 3 buckets:
➡️Primary Systemic vasculitides
➡️Secondary systemic vasculitides
➡️Localized vasculitis
6/
This is a really nice chart from the article.
Right? You’re totally thinking what I’m thinking… there are SO many potential causes of vasculitis!
This is a really nice chart from the article.
Right? You’re totally thinking what I’m thinking… there are SO many potential causes of vasculitis!
7/
In these patients you must do a really thorough review of systems, particularly focusing on renal, joint, and skin pathology.
The presents of myalgias, fevers, weight loss may also be important clues, as are history of malignancy and substance use.
In these patients you must do a really thorough review of systems, particularly focusing on renal, joint, and skin pathology.
The presents of myalgias, fevers, weight loss may also be important clues, as are history of malignancy and substance use.
8/
What to order??
There is a battery of Labs: p-/c-ANCA, ESR, CRP, RF, ANA, dsDNA, anti-SSA/SSB, anti-ccp, cryoglobulins, hep serologies, complement, etc
But a UA is really underrated to look for evidence of systemic pathology with kidney disease.
What to order??
There is a battery of Labs: p-/c-ANCA, ESR, CRP, RF, ANA, dsDNA, anti-SSA/SSB, anti-ccp, cryoglobulins, hep serologies, complement, etc
But a UA is really underrated to look for evidence of systemic pathology with kidney disease.
9/
This patient reports a new diagnosis of adult onset asthma.
Using this nice chart, any guesses on what you might find on lab workup?
This patient reports a new diagnosis of adult onset asthma.
Using this nice chart, any guesses on what you might find on lab workup?
10/
What might be positive?
What might be positive?
11/
For those of you who thought eosinophilia GPA you were correct!!
Adult-onset asthma is diagnosed in the large majority of these patients.
For those of you who thought eosinophilia GPA you were correct!!
Adult-onset asthma is diagnosed in the large majority of these patients.
12/
EMG / NCS are not only important to establish a dx but also help determine where a nerve and muscle biopsy should be done, if needed.
These also serve as a baseline study to compare against after treatment
EMG / NCS are not only important to establish a dx but also help determine where a nerve and muscle biopsy should be done, if needed.
These also serve as a baseline study to compare against after treatment
13/
Tx is determined by the type of vasculitis. An important update was that the new guidelines recommend glucocorticoids+Rituximab for severe GPA or microscopic polyangiitis.
For more, check out this wonderful article by Dr. Jennifer Tracy!
journals.lww.com
@LyellJ
Tx is determined by the type of vasculitis. An important update was that the new guidelines recommend glucocorticoids+Rituximab for severe GPA or microscopic polyangiitis.
For more, check out this wonderful article by Dr. Jennifer Tracy!
journals.lww.com
@LyellJ
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