Vasculitic neuropathy — SCE Neurology MCQ

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HardNeuromuscularVasculitic neuropathySCE Neurology

A patient develops painful asymmetric foot drop followed by wrist drop, livedo reticularis, haematuria and raised inflammatory markers. Nerve conduction studies show multifocal axonal loss. Which investigation best secures the suspected peripheral-nerve diagnosis?

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Correct answer: A — Combined affected-nerve and adjacent-muscle biopsy

The best answer is “Combined affected-nerve and adjacent-muscle biopsy”. The pattern is mononeuritis multiplex from systemic vasculitis; targeted nerve, often combined nerve-and-muscle, biopsy can demonstrate vessel-wall inflammation and is most useful when chosen from an affected but not end-stage territory. “Edrophonium testing with continuous cardiorespiratory monitoring” is less appropriate because Tensilon assesses neuromuscular transmission rather than axonal infarction “Sleep-deprived EEG with activation procedures” is less appropriate because EEG does not sample peripheral nerve vessels “Serum calcium with corrected albumin concentration” is less appropriate because calcium cannot establish necrotising vasculitis “Brain perfusion MRI with arterial-spin labelling” is less appropriate because brain perfusion imaging does not diagnose peripheral mononeuritis multiplex

Reference: Diagnosis and therapeutic options for peripheral vasculitic neuropathy. https://pmc.ncbi.nlm.nih.gov/articles/PMC4357592/