Heat sensitivity of sensory fibers in carpal tunnel syndrome

✍ Scribed by David Burke; Matthew C. Kiernan; Ilona Mogyoros; Cindy Lin

• Publisher: John Wiley and Sons
• Year: 1999
• Tongue: English
• Weight: 67 KB
• Volume: 22
• Category: Article
• ISSN: 0148-639X
• DOI: 10.1002/(sici)1097-4598(199907)22:7<969::aid-mus29>3.0.co;2-v

✦ Synopsis

We read with interest the recent short report titled "Conduction Block in Vasculitic Neuropathy" by Drs. Mohamed et al. (Muscle Nerve 1998;21:1084-1088). The chronic 2-year history and clinical findings of prominent ataxia, symmetric sensory loss, and weakness in their patient is more typical of an acquired demyelinating neuropathy, as the electrophysiology suggests, than a vasculitic disorder. In addition, there was no evident systemic disorder or serologic abnormality. Little in the reported medical and neurologic history or laboratory data supports the presence of a vasculitic disorder. The biopsy data are most notable for demyelination, with very prominent segmental demyelination on teased fiber preparation. A pattern of central or fascicular axonal loss, a feature that might suggest vasculitis-mediated infarction, was not mentioned. Most important, true vasonecrosis was not convincingly demonstrated (at least in the example published). The presence of epineurial vessels with mononuclear cell infiltrates is commonly seen in chronic inflammatory demyelinating polyneuropathy (CIDP).

We believe that this report perpetuates the unsubstantiated belief that vasculitic neuropathy can result in persistent conduction block much like that seen in acute inflammatory demyelinating polyneuropathy (AIDP) or CIDP. In light of the substantial differences between treatments for the two disorders, such an erroneous assumption may lead to inappropriate therapy.