In their article on the neurological complications of sickle cell disease, Prengler and colleagues 1 present an excellent review of the central nervous system complications of sickle cell anemia. They do, however, omit peripheral nervous system complications that we believe require some mention. Peripheral nervous system involvement in sickle cell anemia is significantly less common than central nervous system involvement but nevertheless encompasses a wide spectrum of overt peripheral nervous system disorders ranging from lead neuropathy, nitrous oxide-induced neuropathy, and sodium cyanate-induced axonopathy to mononeuropathy resulting from the direct or indirect effects of the sickle cell anemia. Mononeuropathy from nerve infarction as a complication of sickle cell vasoocclusive crisis has been documented by us and others. 2,3 It has been postulated that the rarity of peripheral nerve infarction in comparison with brain infarction is likely caused by the more generous blood supply of the peripheral nervous system, and only exceptional patients with an anatomically curtailed peripheral nerve vascular supply may develop ischemic nerve injury. 3 We recently reported two patients with mononeuropathy multiplex as a direct consequence of sickle cell disease. 2 In our cases, the diagnosis was delayed because the treating physicians overlooked the symptomatology of a peripheral nerve disorder associated with sickle cell anemia. We believe the peripheral nervous system involvement in sickle cell disease is underdiagnosed and poorly understood. Emphasizing peripheral nerve disorders in sickle cell disease will increase the recognition of such complications and ultimately result in further clarification of the pathophysiology and natural history of these disorders while providing new insights into their prevention and treatment.