Neurology: Case of the Month

Which of the following is the LEAST common clinical presentation for a vasculitic neuropathy?

Which of the following studies is MOST useful to make the diagnosis of vasculitic neuropathy?

[ A ] Nerve conduction studies and electromyography documenting multiple mononeuropathies
[ B ] Nerve biopsy
[ C ] Cerebrospinal fluid analysis demonstrating elevated protein and increased immunoglobulins
[ D ] Serologic studies identifying high titer anti-neutrophil cytoplasmic antibodies (ANCA) and antibodies to proteinase-3

Which of the following histological findings is the MOST specific for vasculitic neuropathy?

Which of the following statements about the pathophysiology of vasculitic neuropathy is TRUE?

[ A ] The predominant cell infiltrates in histological samples are T cells and macrophages.
[ B ] Humoral mechanisms alone mediate the vessel injuries.
[ C ] Expression of cell surface molecules does not contribute to the vasculitic process.
[ D ] Schwann cells are the major sites of immunologic attack.

Which of the following statements about vasculitic neuropathy is TRUE?

[ A ] Clinically isolated, biopsy-proven vasculitic neuropathy is invariably benign and requires no further evaluation.
[ B ] Identification of an antibody associated with vasculitis, such as anti-neutrophil cytoplasmic antibody (ANCA), renders nerve biopsy unnecessary for diagnosis of vasculitic neuropathy.
[ C ] Persistence of neuropathic pain is a valid marker of unsuccessful immune suppression in patients with vasculitic neuropathy.
[ D ] Vasculitic involvement of peripheral nerve precludes involvement of the central nervous system by the vasculitic process.
[ E ] None of the above statements are true.

Test Yourself — Patient 77