Ischaemic Neuropathy
Peripheral nerves need an adequate blood supply.
Neuropathy from acute arterial insufficiency:
• neurologic signs are common as part of an acute occlusion
• referred to as ischaemic monomelic neuropathy
• usually a stocking distribution sensory loss and weakness of distal muscles
Neuropathy from chronic arterial insufficiency:
• most common is a distal sensory and motor deficits (mostly numbness, paraesthesia, burning pain, toe weakness) – but symptoms can be often obscured by the symptoms of ischaemia in other tissues
• 5-10% have ischaemic ‘neuritis’
• chronic ischaemia of nerve causes demyelination and axonal degeneration
• reduction of motor amplitudes on nerve conduction study is common ; prospectively, decline occurs in motor and sensory potential amplitudes with relative preservation of conduction velocities
• ABI correlates with presence of neuropathy signs – the electrophysiological studies support the pathogenesis being a distal axonopathy
Neuropathy from chronic venous insufficiency:
up to a third may have signs of neuropathy (reduced vibration sensation, cold and cold perception)
microangiographic changes and capillary hypertension are believed to be pathological process
may be a cofactor in the development of venous ulceration
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