Ischemic Monomelic Neuropathy A Case Report and Literature Review

Ischemic monomelic neuropathy is an infrequent complication associated with the creation of a hemodialysis arteriovenous fistula. The etiology is unknown but most likely includes an ischemic insult to the proximal limb that results in multiple distal axonal loss mononeuropathies. Risk factors include female sex and diabetes. Clinical presentation commonly includes motor loss, sensory loss, or rest pain developing within 24 hours of the fistula placement. These findings are not specific for ischemic monomelic neuropathy. This often results in a delay of diagnosis. Electromyographic/nerve conduction velocity studies can help substantiate the diagnosis in questionable cases. Methods of treatment vary but should include some attempt at improving distal perfusion of the limb. Ligation of the fistula has been the most commonly employed maneuver. Early treatment results in significant improvement.