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VASCULAR NEUROPATHY: PROBLEMS OF CLINICAL AND DIAGNOSTIC VERIFICATION IN SYSTEM AND NONSYSTEM VASCULITIES
Summary. Vasculitis of medium-sized and small vessels commonly affects peripheral nerves and can occur in context of a systemic vasculitis with multiorgan involvement or a nonsystemic vasculitis limited to the peripheral nervous system. Typically, vasculitic neuropathies tend to be lower extremity predominant and to cause distal symptoms and signs that include pain, weakness, and sensory loss in the distribution of a named nerve followed by involvement of additional nerves in a stepwise fashion over weeks to months. Diagnostic evaluation should focus on signs and symptoms indicative of an underlying systemic vasculitis, although when neuropathy is the initial manifestation of the vasculitis and/or there is no definitive evidence of vasculitis elsewhere, then nerve biopsy is needed for diagnosis. Prompt recognition of these clinical and pathological features is important to better recognize and more effectively treat patients with peripheral nerve vasculitis. The review article provides criteria for the diagnosis of vasculitic neuropathy, as well as a list of diagnostic and laboratory measures necessary for differential diagnosis. The existing heterogeneity of etiopathogenesis, clinical manifestations of vasculitic neuropathies requires close cooperation between general practitioners, neurologists, and rheumatologists for the timely diagnosis of this nosology and the choice of adequate treatment tactics.
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