Ischemic monomelic neuropathy (IMN) may develop in a patient following placement of an arteriovenous shunt for hemodialysis. It occurs if a change in the arterial blood supply results in ischemic damage to nerves but not to other tissues.


Shunt location: proximal forearm or upper arm, following use of the brachial artery


Clinical features:

(1) The onset is acute and occurs within a few hours of placing the shunt.

(2) Most patients have diabetes with peripheral neuropathy and/or peripheral arterial disease.

(3) The patient develops pain, muscle weakness, dysesthesia and/or loss of sensation distal to the shunt.

(4) The hand is warm without signs of ischemia (excludes acute ischemia or shunt steal).

(5) The radial pulse may range from absent to normal.


Nerve conduction studies show loss of axons and reduced nerve conduction velocity in sensory and motor nerves.


Differential diagnosis:

(1) complication of regional nerve block

(2) complication of arm placement during surgery

(3) psychogenic pain

(4) diabetic neuropathy

(5) carpal tunnel syndrome

(6) acute limb ischemia


Therapy consists of immediately closing the shunt.


Neurologic deficits may be permanent although immediate diagnosis and therapy may reduce morbidity.


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