[A case with perineuritis].

Abstract

We reported a 62-year-old woman with perineuritis. She suffered from dysesthesia in the right radial wrist. One month later, dysesthesia in the left radial wrist occurred. Four months later, dysesthesia developed in both soles of the foot. On a neurologic examination, hypalgesia, hypesthesia, dysesthesia and areflexia were disclosed. Sensory disturbance was a distal dominant distribution. Serum anti-Borrelia burgdorferi antibody was not detected. Cerebrospinal fluid examination revealed normal protein content and cell numbers. Motor nerve conduction velocities were normal, but the sensory nerve conduction velocity of median nerve, ulnar nerve and sural nerve could not be elicited. Sural nerve biopsy revealed marked thickening of perineurium and infiltration of mononuclear cells in and around the perineurium. The infiltration of mononuclear cells was also observed around middle-sized epineurial artery and arterioles. Treatment with daily 40 mg of prednisolone only relieved the dysesthsia. After treatment with daily 60 mg of prednisolone the sensory disturbance was gradually improved. Sensory nerve potential could be evolved seven months later.