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We report the clinical and pathologic features of a patient with peripheral neuropathy that was the first clinical expression of cholesterol emboli syndrome(CES).Biopsy of skeletal muscle and peripheral nerve revealed cholesterol clefts in lumens of small arteries,necrotizing arteritis,and severe degeneration of peripheral and intramuscular nerves. At autopsy,the peripheral nervous system was extensively affected by similar changes.We conclude that(1)peripheral neuropathy may be the initial manifestation of CES.Presumably,deposition of cholesterol leads to arteritis.(2)The underlying pathology of CES neuropathy is chronic axonal degeneration,possibly due to chronic ischemia of epineural artieris.(3) Muscle biopsy is important in the antemortem diagnosis of CES.Nerve biopsy may show involvement of epineurial vessels.(4)CED may resemble polyarteritis nodosa clinically and pathologically.(5)CES may be under- recognized and should be included in in the differential diagnosis of any neuropathy of uncertain cause,particularly when there is a history of vascular catheterization,or severe aortic atherosclerosis. |
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embolism
embolism,cholesterol
muscle biopsy
neuropathy
neuropathy,ischemic
neuropathy,peripheral
transluminal angioplasty,coronary artery
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