Disclosures: James Q. Doan, MD: Nothing to disclose

Case Description: Patient had symptoms of weakness and numbness of digits 1-2 on left hand with difficulty of active movement of digits along with a slow healing ulcer over distal phalanx of second digit, which began after undergoing surgery for creation of brachiocephalic fistula of the left upper extremity (LUE). Of note, patient denied any history of diabetes mellitus type 2, thyroid problems, or bleeding disorders; however, patient was currently receiving hemodialysis via the left AVF. Patient also had a history of smoking 1 pack per day and only social alcohol use previously. There was electrodiagnostic evidence of chronic peripheral polyneuropathy of limbs tested; there was possible superimposed left median neuropathy proximal to innervation of the pronator teres muscle versus asymmetric peripheral polyneuropathy.

Setting: Outpatient Physical Medicine & Rehabilitation Clinic

Patient: 84 year-old female with end-stage renal disease on hemodialysis with arteriovenous fistula (AVF) of left arm.

Assessment/Results: Nerve conduction study showed no response of left median and ulnar sensory; left median motor also had no response at the wrist and elbow region; left ulnar motor had prolonged onset latency and decreased conduction velocity. EMG findings indicated chronic re-innervation changes in distal bilateral lower extremities and right upper extremity in areas examined and non-median innervated muscles of left upper extremities. Testing showed ongoing denervation with 3+ fibrillations and positive sharp waves of left pronator teres and flexor pollicis longus muscle in left median innervated muscles.

Discussion: This is a rare case of ischemic monomelic neuropathy (IMN) that may occur after creation of AVFs, leading to multiple distal focal mononeuropathies involving sensory and motor branches.

Conclusion: Ischemic monomelic neuropathy is an under-recognized complication of hemodialysis access creation that should be considered to determine appropriate steps to prevent and decrease nerve damage.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/electrodiagnostic-findings-suggestive-of-ischemic-monomelic-neuropathy-in-dialysis-patient-after-arteriovenous-fistula-creation-a-case-report/