Ischemic hypertrophic neuropathies

The sural nerve biopsy of 2 patients with ischaemic neuropathy was studied by multiple histological sections stained for vessels and nerve fibers. The first patient had weakness and atrophy of upper and lower extremities and marked decreased motor conduction velocity on EMG. The nerve biopsy revealed ubiquitous arteriolar occlusions, segmental demyelination of nerve fibers and nerve fiber damage with a central fascicular pattern. The second patient complained of deep sensory disturbances and had a moderate weakness of distal leg muscles; on EMG there was marked slowing of conduction velocity. A nerve biopsy was done one year after he was operated of aortofemoral bypass when improvement occurred. The biopsy showed an abnormally large sural nerve with patchy loss of fibers in a vascular pattern. Hypertrophic changes of Schwann cells were observed at the periphery of the fascicles. The histological changes observed are explained on the basis of a different susceptibility to ischaemia of Schwann cells and connective tissue cells in respect to nerve fibers