Ischaemic Monomelic Neuropathy

1. ISCHAEMIC MONOMELIC NEUROPATHY
ADE WIJAYA, MD – JULY 2025

2. INTRODUCTION
• Ischemic monomelic neuropathy (IMN) is a rare, albeit debilitating complication of
arteriovenous fistula creation, with a reported incidence of 0.1%–3%
• First reported by Bolton et al. in 1979, the term “ischemic monomelic neuropathy” was
coined byWilbourn in 1983
• Ischemia of multiple nerves of a single extremity
Miles AM. Upper limb ischemia after vascular access surgery: Differential diagnosis and management. Semin Dial 2000;13:312 5.
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Bolton CF, DriedgerAA, Lindsay RM. Ischaemic neuropathy in uraemic patients caused by bovine arteriovenous shunt. J Neurol Neurosurg Psychiatry 1979;42:810 4.
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Wilbourn AJ, Furlan AJ, HulleyW, RuschhauptW. Ischemic monomelic neuropathy. Neurology 1983;33:447 51.
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3. RISK FACTORS
• Female sex
• Diabetes
• Associated neuropathy
• Peripheral vascular occlusive disease
Sheetal S, Byju P, Manoj P. Ischemic monomelic neuropathy. J Postgrad Med 2017;63:42 3.
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Sheetal S, Remadevi SA, Mathew AS, George AM. Ischemic Monomelic Neuropathy. Current Medical Issues. 2022 Oct 1;20(4):257-8.

4. CLINICAL PRESENTATION
• Pain
• Numbness
• Paresthesia
• Weakness
in the distribution of multiple nerves of the limb
Redfern AB, Zimmerman NB. Neurologic and ischemic complications of upper extremity vascular access for dialysis. J Hand Surg Am 1995;20:199 204
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Sheetal S, Remadevi SA, Mathew AS, George AM. Ischemic Monomelic Neuropathy. Current Medical Issues. 2022 Oct 1;20(4):257-8.

5. CLINICAL PRESENTATION
• The limb is usually warm, with the palpable peripheral pulse, which helps in
differentiation from DASS
• In DASS, there is associated muscle and skin necrosis, resulting in a cold, cyanosed limb
• A proximally placed fistula, mainly the brachiocephalic type, predisposes to the
development of this condition
Thimmisetty RK, Pedavally S, Rossi NF, Fernandes JA, Fixley J. Ischemic monomelic neuropathy: Diagnosis, pathophysiology, and management. Kidney Int Rep 2017;2:76 9.
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Sheetal S, Remadevi SA, Mathew AS, George AM. Ischemic Monomelic Neuropathy. Current Medical Issues. 2022 Oct 1;20(4):257-8.

6. PATHOPHYSIOLOGY
• Shunting of the blood away from the distal limb results in distal axonal infarction without
muscle necrosis.
• It is hypothesized to result from the nerve’s lower threshold for ischemia than that of
skin or muscle
Sheetal S, Remadevi SA, Mathew AS, George AM. Ischemic Monomelic Neuropathy. Current Medical Issues. 2022 Oct 1;20(4):257-8.

7. TREATMENT
• The recommended management is restoring of arterial supply by either surgical or
medical intervention; however, the results are variable, and often there is significant
residual morbidity
Ramdon A, Breyre A, KalapatapuV.A case of acute ischemic monomelic neuropathy and review of the literature.AnnVasc Surg 2017;42:301.e1 5.
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Sheetal S, Remadevi SA, Mathew AS, George AM. Ischemic Monomelic Neuropathy. Current Medical Issues. 2022 Oct 1;20(4):257-8.

8. THANKYOU