{
  "abstract": "Background Aortoiliac arterial disease typically presents with buttock/thigh claudication and hip pain. Infrequently, proximal limb arterial occlusion can cause acute distal axonal polyneuropathy (Ischaemic monomelic neuropathy) but usually after vascular intervention (Wilbourn et al., 1983). However, acute bilateral distal painful neuropathy in the setting of asymptomatic aortoiliac stenosis has not been well described.Results A 77 year-old female presented with acute-onset bilateral feet dysesthesia. They were independent preadmission but had become bed-bound due to disabling pain. There were no cardiovascular risk factors apart from smoking. There was no history of recent vascular intervention nor symptoms of peripheral vascular disease.On examination there was reduced sensation to pain and temperature distally to the ankles, without objective muscle weakness. The patient developed concurrent panniculitis in her abdominal wall below the umbilicus.Nerve conduction studies demonstrated a severe length-dependent sensori-motor axonal polyneuropathy. Screening for common nutritional, infectious, autoimmune, toxic and paraneoplastic causes of polyneuropathies were negative. MRI of the spinal cord did not demonstrate pathology.However, the CT angiogram demonstrated arterial occlusion from infra-renal aorta into bilateral common iliac arteries, with femoral arteries supplied by anterior abdominal wall arteries and inferior epigastric arteries.The patient underwent emergent management of aorto-iliac stenosis using a bifurcating stent, and her pain was managed by analgesia. At three months follow-up, her mobility remained moderately impaired despite partial improvement in dysesthesia.Conclusion We describe a case of acute bilateral lower limb sensori-motor axonal neuropathy secondary to an atypical presentation of aortoliac arterial stenosis without typical ischaemic symptoms.Reference Wilbourn AJ, Furlan AJ, Hulley W, Ruschhaupt W. Ischemic rnonornelic neuropathy. Neurology. 1983; 33(4), 447–447. https://doi.org/10.1212/WNL.33.4.447",
  "authors": [
    {
      "affiliations": [
        "Westmead Hospital, Sydney, NSW, Australia"
      ],
      "name": "Yitong Shao"
    },
    {
      "affiliations": [
        "Liverpool Hospital, Sydney, NSW, Australia"
      ],
      "name": "Indumathi Singh"
    },
    {
      "affiliations": [
        "Liverpool Hospital, Sydney, NSW, Australia",
        "Southwestern Sydney Clinical School, University of NSW, Sydney, NSW, Australia"
      ],
      "name": "Daniel Wardman"
    }
  ],
  "title": "3461 Acute painful polyneuropathy as an atypical presentation of aortoiliac arterial stenosis",
  "uid": "09242269-3fbe-58b7-b62a-c82e33d7d268"
}