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Weakness and Paresthesia

By Joshua Sonnen, MD

May 19, 2023

Clinical History:

This 52-year-old patient presented with increased weakness and mildly painful paresthesias. Imaging showed hilar adenopathy and a rheumatology consult showed suspicion for sarcoidosis.



Sural nerve and vastus lateralis biopsies show evidence of:

A. Non-caseating granuloma
B. Vasculitis
C. Diabetic vasculopathy
D. Lyme Disease

Answer: B. Vasculitis <– correct answer


Figure 1- Post vasculitic changes

A. Nerve- patchy/zonal loss of myelinated axons (red on Gomori trichrome)

B. Muscle- grouped atrophy; almost always acute+chronic neurogenic changes

C. Vessel- recanalization of injured vessel; multiple lumena

D. Vessel- Loss of >1/4 internal elastic lamina (red arrows); characteristic of prior vasculitis

Urgent diagnosis- untreated vasculitis may cause rapid and irreversible injury; always warrants call to referring physician.

Reference(s)/ Additional Reading:

Collins MP, Dyck PJB, Hadden RDM. Update on classification, epidemiology, clinical phenotype and imaging of the nonsystemic vasculitic neuropathies. Curr Opin Neurol. 2019 Oct;32(5):684-695.

Collins MP, Hadden RD. The nonsystemic vasculitic neuropathies. Nat Rev Neurol. 2017 Apr 27;13(5):302-316.


Quick note: This post is to be used for informational purposes only and does not constitute medical or health advice. Each person should consult their own doctor with respect to matters referenced. Arkana Laboratories assumes no liability for actions taken in reliance upon the information contained herein.