Necrotizing vasculitis, especially that of the type observed in poly-arteritis nodosa (PAN), affects arteries of the epineurium and induces nerve ischemia when vasa nervorum are occluded. Necrotizing arteritis is associated with symptomatic and asymptomatic nerve lesions owing to ischemia.<sup>1 Asbury A.K., Johnson P.C. Vasculitic neuropathy Major Problems in Pathology (Vol 9, Pathology of Peripheral Nerve) Philadelphia: Saunders (1978).  110-119

Haga clic aquí para ir a la sección de Referencias, 24 Kussmaul A., Maier R. Uber eine bisher nicht beschrebene eigenthumliche Arteriener-krankung (Periarteritis nodosa), die mit Morbus Brightii un rapid fortschreitender allgemeiner Muskellah-mung einhergeht Dtsch Arch Klin Med 1866 ;  1 : 484-517

Haga clic aquí para ir a la sección de Referencias, 27 Lovshin L.I., Kernohan J.W. Peripheral neuritis in periarteritis nodosa Arch Intern Med 1948 ;  82 : 321-338

Haga clic aquí para ir a la sección de Referencias</sup> It also occurs secondarily in the course of neuropathy associated with infection, malignancy, and focal diabetic neuropathy. It further causes ischemic nerve lesions on preexisting ones.

The classification of vasculitis is still a matter of controversy because it has often been based on the size of the vessels predominantly affected,<sup>46 Wees S.J., Sunwood L.N., Oh S.J. Sural nerve biopsy in systemic necrotizing vasculitis Am J Med 1981 ;  71 : 525-532  [cross-ref]

Haga clic aquí para ir a la sección de Referencias</sup> even though overlaps occur. Recent attempts to modify the classification of systemic vasculitides<sup>22 Jennette J.C., Falk R.J., Andrassy K. , y al. Nomenclature of systemic vasculitides Arthritis Rheum 1994 ;  37 : 187-192  [cross-ref]

Haga clic aquí para ir a la sección de Referencias</sup> have not achieved further clarification. Large vessel vasculitis, which includes giant cell arteritis and Takayasu's arteritis, is seldom associated with peripheral neuropathy, and further, neuropathy is rare in cranial (giant cell) arteritis, and when present, is usually due to lesions of epineurial vessels of the type observed in PAN.<sup>5 Caselli R.J., Hunder G.G., Whisnant J.P. Neurologic disease in biopsy-proven giant cell (temporal) arteritis Neurology 1988 ;  38 : 352-359

Haga clic aquí para ir a la sección de Referencias, 36 Said G., Lacroix C., Fujimura H. , y al. The peripheral neuropathy of necrotizing arteritis: A clinicopathologic study Ann Neurol 1988 ;  23 : 461-465  [cross-ref]

Haga clic aquí para ir a la sección de Referencias</sup> Of the medium-sized vessel vasculitic disorders, which include PAN and Kawasaki's disease, neuropathy occurs only in PAN. The group of small vessel vasculitis generally includes Wegener's granulomatosis, Churg-Strauss syndrome, and microscopic polyangiitis (with involvement of capillaries), which actually in many cases, overlaps with PAN. The nomenclature of the systemic vasculitides remains enigmatic<sup>25 Lie J.T. Nomenclature and classification of vasculitis: Plus ça change, plus c'est la même chose Arthritis Rheum 1994 ;  2 : 181-186  [cross-ref]

Haga clic aquí para ir a la sección de Referencias</sup> owing to the lack of specific biologic markers, except for Wegener's granulomatosis in which the presence of antineutrophil cytoplasmic antibodies (c-ANCA) can be of value.