Vasa Nervorum

Peripheral neuropathies maybe widely disseminated or focal. Patients with disseminated polyneuropathy, whether demyelinative or axonal, usually demonstrate distal sensory and/or motor impairment. Multifocal neuropathy, also referred to as mononeuropathy multiplex, is often a consequence of lesions affecting the vasa nervorum, the blood vessels that supply peripheral nerves. The most common diseases to compromise the vasa nervorum and cause infarction of nerve fascicles are diabetes mellitus and periarteritis nodosa. Other frequent causes of mononeuropathy multiplex include infection (e.g. Lyme disease and leprosy) and multiple compression injury (e.g. bilateral carpal tunnel syndrome). When mononeuropathy... 

The view that the nerve lesions are the outcome of degenerative atheromatous changes in the vasa nervorum has been one that has been much debated and despite the repeated reports of poor correlation between occlusive vascular disease and neuropathy it would probably be premature to exclude this as a contributory, if not a causative, factor. 

Inactivation of LA clinical effect occurs by diffusion away from the neuronal Na+ channels and by uptake into the vas nervorum and into the systemic circulation. It is here that metabolic inactivation of the linkage between the aromatic ring and tertiary amine can occur. The mechanism and site are very different for the amide and ester local anesthetics. 

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