Nerve ultrasound in polyneuropathies

Abstract

Ultrasound can be used to visualize pathology in the peripheral nerves of patients with polyneuropathy. Nerve enlargement is the most frequent pathology, but other abnormalities, including abnormal nerve echogenicity and vascularity, are also encountered. This monograph presents an overview of the role of nerve ultrasound in the evaluation and management of both inherited and acquired polyneuropathies. A description of the sonographic techniques and common abnormalities is provided, followed by a presentation of typical findings in different neuropathies. Scoring systems for characterizing the presence and pattern of nerve abnormalities as they relate to different polyneuropathies are presented. Muscle Nerve 57: 716-728, 2018.

Toward in vivo determination of peripheral nervous system immune activity in amyotrophic lateral sclerosis

“…This is somewhat different from the sonographic nerve appearance in patients with CIDP and MMN, in whom nerve enlargement tends to be more pronounced (up to 100% above the normal limit or even larger, especially in CIDP). Immune‐mediated neuropathies also present more asymmetric and regional CSA enlargement, which is especially the case in MMN . Sonographic differences and our careful diagnostic work‐up (discussed in Materials and Methods) convince us that the ALS subsample that was classified to have a state of PNS inflammation did not include LMN disease mimics such as CIDP or MMN.…”

“…Immune-mediated neuropathies also present more asymmetric and regional CSA enlargement, which is especially the case in MMN. 9 Sonographic differences and our careful diagnostic work-up (discussed in Materials and Methods) convince us that the ALS subsample that was classified to have a state of PNS inflammation did not include LMN disease mimics such as CIDP or MMN.…”

“…Nerve sonography has the potential to assess possible surrogates of peripheral nerve immune activity; for instance, cross-sectional nerve area (CSA) enlargement and a large hypoechoic intra-nerval portion can be found in most patients with chronic inflammatory demyelinating polyneuropathy (CIDP). [8][9][10][11] Several studies conversely report CSA reduction in ALS, which is suggestive of PNS degeneration, [12][13][14][15][16] but not all ALS ultrasound studies disclosed nerve atrophy, and individual patients can display normal or even enlarged nerve CSA. 9,12 Such cases might be indicative of an inflammatory component.…”

“…[8][9][10][11] Several studies conversely report CSA reduction in ALS, which is suggestive of PNS degeneration, [12][13][14][15][16] but not all ALS ultrasound studies disclosed nerve atrophy, and individual patients can display normal or even enlarged nerve CSA. 9,12 Such cases might be indicative of an inflammatory component. 13,17 Our retrospective cohort study sought to test the hypothesis that patients with ALS may be classified into suspected PNS degeneration vs. PNS inflammation constellations on the basis of their upper limb CSA.…”

Ultrasonography for the Diagnosis of Carpal Tunnel Syndrome in Diabetic Patients: Missing the Mark?

“…A recent study has shown that nerves are on average slightly enlarged compared to healthy subjects in patients with DM [18]. Nerve enlargement has been found in other neuropathies such as hereditary neuropathies like POEMS or metachromatic leukodystrophy or acquired conditions such as leprosy or sarcoidosis [19]. WFR is, among others, a widely used method to sonographically support the diagnosis of CTS or even exclude the necessity for surgical repair and thus triages patients.…”