A practical approach to enlargement of nerves, plexuses and roots

Khadilkar, Satish V; Yadav, Rakhil S.; Soni, Girish

doi:10.1136/practneurol-2014-001004

Cited by 29 publications

(26 citation statements)

References 38 publications

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“…Electrodiagnostic studies do not provide information on morphological changes of affected nerves in neuropathies, and imaging techniques, especially Magnetic Resonance Imaging (MRI) and nerve ultrasound (US), are gaining an increasing role in the evaluation of polyneuropathies [2].…”

Section: Introductionmentioning

confidence: 99%

Neuroimaging in diagnosis of atypical polyradiculoneuropathies: report of three cases and review of the literature

et al. 2015

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Neuroimaging is increasingly used in the study of peripheral nerve diseases, and sometimes may have a pivotal role in the diagnostic process. We report on three patients with atypical chronic inflammatory polyradiculoneuropathy (CIDP) in whom magnetic resonance imaging (MRI) and nerve Ultrasound (US) were crucial for a correct diagnostic work-out. A literature review on MRI and US in acquired demyelinating polyneuropathies is also provided. Awareness of the imaging features of CIDP will assist in confirmation of the diagnosis, institution of the appropriate therapy, and prevention of inadequate or delayed treatment in atypical CIDP.

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Section: Introductionmentioning

confidence: 99%

Neuroimaging in diagnosis of atypical polyradiculoneuropathies: report of three cases and review of the literature

et al. 2015

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“…In this case, the time course of the neuropathy and MRI findings suggested an immune or inflammatory neuropathic process 1. Nerve biopsy showed the pathological hallmarks of CIDP: demyelination and remyelination (onion bulbs) and inflammation (figure 2), and ruled out other diagnoses.…”

Section: Discussionmentioning

confidence: 68%

“…Peripheral neuropathy is very rare in neurofibromatosis, and despite occasionally being demyelinating, it presents as a mild length-dependent polyneuropathy with characteristic skin and ophthalmological changes, and positive family history 2. Hypertrophic Charcot–Marie–Tooth disease has a different age of onset and clinical course and genes associated with this phenotype were negative ( PMP22 , EGR2 and MPZ ) 1. Hypertrophic CIDP can potentially respond to immunotherapy, but may require a non-standard combination of intravenous immunoglobulin, plasma exchange and/or corticosteroids.…”

Section: Discussionmentioning

confidence: 99%

A treatable hypertrophic neuropathy

2018

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“…Demyelinating neuropathies such as chronic inflammatory demyelinating polyneuropathy (CIDP) and Charcot-Marie -Tooth disease show diffusely thickened peripheral nerves and nerve roots (8,9). MRI and sonography are also able to detect focal enlargement of nerves, plexuses and nerve roots due to infection, inflammation, infiltration and neoplasm (10). Recent comparison between MRI and sonography in CIDP showed that the two techniques are relevant in detecting microstructure such as nerve fascicles, such that sonography could replace MRI in daily practice due to its affordability (11).…”

Section: Discussionmentioning

confidence: 99%

Cervical root sonography to differentiate multifocal motor neuropathy from ALS

et al. 2016

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INTRODUCTIONMultifocal motor neuropathy (MMN) is a demyelinating neuropathy characterized by predominant involvement of motor nerves. MMN can mimic ALS and other lower motor neuron diseases, but, as MMN is treatable by intravenous immune globulin (IVIg) and other immunomodulating therapies (1), its differential diagnosis is important. The diagnosis of MMN is particularly difficult when its diagnostic hallmarks, conduction block (CB) and anti-ganglioside antibody are not demonstrable. In a recent study, CB was identified in only 60% of MMN patients (2). Sonography of the peripheral nerves was recently reported to detect signs of widespread demyelination including in proximal nerve segments of MMN patients with CB (3). Thus, the aim of the present study was to assess whether sonography of the nerve roots can identify nerve hypertrophy as a suggestive evidence of demyelination in MMN patients without CB and further, to help differentiate MMN from ALS. ALS was chosen for comparison because MMN is still one of the most common masqueraders of ALS when upper motor neuron sign is not obvious. SUBJECTS AND METHODS SubjectsRecordings were made from nine patients with MMN (all men), 22 with ALS (15 men), and from 17 normal controls (11 men) in Tokushima University Hospital, Japan. All the patients with MMN and ALS were ambulatory. The inclusion criteria for the patients with MMN were the following : (A) progressive muscle atrophy and weakness involving only a few peripheral nerves or roots, without sensory involvement, (B) lack of upper motor neuron signs, pathological reflexes, or bulbar symptoms/signs, (C) the lack of radiological abnormality of the cervical spine in an MRI scan, (D) lack of CB according to published electrodiagnostic criteria (4), and (E) most importantly, the presence of clinical improvement of the affected limb with IVIg therapy (2 g/kg given over 5 consecutive days), defined as the improvement of the pre -versus post-therapeutic modified MRC score (1 -5 scale including 4 -and 4 + grades) equal to or greater than 2 in at least two of the affected muscles (5, 6). The mean duration of our clinical follow up of the MMN patients was 42.3 months (range : 18 -107 months) and all the patients remained ambulatory. The mean number of patients undergoing IVIg treatment was 9.9 (range : 4 -17) with reproducible post-therapeutic improvement.Inclusion criterion for the ALS group was to meet either the clinically definite, or clinically probable (with or without laboratory support) revised El Escorial ALS criteria. Of note, our ALS patients had predominantly lower motor involvement at the time of the sonographic assessment, thus its clinical distinction from MMN was not straightforward. The control group was made up of individuals with no neurological symptoms or signs. Either MRI or plain four-angle x-ray of the cervical spine was performed in the control subjects to confirm the lack of significant degenerative spine disease. All the patients and control subjects gave informed consent to participate in the study. ...

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A practical approach to enlargement of nerves, plexuses and roots

Cited by 29 publications

References 38 publications

Neuroimaging in diagnosis of atypical polyradiculoneuropathies: report of three cases and review of the literature

Neuroimaging in diagnosis of atypical polyradiculoneuropathies: report of three cases and review of the literature

A treatable hypertrophic neuropathy

Cervical root sonography to differentiate multifocal motor neuropathy from ALS

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