Combined nerve and muscle biopsy in the diagnosis of vasculitic neuropathy. A 16‐year retrospective study of 202 cases

Vital, C; Vital, Anne; Canron, Marie‐Hélène; Jaffré, Anne; Viallard, Jean-Franois; Ragnaud, Jean‐Marie; Brechenmacher, C; Lagueny, A

doi:10.1111/j.1085-9489.2006.00060.x

Cited by 115 publications

(72 citation statements)

References 58 publications

(115 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Rarely, NSVN starts in the PNS and spreads to the skin 23,36 . Similarly to this local skin involvement, peroneus brevis muscle biopsies in patients with NSVN reveal vasculitis in 25% of patients 14,19,34,92 . Hence, NSVN can be viewed as a lower-limb-predominant vasculitis with nerve and occasional subclinical skin and muscle involvement.…”

Section: Diabetic Lumbosacral Radiculoplexus Neuropathymentioning

confidence: 73%

“…PNS microvasculitis with vascular damage is characteristic of the diabetic radiculoplexus neuropathies 11 . However, data from at least four studies that evaluated the size of vessels involved in NSVN [12][13][14][15] indicate that NSVN is not, in most circumstances, a microvasculitis.…”

Section: Classification Of the Vasculitidesmentioning

confidence: 99%

“…Analogous to cutaneous polyarteritis nodosa, some cases reported as NSVN have also predominated in the lower limbs and been accompanied by cutaneous vasculitis 14,[87][88][89] . Prospective investigations have shown that NSVN is often associated with subclinical perivascular inflammation in adjacent cutaneous tissues 90,91 .…”

Section: Diabetic Lumbosacral Radiculoplexus Neuropathymentioning

confidence: 99%

“…Microvasculitis, defined as inflammation of microvessels without vascular damage, was deemed nonspecific, as it can occur in many non-vasculitic neur opathies 10 . Moreover, analyses of two class II studies showed that clinicopathological surrogates of vasculitic neuropathy were generally not associated with microvasculitis 14,93 . Definite vasculitis was divided according to the presence of active or chronic lesions, which coexist in most vasculitic neuropathies.…”

Section: Histopathological Diagnosismentioning

confidence: 99%

“…Given the dearth of data on NSVN, the group reviewed studies that enrolled patients with SVN or NSVN. Eighteen articles were selected, six class II and twelve class III (all case-control studies, except one retrospective cohort survey) 14,34,54,60,[94][95][96][97][98][99][100][101][102][103][104][105][106][107] , which were analysed to identify variables associated with vasculitic neuropathy. By combining evidence from this review with that from class IV studies that showed active axonal degeneration to be increased in all vasculitic neuropathy series, the guideline group designed consensus diagnostic criteria for histopathologically probable vasculitic neuropathy.…”

Section: Histopathological Diagnosismentioning

confidence: 99%

See 4 more Smart Citations

The nonsystemic vasculitic neuropathies

2017

View full text Add to dashboard Cite

The vasculitides are a clinically diverse group of diseases with the histopathological signature of blood vessel-centred inflammation that results in vascular damage and ischaemic injury to the affected tissues 1 . Vasculitis can be caused by drugs, infections and cancers, but diagnostic workup reveals no trigger in most patients. Autoimmune mechanisms are active in all vasculitides, except those caused by direct infection of vessel walls. Most vasculitides are systemic and involve multiple organs and tissues. Those affecting small-to medium-sized vessels often manifest with a vasculitic neuropathy. For example, neuropathies occur in 60-70% of patients with polyarteritis nodosa, eosinophilic granulomatosis with polyangiitis and cryoglobulinaemic vasculitis, and 40-50% of those with microscopic polyangiitis and rheumatoid vasculitis 2 .Vasculitic neuropathy can also occur without systemic vasculitis. This single-organ vasculitis of the PNS has commonly been referred to as nonsystemic vasculitic neuropathy (NSVN), but other forms of clinically isolated PNS vasculitis are now recognized and can be considered variants of NSVN 3 . Although NSVN is classically an acute, relapsing, multifocal neuropathy, it can present as a slowly progressive neuropathy without distinct asymmetries. As such, it should be considered as a possible cause of any progressive axonal neur opathy. NSVN can be diagnosed only with a nerve biopsy, with or without a concomitant muscle or skin biopsy; as nerve biopsies are seldom performed, the condition is under-recognized. The disorder must be distinguished from many other causes of multifocal neuropathy, the definition of which is itself not standardized and requires clarification.A Peripheral Nerve Society guideline group reviewed the literature on vasculitic neuropathy and published consensus recommendations on the classification, diagnosis and immunosuppressive treatment of NSVN in 2010 (REF. 4) Abstract | Nonsystemic vasculitic neuropathy (NSVN) is an under-recognized single-organ vasculitis of peripheral nerves that can only be diagnosed with a nerve biopsy. A Peripheral Nerve Society guideline group published consensus recommendations on the classification, diagnosis and treatment of NSVN in 2010, and new diagnostic criteria for vasculitic neuropathy were developed by the Brighton Collaboration in 2015. In this Review, we provide an update on the classification, diagnosis and treatment of NSVN. NSVN subtypes include Wartenberg migratory sensory neuropathy and postsurgical inflammatory neuropathy. Variants include diabetic radiculoplexus neuropathy and -arguably -neuralgic amyotrophy. NSVN with proximal involvement is sometimes termed nondiabetic lumbosacral radiculoplexus neuropathy. Cutaneous polyarteritis nodosa and other skin-nerve vasculitides overlap with NSVN clinically. Three patterns of involvement in NSVN have been identified: multifocal neuropathy, distal symmetric polyneuropathy, and overlapping multifocal neuropathy (asymmetric polyneuropathy). These patterns lack standard defi...

show abstract