High-Resolution Ultrasonography of the Superficial Peroneal Motor and Sural Sensory Nerves May Be a Non-invasive Approach to the Diagnosis of Vasculitic Neuropathy

Üçeyler, Nurcan; Schäfer, Kristina A.; Mackenrodt, Daniel; Sommer, Claudia; Müllges, Wolfgang

doi:10.3389/fneur.2016.00048

Cited by 28 publications

(22 citation statements)

References 49 publications

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“…Mean cross-sectional areas of the tibial, peroneal and -to a lesser extent -median and ulnar nerves were larger than those in healthy controls. In a third study, ultrasonography was used to assess the sural, superficial pero neal, tibial and deep peroneal nerves in six patients with biopsy-proven vasculitic neuropathy (four with NSVN), six with chronic inflammatory demyelinating poly neuropathy (CIDP), five with non-immune neuropathies and 26 healthy controls 124 . In patients with vasculitic neuropathy, the cross-sectional area of the sural nerve was significantly greater than that in healthy and disease controls, and the longitudinal diameter of the superficial peroneal nerve was greater than that in healthy controls.…”

Section: Mutifocal Neuropathy Early Overlapping Mutifocal Neuropathymentioning

confidence: 99%

The nonsystemic vasculitic neuropathies

2017

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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...

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Section: Mutifocal Neuropathy Early Overlapping Mutifocal Neuropathymentioning

confidence: 99%

The nonsystemic vasculitic neuropathies

2017

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“…In 14 patients with systemic vasculitis, 70% (22 of 31) of clinically involved nerves showed focal nerve enlargement . Nerve enlargement in vasculitis may preferentially involve the sural and superficial peroneal nerves, may occur in nerve regions just proximal to common sites of entrapment, typically does not involve the brachial plexus, and only rarely shows hypervascularization …”

Section: Nerve Sonography In Other Polyneuropathiesmentioning

confidence: 99%

Nerve ultrasound in polyneuropathies

et al. 2018

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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.

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“…Very mild, diffuse nerve enlargement has been described in diabetic polyneuropathy and mononeuritis multiplex; however, these changes are subtle and more evident on a population basis rather than in individual cases. 34,35 There are very few conditions in which nerves are pathologically small, but decreased nerve cross-sectional area has been described in the rare condition of cerebellar ataxia neuropathy vestibular areflexia syndrome. 36…”

Section: Axonalmentioning

confidence: 99%

Neuromuscular Ultrasound for Peripheral Neuropathies

Penry

Cartwright

2019

Semin Neurol

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Neuromuscular ultrasound (NMUS) is a diagnostic technique that is now commonly used to complement electrodiagnostic studies when evaluating for suspected peripheral nerve pathology. The use of NMUS has been described in focal mononeuropathies, polyneuropathies, and motor neuron disease. This article provides a general overview of NMUS for the evaluation of peripheral neuropathies based on clinical practice guidelines, primary literature, and expert opinion. The characteristic changes detected by NMUS are described in focal mononeuropathies (including entrapment and other causes), polyneuropathies (including demyelinating and axonal processes), and motor neuron disease.

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High-Resolution Ultrasonography of the Superficial Peroneal Motor and Sural Sensory Nerves May Be a Non-invasive Approach to the Diagnosis of Vasculitic Neuropathy

Cited by 28 publications

References 49 publications

The nonsystemic vasculitic neuropathies

The nonsystemic vasculitic neuropathies

Nerve ultrasound in polyneuropathies

Neuromuscular Ultrasound for Peripheral Neuropathies

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