Nerve Ultrasound as Helpful Tool in Polyneuropathies

Abstract

Background: Polyneuropathies (PNP) are a broad field of diseases affecting millions of people. While the symptoms presented are mostly similar, underlying causes are abundant. Thus, early identification of treatable causes is often difficult. Besides clinical data and basic laboratory findings, nerve conduction studies are crucial for etiological classification, yet limited. Besides Magnetic Resonance Imaging (MRI), high-resolution nerve ultrasound (HRUS) has become a noninvasive, fast, economic and available tool to help distinguish different types of nerve alterations in neuropathies. Methods: We aim to describe typical ultrasound findings in PNP and patterns of morphological changes in hereditary, immune-mediated, diabetic, metabolic and neurodegenerative PNP. Literature research was performed in PubMed using the terms ‘nerve ultrasound’, neuromuscular ultrasound, high-resolution nerve ultrasound, peripheral nerves, nerve enlargement, demyelinating, hereditary, polyneuropathies, hypertrophy’. Results: Plenty of studies over the past 20 years investigated the value of nerve ultrasound in different neuropathies. Next to nerve enlargement, patterns of nerve enlargement, echointensity, vascularization and elastography have been evaluated for diagnostic terms. Furthermore, different scores have been developed to distinguish different etiologies of PNP. Conclusions: Where morphological alterations of the nerves reflect underlying pathologies, early nerve ultrasound might enable a timely start of available treatment and also facilitate follow up of therapy success.

Nerve ultrasound findings in Sjögren's syndrome‐associated neuropathy

“…However, this fraction might even be underestimated as high cutoff values for enlarged CSAs in comparison to other studies were applied 23 . Nevertheless, comparable studies on patients with CIDP found pathologic ultrasound findings with similar frequencies (64–89%) 24–26 . In our study, abnormalities on nerve ultrasound were observed in four out of seven patients with Sjögren's syndrome and clinical signs of neuropathy but without neurophysiologic evidence of neuropathy.…”

“…23 Nevertheless, comparable studies on patients with CIDP found pathologic ultrasound findings with similar frequencies (64-89%). [24][25][26] In our study, abnormalities on nerve ultrasound were observed in four out of seven patients with Sjögren's syndrome and clinical signs of neuropathy but without neurophysiologic evidence of neuropathy. This finding suggests that nerve ultrasound might give additional information on the existence of a Sjögren's syndrome-associated neuropathy in cases of nerve conduction studies failing to detect nerve damage.…”

Cross-Sectional Area Reference Values for Sonography of Peripheral Nerves in Taiwanese Adults

“…Since UPSS scores have not yet been validated using independent samples, further studies assessing several additional nerve sites is warranted to refine the total score. In addition, various ultrasound scoring tools are available and have been shown applicable with high accuracy ( 1 , 26 ), tools in addition to UPSS should be considered in the future.…”

Sonographic characteristics of median nerve neuropathy in Hansen’s disease: a case-control study

“…15 While enlargement is very focal in entrapments, tumors and trauma, it is diffuse, multifocal and more proximal in non-Hansen's polyneuropathies. 16,17 Therefore, the peculiar enlargement pattern identified in this paper appears unique to leprosy. Nagappa et al showed that the median nerve in leprosy was maximally enlarged proximal to wrist crease with gradual tapering proximally while it enlarged most at the distal wrist crease in carpal tunnel syndrome.…”