Ultrasonography shows extensive nerve enlargements in multifocal motor neuropathy

Beekman, Roy; Berg, Leonard H van den; Franssen, Hessel; Visser, Leo H.; Asseldonk, J.T.H. van; Wokke, John H. J.

doi:10.1212/01.wnl.0000169179.67764.30

Cited by 188 publications

(167 citation statements)

References 9 publications

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“…Table 4 also shows that CSA values across these studies are consistent for the major upper limb nerves, with the exception of the radial nerve in the spiral groove reported by Cartwright et al [16]. However, in the most recent study of Won et al [17] and in previous studies reporting reference values for the radial nerve [8,19] in that the C5 root is the smallest among the cervical roots. Concerning lower limb nerves, variability appears to be higher.…”

Section: Discussionsupporting

confidence: 62%

“…The increase of CSA of the involved nerve allows precise localization in entrapment neuropathies and peripheral nerve tumors [1][2][3][4]. Moreover, enlargements of multiple nerves in acquired and hereditary polyneuropathies are also described [5][6][7][8][9]. Therefore, it is essential to compare nerve size parameters measured in patients to reference values.…”

Section: Discussionmentioning

confidence: 99%

“…Neurosonography provides a reliable diagnosis and localization in entrapment neuropathies, traumatic peripheral nerve injuries and tumors of the peripheral nerves, and it has become a useful supplementary tool for electrodiagnostic studies in these conditions [1][2][3][4]. Characteristic nerve size changes in polyneuropathies have been reported as well [5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

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High-Resolution Ultrasonography of Peripheral Nerves: Measurements on 14 Nerve Segments in 56 Healthy Subjects and Reliability Assessments

Boehm¹,

Scheidl

Bereczki

et al. 2014

Ultraschall in Med

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Purpose: The aim of this study was to assess different aspects of reliability in high resolution ultrasonography (HRUS) of the peripheral nerves and to establish reference values for the most frequently examined nerve segments. Materials and Methods:A nerve size parameter, the cross-sectional area (CSA) of the C5, C6 and C7 cervical roots, the median, ulnar, radial, superficial radial, peroneal, tibial, and the sural nerves was measured using HRUS at altogether 14 predefined anatomical sites in two different cohorts of healthy subjects (n=56), and the inter-rater, intra-rater and interequipment reliability of measurements was assessed.Results: Mean CSA of the 14 nerve segments ranged from 2 to 10 mm 2 . Intra-rater, inter-rater and inter-equipment reliability was high with intraclass correlation coefficients of 0.93, 0.98, and 0.86, respectively. CSA values showed no consistent correlation with age, height, and body weight, but males had significantly larger values than females for nerve segments on the arm after correcting for age, weight and height in multivariate analysis. CSA values did not differ when two independent cohorts were compared. Conclusion:Peripheral nerve ultrasonography is a reliable and reproducible diagnostic method in the hands of experienced examiners. Normal values for several upper and lower extremity nerves are provided by our study.

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Section: Discussionsupporting

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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High-Resolution Ultrasonography of Peripheral Nerves: Measurements on 14 Nerve Segments in 56 Healthy Subjects and Reliability Assessments

Boehm¹,

Scheidl

Bereczki

et al. 2014

Ultraschall in Med

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“…Moreover, comparative studies combining MR data of MMN, LSS and CIDP patients have not been performed. Symmetric brachial plexus abnormalities have been described using high‐resolution ultrasound (HRUS) in asymmetric inflammatory neuropathies (Beekman et al., 2005). This discrepancy in results between HRUS and MRI may be caused by the lack of standardized MRI or HRUS criteria defining abnormality and asymmetry, but may also reflect differences in diagnostic sensitivity and specificity.…”

Section: Discussionmentioning

confidence: 99%

Brachial plexus magnetic resonance imaging differentiates between inflammatory neuropathies and does not predict disease course

et al. 2017

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ObjectiveThe main objective of this study was to evaluate the correlation between the distribution of brachial plexus magnetic resonance imaging (MRI) abnormalities and clinical weakness, and to evaluate the value of brachial plexus MRI in predicting disease course and response to treatment in multifocal motor neuropathy (MMN), Lewis‐Sumner syndrome (LSS) and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP).MethodsSixty‐seven patients with an inflammatory neuropathy diagnosed at our tertiary referral center for neuromuscular diseases had undergone bilateral T2‐weighted short tau inversion recovery (STIR) MRI of the brachial plexus. We obtained clinical follow‐up data and scored all MRIs for abnormalities and the symmetry of their distribution.ResultsBrachial plexus MRI abnormalities were detected in 45% of the patients. An abnormal MRI did not predict disease course in terms of patterns of weakness, sensory disturbances or response to treatment. Within the spectrum of radiological abnormalities, asymmetrical clinical syndromes, MMN and LSS were significantly associated with asymmetrical radiological abnormalities, whereas symmetrical abnormalities predominated in CIDP (p < .001, phi 0.791).ConclusionT2 STIR brachial plexus MRI abnormalities correspond with the distribution of neurological deficits in inflammatory neuropathies, but do not correlate with specific clinical characteristics, response to treatment or disease course.

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“…1 Sonographic diffuse or multifocal nerve enlargement were reported in various demyelinating polyneuropathies, such as chronic inflammatory demyelinating polyneuropathy (CIDP), multifocal motor neuropathy (MMN), and some hereditary polyneuropathies. [2][3][4][5][6] Previous studies described swelling of a single hypoechoic fascicle resulting in focal enlargement of nerve diameter at sites of concurrent conduction blocks in CIDP patients. 7,8 MADSAM is an immune mediated neuropathy, a variant of CIDP, which appears clinically as a chronic sensorimotor multiple mononeuropathy with multifocal conduction blocks in electrophysiological studies.…”

Section: Introductionmentioning

confidence: 99%

Ultrasonography of MADSAM neuropathy: Focal nerve enlargements at sites of existing and resolved conduction blocks

Scheidl

Bőhm

Simó

et al. 2012

Neuromuscular Disorders

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Using the emerging technique of peripheral nerve ultrasonography, multiple focal nerve swellings corresponding to sites of existing conduction blocks have been described in demyelinating polyneuropathies. We report two cases of multifocal acquired demyelinating sensory and motor neuropathy (MADSAM). In the first, multiple focal nerve enlargements were detected by ultrasound at sites of previous conduction blocks, well after complete clinical and electrophysiological resolution. In the second case, existing proximal conduction blocks could be localized by ultrasound. Our cases highlight the importance of nerve ultrasound in identifying conduction blocks and demonstrate that ultrasonographic morphological changes may outlast functional recovery in demyelinating neuropathies.

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Ultrasonography shows extensive nerve enlargements in multifocal motor neuropathy

Cited by 188 publications

References 9 publications

High-Resolution Ultrasonography of Peripheral Nerves: Measurements on 14 Nerve Segments in 56 Healthy Subjects and Reliability Assessments

High-Resolution Ultrasonography of Peripheral Nerves: Measurements on 14 Nerve Segments in 56 Healthy Subjects and Reliability Assessments

Brachial plexus magnetic resonance imaging differentiates between inflammatory neuropathies and does not predict disease course

Ultrasonography of MADSAM neuropathy: Focal nerve enlargements at sites of existing and resolved conduction blocks

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