Usefulness of superficial peroneal nerve/peroneus brevis muscle biopsy in the diagnosis of vasculitic neuropathy

Agadi, JB; Govindarajan, Raghav; Mahadevan, Anita; Shankar, S. K.

doi:10.1016/j.jocn.2011.11.034

Cited by 40 publications

(28 citation statements)

References 31 publications

(66 reference statements)

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“…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: 75%

“…In 2015, the Brighton Collaboration Vasculitic Peripheral Neuropathy (VPN) Working Group adapted these criteria with only one substantive change -the addition of "Brighton case definition for any form of vasculitis other than nerve or muscle" as a new but partially redundant exclusion criterion 16 . course, but the disease steadily progresses in 40% 3,19,34,35 . Approximately 5-10% of patients present with acute, rapidly progressive deficits and are diagnosed within 1 month, but most patients progress subacutely or chronically 30,31,[35][36][37] .…”

Section: Classification Of the Vasculitidesmentioning

confidence: 99%

“…Approximately 5-10% of patients present with acute, rapidly progressive deficits and are diagnosed within 1 month, but most patients progress subacutely or chronically 30,31,[35][36][37] . Median duration of symptoms at diagnosis is 2.5-12 months 13,19,31,[35][36][37][38] . In one study, the median delay to diagnosis was 2 years; combined with the relatively mild neurological involvement in this cohort, this delay suggests a bias against inclusion of more severely affected patients 30 .…”

Section: Classification Of the Vasculitidesmentioning

confidence: 99%

“…Decomposing the neurological deficits seen in five NSVN series 3,15,19,35,36 into their constituent terminal nerves shows that the prevalence of individual motor nerve involvement is as follows: common peroneal (or peroneal division of sciatic) in 91% of patients, tibial (or tibial division of sciatic) in 61%, ulnar in 58%, femoral in 53%, superior gluteal in 42%, median in 41%, radial in 35%, axillary in 33%, and musculocutaneous in 26%. Cranial neuropathies occur in 6% of patients.…”

Section: Clinical Features Of Nsvnmentioning

confidence: 99%

“…A PubMed search of the years 2008-2016 yielded two additional studies with information on histopathological predictors of vasculitic neuropathy 19,91 (Supplementary information S3 (table)). The first was a class II retrospective cohort study of 43 patients undergoing biopsy of the superficial peroneal nerve and peroneus brevis muscle for suspected vasculitis.…”

Section: Histopathological Diagnosismentioning

confidence: 99%

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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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