Vasculitic neuropathy: A retrospective analysis of nerve biopsies and clinical features from a single tertiary care center

Hui, Monalisa; Meena, A K; Rajasekhar, Liza; Yareeda, Sireesha; Afshan, Jabeen; Mridula, Rukmini; Borgohain, Rupam; Uppin, Megha S

doi:10.4103/aian.aian_47_18

Cited by 6 publications

(8 citation statements)

References 23 publications

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“…Most cases of acute angioedema are similarly treated with an aggressive combination of the aforementioned drugs before tailoring subsequent treatment based on clinical history, as in the case of hereditary angioedema, or follow-up for allergic reactions as was seen in the case of our patient. Rarely, refractory cases may require surgical decompression to maximize immediate relief [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Isolated Ulnar Neuropathy After Acute Angioedema

Itani,

Malick,

Nangrani

et al. 2023

Cureus

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Ulnar neuropathy commonly causes hand paresthesia, often associated with mechanical compression or repetitive movements across the elbow or wrist. There are a few cases that document ulnar nerve injury from rapid compression in the absence of trauma. We present a 30-year-old previously healthy male who developed bilateral hand and forearm swelling, numbness, and pain after an allergic reaction initially treated with epinephrine and steroids. Following treatment, swelling improved; however, paresthesia and weakness persisted. Electrodiagnostic studies performed two months later showed severe ulnar neuropathy prominent at the left proximal wrist, confirmed by ulnar motor inching studies. Signs of acute or subacute denervation and active reinnervation were noted in the left flexor digitorum profundus and abductor digiti minimi. Right-sided studies were unrevealing, although magnetic resonance imaging (MRI) showed an acute flexor pollicis longus tear. Given the timing of events, it was felt that the ulnar neuropathy and acute muscle tear were related to the rapid onset of angioedema. Further research should be conducted on how acute episodes of angioedema (allergy) can cause nerve compression in different extremities. There are very scant reports of different types of angioedema (such as vibratory or hereditary) associated with neuropathy; however, there are no reports of acute allergic angioedema associated with neuropathy. A more comprehensive understanding of the pathophysiology of neuropathy following acute angioedema will help guide treatment approaches both acutely and after symptom presentation.

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Section: Discussionmentioning

confidence: 99%

Isolated Ulnar Neuropathy After Acute Angioedema

Itani,

Malick,

Nangrani

et al. 2023

Cureus

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“…[ANCA] serology) is generally unrevealing in patients with NSVN but may help confirm an ANCA-associated systemic vasculitis as a cause of VN. 181 Diagnostic certainty often depends on the results of a nerve biopsy. The sural nerve is most frequently biopsied, although superficial fibular and superficial radial nerve biopsies are occasionally performed.…”

Section: Vasculitic Neuropathymentioning

confidence: 99%

“…Serological analysis (e.g., anti‐neutrophil cytoplasmic antibody [ANCA] serology) is generally unrevealing in patients with NSVN but may help confirm an ANCA‐associated systemic vasculitis as a cause of VN 181 …”

Section: Polyneuropathymentioning

confidence: 99%

Electrodiagnostic studies and new diagnostic modalities for evaluation of peripheral nerve disorders

Hannaford,

Paling,

Silsby

et al. 2024

Muscle and Nerve

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Electrodiagnostic studies (EDx) are frequently performed in the diagnostic evaluation of peripheral nerve disorders. There is increasing interest in the use of newer, alternative diagnostic modalities, in particular imaging, either to complement or replace established EDx protocols. However, the evidence to support this approach has not been expansively reviewed. In this paper, diagnostic performance data from studies of EDx and other diagnostic modalities in common peripheral nerve disorders have been analyzed and described, with a focus on radiculopathy, plexopathy, compressive neuropathies, and the important neuropathy subtypes of Guillain‐Barré syndrome, chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), vasculitic neuropathy and diabetic neuropathy. Overall EDx retains its place as a primary diagnostic modality in the evaluated peripheral nerve disorders. Magnetic resonance imaging and ultrasound have developed important complementary diagnostic roles in compressive and traumatic neuropathies and atypical CIDP, but their value is more limited in other neuropathy subtypes. Identification of hourglass constriction in nerves of patients with neuralgic amyotrophy may have therapeutic implications. Investigation of radiculopathy is confounded by poor correlation between clinical features and imaging findings and the lack of a diagnostic gold standard. There is a need to enhance the literature on the utility of these newer diagnostic modalities.

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“…Vasculitic neuropathy is a common indication for nerve biopsy with a reported sensitivity of 54.76% and reports of a 5.1% increase in diagnostic yield when underwent with a combined muscle biopsy [17][18][19]. When underwent with a combined muscle and skin biopsy, cutaneous vasculitis was identified in 20% of suspected patients with vasculitic neuropathy [20].…”

Section: Vasculitismentioning

confidence: 99%

“…The neurological manifestations of sarcoidosis include cranial, optic, and peripheral neuropathy, endocrine and hypothalamic dysfunction, seizures, meningitis, myelopathy, and myopathy [16,19,24,[47][48][49][50]. Confirmatory nerve biopsy demonstrates non-caseating granulomas, typically found in the epi-and perineurium, that are independent of other etiologies such as leprosy and tuberculosis [49].…”

Section: Neurosarcoidosismentioning

confidence: 99%

Neurosurgical Intervention for Nerve and Muscle Biopsies

Mohamed,

Caussat,

Mouhawasse

et al. 2024

Preprint

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(1) Background: Neurologic and musculoskeletal diseases represent a considerable portion of the underlying etiologies responsible for the widely prevalent symptoms of pain, weakens, numbness, and paresthesia. Because of the subjective and often nonspecific nature of these symptoms, different diagnostic modalities have been explored and utilized.; (2) Methods: Literature review; (3) Results: Nerve and muscle biopsy remains the gold standard for diagnosing many of the responsible neurological and musculoskeletal conditions. However, the need for invasive tissue sampling is diminishing as more investigations explore alternative diagnostic modalities. Because of this, it is important to explore the current role of neurosurgical intervention for nerve and muscle biopsies and its current relevance in the diagnostic landscape of neurological and musculoskeletal disorders. With consideration of the role of nerve and muscle biopsy, it is also important to explore innovations and emerging techniques for conducting these procedures. This review explores the indications and emerging techniques for neurological intervention for nerve and muscle biopsies; (4) Conclusions: The role of neurosurgical intervention for nerve and muscle biopsy remains relevant in diagnosing many neurological and musculoskeletal disorders. Biopsy is especially relevant as a supportive point of evidence for diagnosis in atypical cases. Additionally, emerging techniques have been explored to guide diagnostics and biopsy, conduct less invasive biopsies, and reduce risks of worsening neurologic function and other symptoms secondary to biopsy.

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Vasculitic neuropathy: A retrospective analysis of nerve biopsies and clinical features from a single tertiary care center

Cited by 6 publications

References 23 publications

Isolated Ulnar Neuropathy After Acute Angioedema

Isolated Ulnar Neuropathy After Acute Angioedema

Electrodiagnostic studies and new diagnostic modalities for evaluation of peripheral nerve disorders

Neurosurgical Intervention for Nerve and Muscle Biopsies

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