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Slouma M, Ben Dhia S, Cheour E, Gharsallah I. Acroparesthesias: An Overview. Curr Rheumatol Rev 2024; 20:115-126. [PMID: 37921132 DOI: 10.2174/0115733971254976230927113202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 08/09/2023] [Accepted: 08/18/2023] [Indexed: 11/04/2023]
Abstract
Acroparesthesia is a symptom characterized by a subjective sensation, such as numbness, tingling, prickling, and reduced sensation, affecting the extremities (fingers and toes). Despite its frequency, data regarding its diagnostic approach and management are scarce. The etiological diagnosis of acroparesthesia is sometimes challenging since it can be due to abnormality anywhere along the sensory pathway from the peripheral nervous system to the cerebral cortex. Acroparesthesia can reveal several diseases. It can be associated with rheumatic complaints such as arthritis or myalgia. Further cautions are required when paresthesia is acute (within days) in onset, rapidly progressive, severe, asymmetric, proximal, multifocal, or associated with predominant motor signs (limb weakness) or severe dysautonomia. Acroparesthesia may reveal Guillain-Barré syndrome or vasculitis, requiring rapid management. Acroparesthesia is a predominant symptom of polyneuropathy, typically distal and symmetric, often due to diabetes. However, it can occur in other diseases such as vitamin B12 deficiency, monoclonal gammopathy of undetermined significance, or Fabry's disease. Mononeuropathy, mainly carpal tunnel syndrome, remains the most common cause of acroparesthesia. Ultrasonography contributes to the diagnosis of nerve entrapment neuropathy by showing nerve enlargement, hypoechogenic nerve, and intraneural vascularity. Besides, it can reveal its cause, such as space-occupying lesions, anatomical nerve variations, or anomalous muscle. Ultrasonography is also helpful for entrapment neuropathy treatment, such as ultrasound-guided steroid injection or carpal tunnel release. The management of acroparesthesia depends on its causes. This article aimed to review and summarize current knowledge on acroparesthesia and its causes. We also propose an algorithm for the management of acroparesthesia.
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Affiliation(s)
- Maroua Slouma
- Department of Rheumatology, Military Hospital, Tunis, Tunisia
- Department of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Siwar Ben Dhia
- Department of Rheumatology, Military Hospital, Tunis, Tunisia
- Department of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Elhem Cheour
- Department of Medicine, Tunis El Manar University, Tunis, Tunisia
- Pain Treatment Center, La Rabta Hospital, Tunis, Tunisia
| | - Imen Gharsallah
- Department of Rheumatology, Military Hospital, Tunis, Tunisia
- Department of Medicine, Tunis El Manar University, Tunis, Tunisia
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Chen Y, Tang X. Chronic Inflammatory Demyelinating Polyradiculoneuropathy in Association With Concomitant Diseases: Identification and Management. Front Immunol 2022; 13:890142. [PMID: 35860284 PMCID: PMC9289227 DOI: 10.3389/fimmu.2022.890142] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/27/2022] [Indexed: 11/17/2022] Open
Abstract
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a rare, heterogeneous, but treatable autoimmune-mediated peripheral neuropathy characterized by demyelination. CIDP can occur independently or simultaneously with a variety of diseases such as diabetes, monoclonal gammopathy of undetermined significance (MGUS), connective tissue disease, and HIV. It is important to identify CIDP and specific peripheral neuropathies caused by these diseases; this review aims to summarize the CIDP literatures related to diabetes, MGUS, SLE, and HIV, and to be helpful for the management of such patients.
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Bae DW, An JY. Cross-sectional area reference values for high-resolution ultrasonography of the lower extremity nerves in healthy Korean adults. Medicine (Baltimore) 2022; 101:e29842. [PMID: 35777005 PMCID: PMC9239665 DOI: 10.1097/md.0000000000029842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The cross-sectional area (CSA) reference values of the lower extremity nerves in Asians have been rarely reported. For this study, 107 sex- and age-matched, healthy subjects with a mean age of 46 years (range, 24-75 years) were recruited. All subjects underwent standardized nerve conduction studies of the upper and lower extremities. The CSA was measured unilaterally at 12 sites in the lower extremity nerves, including the femoral, lateral femoral cutaneous, sciatic, common peroneal, superficial peroneal, deep peroneal, tibial, and sural nerves. The CSA significantly correlated with height, weight, and body mass index. The CSA was significantly larger in males than females at most nerves except for the lateral femoral cutaneous, common peroneal (fibular head), and superficial peroneal nerves (distal calf). There was no statistically significant difference between the age groups except for the tibial nerve (ankle). The results of this study provide CSA reference values for the lower extremity nerves including small branches and the values can be useful in the ultrasonographic investigation of various peripheral neuropathies in East Asian populations.
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Affiliation(s)
- Dae Woong Bae
- Department of Neurology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Young An
- Department of Neurology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- *Correspondence: Jae Young An, Department of Neurology, St. Vincent’s Hospital, The Catholic University of Korea, 93-6, Ji-dong, Paldal-gu, Suwon, Gyeonggi-do 442-723, Korea (e-mail: )
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Athanasopoulos D, Motte J, Fisse AL, Grueter T, Trampe N, Sturm D, Tegenthoff M, Sgodzai M, Klimas R, Querol L, Gold R, Pitarokoili K. Longitudinal study on nerve ultrasound and corneal confocal microscopy in NF155 paranodopathy. Ann Clin Transl Neurol 2020; 7:1061-1068. [PMID: 32432402 PMCID: PMC7318093 DOI: 10.1002/acn3.51061] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/24/2020] [Accepted: 04/24/2020] [Indexed: 12/22/2022] Open
Abstract
We report the case of a 27‐year‐old patient with subacute anti‐neurofascin‐155 neuropathy with bifacial palsy, who showed excellent response to rituximab. We provide longitudinal data of established clinical scores, nerve conduction studies, antibody titers, and novel imaging methods (nerve ultrasonography and corneal confocal microscopy). Clinical and electrophysiological improvement followed the reduction of serum antibody titer and correlated with a reduction of corneal inflammatory cellular infiltrates whereas the increase in the cross‐sectional area of the peripheral nerves remained 12 months after first manifestation. Our findings suggest that novel techniques provide useful follow‐up parameters in paranodopathies.
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Affiliation(s)
| | - Jeremias Motte
- Department of Neurology, St. Josef Hospital, Ruhr-University, Bochum, Germany
| | - Anna Lena Fisse
- Department of Neurology, St. Josef Hospital, Ruhr-University, Bochum, Germany
| | - Thomas Grueter
- Department of Neurology, St. Josef Hospital, Ruhr-University, Bochum, Germany
| | - Nadine Trampe
- Department of Neurology, Katholische Kliniken Emscher-Lippe, Germany
| | - Dietrich Sturm
- Department of Neurology, Agaplesion Bethesda Hospital, Wuppertal, Germany.,Department of Neurology, Bergmannsheil University Hospital, Ruhr University, Bochum, Germany
| | - Martin Tegenthoff
- Department of Neurology, Bergmannsheil University Hospital, Ruhr University, Bochum, Germany
| | - Melissa Sgodzai
- Department of Neurology, St. Josef Hospital, Ruhr-University, Bochum, Germany
| | - Rafael Klimas
- Department of Neurology, St. Josef Hospital, Ruhr-University, Bochum, Germany
| | - Luis Querol
- Unidad de Enfermedades Neuromusculares, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Ralf Gold
- Department of Neurology, St. Josef Hospital, Ruhr-University, Bochum, Germany
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Ultrasound Parameters Other Than the Direct Measurement of Ulnar Nerve Size for Diagnosing Cubital Tunnel Syndrome: A Systemic Review and Meta-analysis. Arch Phys Med Rehabil 2019; 100:1114-1130. [DOI: 10.1016/j.apmr.2018.06.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 06/14/2018] [Accepted: 06/18/2018] [Indexed: 12/12/2022]
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Ultrasound and EMG-NCV study (electromyography and nerve conduction velocity) correlation in diagnosis of nerve pathologies. J Ultrasound 2017; 20:111-122. [PMID: 28593000 DOI: 10.1007/s40477-016-0232-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 11/13/2016] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Nerve disorders are commonly encountered in clinical practice. Ultrasonography (USG) is a useful modality in the evaluation of most of the peripheral and superficial pathologies amenable to penetration by ultrasound. The primary objective is to study the USG findings of various peripheral nerve pathologies and to correlate them with electrophysiological (EMG-NCV) findings. METHOD 42 patients referred with suspicion of peripheral nervous system affection were evaluated with USG along with EMG-NCV. After reviewing detailed anatomy of the region, the affected nerve was visualized along the major neurovascular bundle or at a known anatomical landmark with a high-frequency (9-20 MHz) linear/hockey stick transducer. RESULTS The USG parameters, namely loss of fibrillary pattern, hypoechogenicity and nerve thickening, showed significant p value (p < 0.05) on the tests of significance, suggesting these parameters are significant predictors of nerve affection/pathology on USG. Each ultrasound parameter was correlated individually with SNAP and CMAP. The results revealed positive correlation of echogenicity (r = 0.210, p = 0.05), fibrillary pattern (r = 0.209, p = 0.05) and thickening (r = 0.387, p < 0.05) with sensory nerve action potential (SNAP) and compound muscle action potential (CMAP). CONCLUSION USG can be used as corroborative investigation to strengthen the findings of EMG-NCV. This combination represents a powerful tool in enabling appropriate planning for treatment, preventing unnecessary intervention and thus improving overall outcomes in patients with peripheral neuropathy.
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Grimm A, Décard BF, Axer H. Ultrasonography of the peripheral nervous system in the early stage of Guillain-Barré syndrome. J Peripher Nerv Syst 2015; 19:234-41. [PMID: 25418824 DOI: 10.1111/jns.12091] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 06/22/2014] [Accepted: 07/31/2014] [Indexed: 12/18/2022]
Abstract
Ultrasonography can be used to visualize peripheral nerve abnormalities in immune-mediated neuropathies. The objective of this study was to prove the role of ultrasonography (US) in acute phase of Guillain-Barré syndrome (GBS). Systematic ultrasonic measurements of several peripheral nerves including the vagal nerve as well as the sixth cervical nerve root were performed in 18 patients with GBS at days 1-3 after symptom onset and compared to 21 healthy controls. Nerve conduction studies (NCS) of corresponding nerves were undertaken. Consequently, significant differences between the groups were found in compound muscle action potential amplitudes, F-wave latency, and persistency. Ultrasonic cross-sectional areas (CSAs) showed significant enlargement in all nerves except of the ulnar nerve (upper arm) and the sural nerve compared to healthy controls, most prominent in proximal and middle median nerve (p < 0.01). The vagal nerve also showed enlargement compared to controls (p < 0.05), which was most pronounced in patients with autonomic dysfunction compared to patients without (p < 0.05). C6 root diameter showed a significant correlation to the amount of cerebrospinal fluid (CSF)-protein (Pearson correlation, p < 0.05). US shows nerve enlargement in several peripheral nerves including vagal nerve and C6 root in acute phase of GBS and could be an additional diagnostic tool for example, in GBS of atypical onset and autonomic dysfunction.
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Affiliation(s)
- Alexander Grimm
- Department of Neurology, Basel University Hospital, Basel, Switzerland
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Kerasnoudis A, Tsivgoulis G. Nerve Ultrasound in Peripheral Neuropathies: A Review. J Neuroimaging 2015; 25:528-38. [PMID: 25996962 DOI: 10.1111/jon.12261] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 04/06/2015] [Indexed: 12/12/2022] Open
Abstract
Peripheral neuropathies are one of the most common reasons for seeking neurological care in everyday practice. Electrophysiological studies remain fundamental for the diagnosis and etiological classification of peripheral nerve impairment. The recent technological development though of high resolution ultrasound has allowed the clinician to obtain detailed structural images of peripheral nerves. Nerve ultrasound mainly focuses on the evaluation of the cross sectional area, cross sectional area variability along the anatomical course, echogenity, vascularity and mobility of the peripheral nerves. An increase of the cross sectional area, hypervascularity, disturbed fascicular echostructure and reduced nerve mobility are some of the most common findings of entrapments neuropathies, such as the carpal or cubital tunnel syndrome. Both the cross-sectional area increase and the hypervascularity detected with the Doppler technique seem to correlate significantly with the clinical and electrophysiological severity of the later mononeuropathies. Significantly greater cross sectional area values of the clinically affected cervical nerve root are often detected in cases of cervical radiculopathy. In such cases, the ultrasound findings seem also to correlate significantly with disease duration. On the other hand, multifocal cross sectional area enlargement of cervical roots and/or peripheral nerves is often documented in cases of immune-mediated neuropathies. None of the later pathological ultrasound findings seem to correlate significantly with the electrophysiological parameters or the functional disability. The aim of this review is to provide a timely update on the role of neuromuscular ultrasound in the diagnostic of the most common entrapment and immune-mediated peripheral neuropathies in clinical practice.
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Affiliation(s)
| | - Georgios Tsivgoulis
- Second Department of Neurology, University of Athens, School of Medicine, "Attikon" University Hospital, Athens, Greece.,International Clinical Research Center, St. Anne's University Hospital in Brno, Brno, Czech Republic
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Grimm A, Décard BF, Athanasopoulou I, Schweikert K, Sinnreich M, Axer H. Nerve ultrasound for differentiation between amyotrophic lateral sclerosis and multifocal motor neuropathy. J Neurol 2015; 262:870-80. [PMID: 25626722 DOI: 10.1007/s00415-015-7648-0] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 01/12/2015] [Accepted: 01/13/2015] [Indexed: 12/15/2022]
Abstract
Ultrasound is useful for non-invasive visualization of focal nerve pathologies probably resulting from demyelination, remyelination, edema or inflammation. In patients with progressive muscle weakness, differentiation between multifocal motor neuropathy (MMN) and amyotrophic lateral sclerosis (ALS) is essential regarding therapy and prognosis. Therefore, the objective of this study was to investigate whether nerve ultrasound can differentiate between ALS and MMN. Systematic ultrasound measurements of peripheral nerves and the 6th cervical nerve root (C6) were performed in 17 patients with ALS, in 8 patients with MMN and in 28 healthy controls. Nerve conduction studies of corresponding nerves were undertaken in MMN and ALS patients. Electromyography was performed in ALS patients according to revised El-Escorial criteria. ANOVA and unpaired t test with Bonferroni correction revealed significant differences in cross-sectional areas (CSA) of different nerves and C6 diameter between the groups. Nerve enlargement was found significantly more frequently in MMN than in other groups (p < 0.001). Receiver operating characteristics analysis revealed detection of enlarged nerves/roots in at least four measurement points to serve as a good marker to differentiate MMN from ALS with a sensitivity of 87.5% and a specificity of 94.1%. Ultrasonic focal nerve enlargement in MMN was often not colocalized with areas of conduction blocks found in nerve conduction studies. Systematic ultrasound measurements in different nerves and nerve roots are valuable for detecting focal nerve enlargement in MMN, generally not found in ALS and thus could serve as a diagnostic marker to differentiate between both entities in addition to electrodiagnostic studies.
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Affiliation(s)
- Alexander Grimm
- Department of Neurology, Neuromuscular Center, Basel University Hospital, University Basel, Petersgraben 4, 4000, Basel, Switzerland,
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Grimm A, Heiling B, Schumacher U, Witte OW, Axer H. Ultrasound differentiation of axonal and demyelinating neuropathies. Muscle Nerve 2014; 50:976-83. [PMID: 24634226 DOI: 10.1002/mus.24238] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2014] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Ultrasound can be used to visualize peripheral nerve abnormality. Our objective in this study was to prove whether nerve ultrasound can differentiate between axonal and demyelinating polyneuropathies (PNPs). METHODS Systematic ultrasound measurements of peripheral nerves were performed in 53 patients (25 with demyelinating, 20 with axonal, 8 with mixed neuropathy) and 8 healthy controls. Nerve conduction studies of corresponding nerves were undertaken. RESULTS Analysis of variance revealed significant differences between the groups with regard to motor conduction velocity, compound muscle action potential amplitude, and cross-sectional area (CSA) of different nerves at different locations. Receiver operating characteristic curve analysis revealed CSA measurements to be well suited for detection of demyelinating neuropathies, and boundary values of peripheral nerve CSA could be defined. CONCLUSIONS Systematic ultrasound CSA measurement in different nerves helped detect demyelination, which is an additional cue in the etiological diagnosis of PNP, along with nerve conduction studies and nerve biopsy.
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Affiliation(s)
- Alexander Grimm
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany; Department of Neurology, Basel University Hospital, Petersgraben 4 CH-4000, Basel, Switzerland; Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany
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11
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Scheidl E, Böhm J, Simó M, Bereznai B, Bereczki D, Arányi Z. Different patterns of nerve enlargement in polyneuropathy subtypes as detected by ultrasonography. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:1138-1145. [PMID: 24613217 DOI: 10.1016/j.ultrasmedbio.2013.12.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Revised: 12/11/2013] [Accepted: 12/12/2013] [Indexed: 06/03/2023]
Abstract
The purpose of our study was to examine how the pathologic type of polyneuropathy affects nerve size as assessed by high-resolution ultrasonography with a 15 MHz transducer. Cross-sectional area (CSA) of the C5-C7 nerve roots and several upper and lower limb nerves at multiple sites was measured in 38 patients with acquired diffuse sensorimotor demyelinating or axonal polyneuropathy and in 34 healthy control subjects. Significant differences were found among the groups for all nerve and root segments: Both types of polyneuropathy are characterized by nerve enlargement in comparison to controls, but in different patterns. In demyelinating polyneuropathies, an additional degree of nerve thickening appears in proximal upper limb nerves and cervical nerve roots compared with axonal polyneuropathies. With respect to the other nerves, a similar degree of nerve enlargement was observed in both patient groups. These results highlight that ultrasonography may be a complementary tool in differentiating polyneuropathies.
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Affiliation(s)
- Erika Scheidl
- Department of Neurology, Semmelweis University, Budapest, Hungary.
| | - Josef Böhm
- Department of Neurology, Freiberg County Hospital, Freiberg, Germany
| | - Magdolna Simó
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | | | - Dániel Bereczki
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Arányi
- Department of Neurology, Semmelweis University, Budapest, Hungary
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Kerasnoudis A, Pitarokoili K, Behrendt V, Gold R, Yoon MS. Correlation of nerve ultrasound, electrophysiological, and clinical findings in post Guillain-Barré syndrome. J Peripher Nerv Syst 2014; 18:232-40. [PMID: 24028191 DOI: 10.1111/jns5.12037] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Revised: 07/14/2013] [Accepted: 07/29/2013] [Indexed: 12/30/2022]
Abstract
We aimed to correlate functional disability, electrophysiology, and nerve ultrasound in patients after Guillain-Barré syndrome (GBS). Seventy-five healthy controls and 41 post-GBS patients (mean 3.4 years, SD ± 2.91 years after onset) underwent clinical, sonographic, and electrophysiological evaluation. Compared to healthy controls, the post-GBS patients showed: (1) a mean Rasch-built Overall Disability Scale score of 31.8 (SD ± 11.6), modified Rasch-built fatigue severity scale score of 15.6 (SD ± 3.2), Medical Research Council sum score of 22 (SD ± 5.6); (2) electrophysiological signs of permanent axonal loss in the majority of the peripheral nerves; (3) sonographical evidence of higher cross-sectional area values (CSA) of the ulnar (elbow, p < 0.001), radial (spiral groove, p < 0.001), tibial nerve (popliteal fossa, p < 0.001) and brachial plexus (supraclavicular space, p < 0.001). No correlation between sonographic and electrophysiological findings was found. Neither nerve ultrasound nor electrophysiology correlated with muscle strength, overall disability, and fatigue scale. Compared to healthy controls, post-GBS patients had significant functional disability. Despite significant abnormalities in both electrophysiology and ultrasound compared to healthy controls, neither electrophysiology nor nerve ultrasound correlated with functional disability of these patients.
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Affiliation(s)
- Antonios Kerasnoudis
- Department of Neurology, St. Josef Hospital, Ruhr University of Bochum, Bochum, Germany
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Kerasnoudis A, Pitarokoili K, Behrendt V, Gold R, Yoon MS. Correlation of nerve ultrasound, electrophysiological and clinical findings in chronic inflammatory demyelinating polyneuropathy. J Neuroimaging 2014; 25:207-216. [PMID: 24593005 DOI: 10.1111/jon.12079] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 08/04/2013] [Accepted: 08/11/2013] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND PURPOSE We present the nerve ultrasound findings in chronic inflammatory demyelinating polyneuropathy (CIDP) and examine their correlation with electrophysiology and functional disability. METHODS A total of 75 healthy controls and 48 CIDP patients underwent clinical, sonographic and electrophysiological evaluation a mean of 3.9 years(SD+/-2.7) after disease onset. RESULTS Nerve ultrasound revealed statistically significant higher cross-sectional area (CSA) values of the median (P<.0001), ulnar (P<.0001), radial (P<.0001), tibial (P<.0001), fibular nerve(P<.0001) in most of the anatomic sites and brachial plexus (supraclavicular, P<.0001;interscalene space, P = .0118),when compared to controls. The electroneurography documented signs of permanent axonal loss in the majority of peripheral nerves. A correlation between sonographic and electrophysiological findings was found only between the motor conduction velocity and CSA of the tibial nerve at the ankle (r = -.451, P = .007). Neither nerve sonography nor electrophysiology correlated with functional disability. The CSA of the median nerve in carpal tunnel and the ulnar nerve in Guyon's canal correlated with disease duration (P = .036, P = .027 respectively). DISCUSSION CIDP seems to show inhomogenous CSA enlargement in brachial plexus and peripheral nerves, with weak correlation to electrophysiological findings. Neither nerve sonography nor electrophysiology correlated with functional disability in CIDP patients. Multicenter, prospective studies are required to proof the applicability and diagnostic values of these findings.
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Affiliation(s)
- A Kerasnoudis
- Department of Neurology, St. Josef Hospital, Ruhr-University of Bochum, Germany
| | - K Pitarokoili
- Department of Neurology, St. Josef Hospital, Ruhr-University of Bochum, Germany
| | - V Behrendt
- Department of Neurology, St. Josef Hospital, Ruhr-University of Bochum, Germany
| | - R Gold
- Department of Neurology, St. Josef Hospital, Ruhr-University of Bochum, Germany
| | - M-S Yoon
- Department of Neurology, St. Josef Hospital, Ruhr-University of Bochum, Germany
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Tsukamoto H, Granata G, Coraci D, Paolasso I, Padua L. Ultrasound and neurophysiological correlation in common fibular nerve conduction block at fibular head. Clin Neurophysiol 2014; 125:1491-5. [PMID: 24461795 DOI: 10.1016/j.clinph.2013.11.041] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 10/30/2013] [Accepted: 11/22/2013] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Ultrasound (US) and neurophysiological examination are useful tools in the evaluation of common fibular mononeuropathy. There is only a report comparing US and electrophysiological parameters in patients with common fibular nerve (CFN) conduction block at fibular head. We investigated the correlation between US and neurophysiologic findings in this condition. METHODS We retrospectively reviewed patients with CFN assessed in our lab during last 2 years. Each patient underwent to clinical, neurophysiological and ultrasound evaluations. Cross sectional area (CSA) of CFN at fibular head was assessed. RESULTS Twenty-four patients were included. Motor nerve conduction study showed a reduction of distal compound muscle action potential (CMAP) amplitude in 10 patients (mean 1.3 mV). US showed an increased CSA in 10 patients. Statistical analysis revealed a strong correlation between the increased CSA and the CMAP reduction of CFN. CONCLUSION Our data suggest that usually US examination is normal in CFN conduction block at fibular head. However the association with axonal damage is frequently accompanied by an increase of CSA. SIGNIFICANCE Ultrasound evaluation may represent a powerful diagnostic/prognostic tool in cases with CPN conduction block at fibular head because it usually shows normal pattern in pure conduction block and increase of CSA in associated axonal damage.
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Affiliation(s)
- Hiroshi Tsukamoto
- Institute of Neurology, Catholic University of Sacred Heart, Rome, Italy.
| | - Giuseppe Granata
- Institute of Neurology, Catholic University of Sacred Heart, Rome, Italy
| | | | | | - Luca Padua
- Institute of Neurology, Catholic University of Sacred Heart, Rome, Italy; Don Carlo Gnocchi Onlus Foundation, Milan, Italy
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Padua L, Paolasso I, Pazzaglia C, Granata G, Lucchetta M, Erra C, Coraci D, De Franco P, Briani C. High ultrasound variability in chronic immune-mediated neuropathies. Review of the literature and personal observations. Rev Neurol (Paris) 2013; 169:984-90. [DOI: 10.1016/j.neurol.2013.07.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 07/26/2013] [Accepted: 07/26/2013] [Indexed: 12/12/2022]
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Kerasnoudis A, Pitarokoili K, Behrendt V, Gold R, Yoon MS. Nerve ultrasound score in distinguishing chronic from acute inflammatory demyelinating polyneuropathy. Clin Neurophysiol 2013; 125:635-41. [PMID: 24070674 DOI: 10.1016/j.clinph.2013.08.014] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 08/04/2013] [Accepted: 08/08/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Aim of this study was to develop and evaluate the applicability of an ultrasound score (Bochum ultrasound score - BUS) in distinguishing chronic (CIDP) from acute inflammatory demyelinating polyneuropathy (AIDP). METHODS Step 1: For the development of BUS 75 healthy-controls, 20 CIDP, 20 AIDP patients underwent US 4.55 ± 3.5 and 3.4 ± 2.91 years, respectively after onset. After comparing the distribution pattern and frequency of pathological US changes between the two study groups, we developed BUS, summarizing the cross sectional area (CSA) of: (1) the ulnar nerve in Guyons' canal, (2) the ulnar nerve in upper-arm, (3) the radial nerve in spiral groove, (4) the sural nerve between the gastrocnemius muscle. Step 2: The BUS underwent blinded evaluation in further 10 CIDP, 21 AIDP patients 3.8 ± 2.7 and 2.3 ± 1.5 years, respectively after onset. Step 3: The BUS underwent blinded, prospective evaluation in 8 patients with acute/subacute polyradiculoneuropathy (5 CIDP, 3 AIDP) 2.6 ± 1.8 weeks after onset. RESULTS The BUS showed a sensitivity of 90% and specificity of 90.4% (positive predictive value, PPV=81.8%; negative predictive value, NPV=95%) in distinguishing CIDP from AIDP, when they showed no differences in disease duration (p=0.0551).In addition, the BUS distinguished subacute-CIDP from AIDP with a sensitivity of 80%, specificity of 100% (PPV=100%, NPV=75%). CONCLUSION The BUS seems to allow a reliable distinction of CIDP from AIDP. SIGNIFICANCE The BUS may be helpful in distinguishing subacute-CIDP from AIDP.
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Affiliation(s)
- A Kerasnoudis
- Department of Neurology, St. Josef Hospital, Ruhr University of Bochum, Germany.
| | - K Pitarokoili
- Department of Neurology, St. Josef Hospital, Ruhr University of Bochum, Germany.
| | - V Behrendt
- Department of Neurology, St. Josef Hospital, Ruhr University of Bochum, Germany.
| | - R Gold
- Department of Neurology, St. Josef Hospital, Ruhr University of Bochum, Germany.
| | - M-S Yoon
- Department of Neurology, St. Josef Hospital, Ruhr University of Bochum, Germany.
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Kerasnoudis A, Pitarokoili K, Behrendt V, Gold R, Yoon MS. Cross sectional area reference values for sonography of peripheral nerves and brachial plexus. Clin Neurophysiol 2013; 124:1881-8. [DOI: 10.1016/j.clinph.2013.03.007] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 01/30/2013] [Accepted: 03/10/2013] [Indexed: 01/25/2023]
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