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Gasemaltayeb R, Wannarong T, Ticku H, Preston DC. Neuromuscular ultrasound: Impact on diagnosis and management. Muscle Nerve 2024; 69:295-302. [PMID: 37818726 DOI: 10.1002/mus.27983] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 09/21/2023] [Accepted: 09/23/2023] [Indexed: 10/13/2023]
Abstract
INTRODUCTION/AIM High-resolution ultrasound (HRUS) is increasingly used in evaluating neuromuscular conditions. Its potential advantages include its ability to discern anatomic information and make specific etiological diagnoses. Although many studies have demonstrated HRUS effectiveness, especially in mononeuropathies, more information is needed to better determine how often and to what extent useful information is obtained; how it influences diagnosis, clinical decision-making, and patient management; and how it is used with electrodiagnostic (EDx) studies. METHODS A retrospective cohort study was performed on patients referred for HRUS at a university laboratory during 2021. Demographic information, referral diagnoses, clinical information, HRUS findings, and follow-up patient management were analyzed. For patients who had EDx, results were compared with HRUS. Determinations were made whether HRUS did or did not aid in the diagnosis. For patients in whom HRUS resulted in a diagnosis, determination was made whether it confirmed the diagnosis made clinically or by EDx but did not change management; added additional important information; and/or made a decisive impact on subsequent management. RESULTS Five hundred two patients were analyzed, most referred for mononeuropathy, brachial plexopathy, and polyneuropathy. HRUS was abnormal in 81.7% of patients. HRUS added additional useful information in 79.0% and was decisive in management in 62.7%. In patients who also had abnormal EDx, HRUS resulted in decisive management in 49.5%. DISCUSSION HRUS is an effective diagnostic tool that frequently adds localizing and structural information that is otherwise not obtainable by clinical and EDx evaluation. In a substantial number of patients selected for HRUS, it is decisive in guiding further management.
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Affiliation(s)
- Raed Gasemaltayeb
- Neurological Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Thapat Wannarong
- Neuromuscular Division, Department of Neurology, Duke University Hospital, Durham, North Carolina, USA
| | - Hemani Ticku
- Neurological Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - David C Preston
- Neurological Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
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2
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Hearn SL, Jorgensen SP, Robinson LR. Unblocking the ulnar nerve: It takes time. Muscle Nerve 2023; 68:693-695. [PMID: 37632343 DOI: 10.1002/mus.27958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/01/2023] [Accepted: 08/04/2023] [Indexed: 08/28/2023]
Affiliation(s)
- Sandra L Hearn
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Shawn P Jorgensen
- Department of Physical Medicine and Rehabilitation, Albany Medical College, Albany, New York, USA
- Department of Family Medicine, Larner Medical College at the University of Vermont, Burlington, Vermont, USA
- Adirondack Rehabilitation Medicine, PLLC, Queensbury, New York, USA
| | - Lawrence R Robinson
- Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
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3
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Ultrasonographic evaluation reveals thinning of cervical nerve roots and peripheral nerves in spinal and bulbar muscular atrophy. Neurol Sci 2022; 43:4267-4274. [DOI: 10.1007/s10072-022-05969-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/22/2022] [Indexed: 11/25/2022]
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4
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Use of Neuromuscular Ultrasound in the Diagnosis of Disulfiram Polyneuropathy. J Clin Neuromuscul Dis 2022; 23:201-204. [PMID: 35608643 DOI: 10.1097/cnd.0000000000000380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ABSTRACT We present the case of a 37-year-old woman with alcohol use disorder, who developed leg cramping, bilateral foot drop, and hand weakness 3 months after starting disulfiram. This was accompanied by an 18-pound involuntary weight loss. Electrophysiologic findings showed a motor predominant axonal neuropathy. Neuromuscular ultrasound showed normal to small cross-sectional area of all nerves studied. This case is discussed, and the ultrasound findings are compared with another reported case.
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5
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Fodor D, Rodriguez-Garcia SC, Cantisani V, Hammer HB, Hartung W, Klauser A, Martinoli C, Terslev L, Alfageme F, Bong D, Bueno A, Collado P, D'Agostino MA, de la Fuente J, Iohom G, Kessler J, Lenghel M, Malattia C, Mandl P, Mendoza-Cembranos D, Micu M, Möller I, Najm A, Özçakar L, Picasso R, Plagou A, Sala-Blanch X, Sconfienza LM, Serban O, Simoni P, Sudoł-Szopińska I, Tesch C, Todorov P, Uson J, Vlad V, Zaottini F, Bilous D, Gutiu R, Pelea M, Marian A, Naredo E. The EFSUMB Guidelines and Recommendations for Musculoskeletal Ultrasound - Part I: Extraarticular Pathologies. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2022; 43:34-57. [PMID: 34479372 DOI: 10.1055/a-1562-1455] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The first part of the guidelines and recommendations for musculoskeletal ultrasound, produced under the auspices of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB), provides information about the use of musculoskeletal ultrasound for assessing extraarticular structures (muscles, tendons, entheses, ligaments, bones, bursae, fasciae, nerves, skin, subcutaneous tissues, and nails) and their pathologies. Clinical applications, practical points, limitations, and artifacts are described and discussed for every structure. After an extensive literature review, the recommendations have been developed according to the Oxford Centre for Evidence-based Medicine and GRADE criteria and the consensus level was established through a Delphi process. The document is intended to guide clinical users in their daily practice.
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Affiliation(s)
- Daniela Fodor
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Vito Cantisani
- Department of Radiological, Oncological and Anatomo-pathological Sciences, "Sapienza" University, Rome, Italy
| | - Hilde B Hammer
- Department of Rheumatology, Diakonhjemmet Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Wolfgang Hartung
- Clinic for Rheumatology and Clinical Immunology, Asklepios Clinic, Bad Abbach, Germany
| | - Andrea Klauser
- Department of Radiology, Medical University Innsbruck, Section Head Rheumatology and Sports Imaging, Innsbruck, Austria
| | - Carlo Martinoli
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Lene Terslev
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Fernando Alfageme
- Dermatology Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - David Bong
- Instituto Poal de Reumatologia Barcelona, EULAR Working Group Anatomy for the Image, University of Barcelona, International University of Catalunya, Spain
| | - Angel Bueno
- Department of Musculoskeletal Radiology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Paz Collado
- Rheumatology Department, Transitional Care Clinic, Hospital Universitario Severo Ochoa, Madrid, Spain
| | - Maria Antonietta D'Agostino
- Istituto di Reumatologia Università Cattolica del Sacro Cuore, UOC Reumatologia, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | | | - Gabriella Iohom
- Department of Anaesthesiology and Intensive Care Medicine, Cork University Hospital and University College Cork, Cork, Ireland
| | - Jens Kessler
- Department of Anaesthesiology, Division of Pain Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Manuela Lenghel
- Radiology Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Clara Malattia
- UOC Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI) University of Genoa, Genoa, Italy
| | - Peter Mandl
- Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | | | - Mihaela Micu
- Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital Cluj-Napoca, Romania
| | - Ingrid Möller
- Instituto Poal de Reumatologia Barcelona, EULAR Working Group Anatomy for the Image, University of Barcelona, International University of Catalunya, Spain
| | - Aurelie Najm
- Institute of Infection, Immunity and Inflammation, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Riccardo Picasso
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Athena Plagou
- Ultrasound Unit, Private Radiological Institution, Athens, Greece
| | - Xavier Sala-Blanch
- Department of Anaesthesiology, Hospital Clinic, Department of Human Anatomy, Faculty of Medicine, University of Barcelona, Spain
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milano Italy
- Department of Biomedical Sciences for Health, University of Milano, Milano, Italy
| | - Oana Serban
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Paolo Simoni
- Paediatric Imaging Department, "Reine Fabiola" Children's University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | | | - Plamen Todorov
- Department of Internal Disease Propaedeutic and Clinical Rheumatology, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Jacqueline Uson
- Department of Rheumatology Hospital Universitario Móstoles, Universidad Rey Juan Carlos, Madrid, Spain
| | - Violeta Vlad
- Sf. Maria Hospital, Rheumatology Department, Bucharest, Romania
| | - Federico Zaottini
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Diana Bilous
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Roxana Gutiu
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Michael Pelea
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Anamaria Marian
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Esperanza Naredo
- Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid, Madrid, Spain
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Reddy YM, K. Murthy J, Suresh L, Jaiswal S, Pidaparthi L, S. Kiran ES. Diagnosis and severity evaluation of ulnar neuropathy at the elbow by ultrasonography: A case-control study. J Med Ultrasound 2022; 30:189-195. [DOI: 10.4103/jmu.jmu_152_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 07/31/2021] [Accepted: 08/09/2021] [Indexed: 11/04/2022] Open
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7
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Jorgensen SP, Cartwright MS, Norbury J. Neuromuscular Ultrasound: Indications in the Electrodiagnostic Laboratory. Am J Phys Med Rehabil 2022; 101:78-88. [PMID: 33990480 DOI: 10.1097/phm.0000000000001790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Accurate assessment of neuromuscular disorders is critical to facilitate timely treatment and achieve the best outcomes. Historically, electrodiagnostic studies have filled this role, but recently, neuromuscular ultrasound is being used in the electrodiagnostic laboratory. This review discusses the uses of neuromuscular ultrasound in the electrodiagnostic laboratory that have strong evidence, emphasizing those that could be adopted in a typical electrodiagnostic laboratory with a reasonable level of equipment and training. The evidence currently supports using neuromuscular ultrasound to diagnose carpal tunnel syndrome and ulnar neuropathies at the elbow and as a supplementary test when electrodiagnostic studies are suspected to be falsely negative or in axonal nonlocalizing lesions. Neuromuscular ultrasound can identify the causes of focal mononeuropathies, which can change treatment in specific cases. It is sensitive at identifying fasciculations and providing complementary evidence of autoimmune demyelinating polyneuropathies. It is particularly helpful in assessing nerves after trauma. Neuromuscular ultrasound is likely to prove even more useful in the electrodiagnostic laboratory as the technology continues to advance.
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Affiliation(s)
- Shawn P Jorgensen
- From the Department of Physical Medicine and Rehabilitation, Albany Medical College, Albany, New York (SPJ); Department of Family Medicine, Larner Medical College at the University of Vermont, Burlington, Vermont (SPJ); Adirondack Rehabilitation Medicine, PLLC, Queensbury, New York (SPJ); Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, North Carolina (MSC); and Division of Physical Medicine and Rehabilitation, Department of Neurology, Texas Tech University Health Sciences Center, Lubbock, Texas (JN)
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8
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Chhabra A, Ratakonda R, Zaottini F, Picasso R, Martinoli C. Hand and Wrist Neuropathies: High-resolution Ultrasonography and MR Neurography. Semin Musculoskelet Radiol 2021; 25:366-378. [PMID: 34450661 DOI: 10.1055/s-0041-1730406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
High-resolution ultrasonography (US) and magnetic resonance neurography (MRN) have followed parallel paths for peripheral nerve imaging with little comparison of the two modalities. They seem equally effective to study a variety of neuropathies affecting large and small nerves in the wrist and hand. This article outlines the technical considerations of US and MRN and discusses normal and abnormal imaging appearances of hand and wrist nerves from etiologies such as entrapment, injury, tumor, and proximal and diffuse neuropathy, with specific case illustrations.
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Affiliation(s)
- Avneesh Chhabra
- Radiology and Orthopedic Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Raghu Ratakonda
- Radiology and Orthopedic Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Federico Zaottini
- Radiology Unit, Department of Health Sciences (DISSAL), Università di Genova, Genova, Italy.,IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Riccardo Picasso
- Radiology Unit, Department of Health Sciences (DISSAL), Università di Genova, Genova, Italy.,IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Carlo Martinoli
- Radiology Unit, Department of Health Sciences (DISSAL), Università di Genova, Genova, Italy.,IRCCS Ospedale Policlinico San Martino, Genova, Italy
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9
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Zanette G, Tamburin S, Taioli F, Lauriola MF, Badari A, Ferrarini M, Cavallaro T, Fabrizi GM. Nerve size correlates with clinical severity in Charcot–Marie–Tooth disease 1A. Muscle Nerve 2019; 60:744-748. [DOI: 10.1002/mus.26688] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 08/21/2019] [Accepted: 08/27/2019] [Indexed: 02/06/2023]
Affiliation(s)
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement SciencesUniversity of Verona Verona Italy
- Neurology DivisionDepartment of Neuroscience AOUI Verona Verona Italy
| | - Federica Taioli
- Department of Neurosciences, Biomedicine and Movement SciencesUniversity of Verona Verona Italy
- Neurology DivisionDepartment of Neuroscience AOUI Verona Verona Italy
| | | | - Andrea Badari
- Neurology DivisionPederzoli Hospital Peschiera del Garda, Verona Italy
| | - Moreno Ferrarini
- Department of Neurosciences, Biomedicine and Movement SciencesUniversity of Verona Verona Italy
- Neurology DivisionDepartment of Neuroscience AOUI Verona Verona Italy
| | - Tiziana Cavallaro
- Neurology DivisionDepartment of Neuroscience AOUI Verona Verona Italy
| | - Gian Maria Fabrizi
- Department of Neurosciences, Biomedicine and Movement SciencesUniversity of Verona Verona Italy
- Neurology DivisionDepartment of Neuroscience AOUI Verona Verona Italy
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10
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Tawfik EA, Cartwright MS, Grimm A, Boon AJ, Kerasnoudis A, Preston DC, Wilder‐Smith E, Axer H, Hobson‐Webb LD, Alfen N, Crump N, Shahrizaila N, Inkpen P, Mandeville R, Sakamuri S, Shook SJ, Shin S, Walker FO. Guidelines for neuromuscular ultrasound training. Muscle Nerve 2019; 60:361-366. [DOI: 10.1002/mus.26642] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 07/11/2019] [Accepted: 07/15/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Eman A. Tawfik
- Department of Physical Medicine & Rehabilitation, Faculty of MedicineAin Shams University Cairo Egypt
| | | | - Alexander Grimm
- Department of NeurologyUniversity Hospital Tuebingen Tuebingen Germany
| | - Andrea J. Boon
- Department of Physical Medicine and RehabilitationMayo Clinic Rochester Minnesota
| | | | - David C. Preston
- Neurological Institute, University Hospitals, Cleveland Medical CenterCase Western Reserve University Cleveland Ohio
| | - Einar Wilder‐Smith
- Department of NeurologyYong Loo Lin School of Medicine, National University Singapore Singapore
| | - Hubertus Axer
- Hans Berger Department of NeurologyJena University Hospital Jena Germany
| | - Lisa D. Hobson‐Webb
- Department of Neurology, Neuromuscular DivisionDuke University School of Medicine Durham North Carolina
| | - Nens Alfen
- Department of Neurology and Clinical Neurophysiology, Donders Institute for Brain, Cognition, and BehaviorRadboud University Medical Center Nijmegen The Netherlands
| | - Nicholas Crump
- Department of NeurologyAustin Health and University of Melbourne Heidelberg Victoria Australia
| | - Nortina Shahrizaila
- Division of Neurology, Department of Medicine, Faculty of MedicineUniversity of Malaya Kuala Lumpur Malaysia
| | - Peter Inkpen
- Division of Physical Medicine and RehabilitationUniversity of British Columbia Vancouver British Columbia Canada
| | - Ross Mandeville
- Department of NeurosciencesUniversity of California San Diego School of Medicine La Jolla California
| | - Sarada Sakamuri
- Department of Neurology and Neurological SciencesStanford University Stanford California
| | - Steven J. Shook
- Department of NeurologyNeuromuscular Center, Cleveland Clinic Cleveland Ohio
| | - Susan Shin
- Department of Neurology, Mount Sinai School of Medicine New York New York
| | - Francis O. Walker
- Department of NeurologyWake Forest School of Medicine Winston‐Salem North Carolina
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11
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Wee TC, Simon NG. Ultrasound elastography for the evaluation of peripheral nerves: A systematic review. Muscle Nerve 2019; 60:501-512. [PMID: 31269240 DOI: 10.1002/mus.26624] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 06/24/2019] [Accepted: 06/29/2019] [Indexed: 02/06/2023]
Abstract
Peripheral nerve disorders are commonly encountered in clinical practice. Electrodiagnostic studies remain the cornerstone of the evaluation of nerve disorders. More recently, ultrasound has played an increasing complementary role in the neuromuscular clinic. Ultrasound elastography is a technique that measures the elastic properties of tissues. Given the histological changes that occur in diseased peripheral nerves, nerve ultrasound elastography has been explored as a noninvasive way to evaluate changes in nerve tissue composition. Studies to date suggest that nerve stiffness tends to increase in the setting of peripheral neuropathy, regardless of etiology, consistent with loss of more compliant myelin, and replacement with connective tissue. The aim of this systematic review is to summarize the current literature on the use of ultrasound elastography in the evaluation of peripheral neuropathy. Limitations of ultrasound elastography and gaps in current literature are discussed, and prospects for future clinical and research applications are raised.
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Affiliation(s)
- Tze Chao Wee
- Department of Rehabilitation Medicine, Changi General Hospital, Singapore
| | - Neil G Simon
- St Vincent's Clinical School, University of New South Wales, Darlinghurst, New South Wales, Australia
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12
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Pelosi L, Iodice R, Antenora A, Kilfoyle D, Mulroy E, Rodrigues M, Roxburgh R, Iovino A, Filla A, Manganelli F, Santoro L. Spinocerebellar ataxia type 2-neuronopathy or neuropathy? Muscle Nerve 2019; 60:271-278. [PMID: 31228263 DOI: 10.1002/mus.26613] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 06/13/2019] [Accepted: 06/16/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Use of peripheral nerve ultrasound alongside standard electrodiagnostic tests may help to gain insight into the pathophysiology of peripheral nerve involvement in type 2 spinocerebellar ataxia (SCA2). METHODS Twenty-seven patients with SCA2 underwent ultrasound cross-sectional area (CSA) measurement of median, ulnar, sural and tibial nerves, and motor (median, ulnar, tibial) and sensory (median, ulnar, radial, sural) nerve conduction studies. RESULTS Twenty patients had pathologically small-nerve CSAs, suggestive of sensory neuronopathy. In these patients, electrophysiology showed non-length-dependent sensory neuropathy (14 of 20), "possible sensory neuropathy" (1 of 20), or normal findings (5 of 20). Four different patients had length-dependent sensory neuropathy on electrophysiology, and 1 had enlarged nerve CSAs. Regression analysis showed an inverse relationship between ataxia scores and upper limb nerve CSA (P < 0.03). DISCUSSION Our findings suggest that a majority of patients with SCA2 (74%) have a sensory neuronopathy and this correlates with disability. A minority of patients have findings consistent with axonal neuropathy (18%). Muscle Nerve, 2019.
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Affiliation(s)
- Luciana Pelosi
- Department of Neurology and Clinical Neurophysiology, Bay of Plenty District Health Board, Tauranga Hospital, Tauranga, New Zealand
| | - Rosa Iodice
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II, Naples, Italy
| | - Antonella Antenora
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II, Naples, Italy
| | - Dean Kilfoyle
- Department of Neurology, Auckland District Health Board, Auckland, New Zealand
| | - Eoin Mulroy
- Department of Neurology, Auckland District Health Board, Auckland, New Zealand
| | - Miriam Rodrigues
- Department of Neurology, Auckland District Health Board, Auckland, New Zealand
| | - Richard Roxburgh
- Department of Neurology, Auckland District Health Board, Auckland, New Zealand.,Centre of Brain Research Neurogenetics Research Clinic, University of Auckland, Auckland, New Zealand
| | - Aniello Iovino
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II, Naples, Italy
| | - Alessandro Filla
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II, Naples, Italy
| | - Fiore Manganelli
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II, Naples, Italy
| | - Lucio Santoro
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II, Naples, Italy
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13
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Leadbetter R, Weatherall M, Pelosi L. Nerve ultrasound as a diagnostic tool for sensory neuronopathy in spinocerebellar ataxia syndrome. Clin Neurophysiol 2019; 130:568-572. [PMID: 30713001 DOI: 10.1016/j.clinph.2018.12.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 11/30/2018] [Accepted: 12/16/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The objective was to assess if nerve ultrasound has a role in diagnosing sensory neuronopathy in spinocerebellar ataxia syndrome (SCA) by examining if proposed diagnostic cut-off criteria of ultrasound in sensory neuronopathy caused by cerebellar ataxia neuropathy vestibular areflexia syndrome (CANVAS) were also discriminatory for SCA-related sensory neuronopathy. METHODS Optimal diagnostic cut-off criteria for nerve size measured by diagnostic ultrasound were developed in 14 patients with CANVAS and 42 healthy controls using six peripheral nerve sites; and logistic regression and receiver operating characteristic (ROC) curves. These proposed cut-off values were tested in seven patients with spinocerebellar ataxia type 2 (SCA2) patients with sensory neuronopathy. RESULTS Ultrasound of upper limb nerves was highly accurate in differentiating between CANVAS and healthy controls with areas under the ROC curves between 0.97 and 0.99. Optimal cut-off measurements from the CANVAS patients also accurately diagnosed sensory neuronopathy in all patients with SCA2. CONCLUSIONS Upper limb ultrasound is a sensitive tool for detecting sensory neuronopathy in established cases of CANVAS and SCA2. SIGNIFICANCE Ultrasound could aid the diagnosis of sensory neuronopathy in spinocerebellar ataxias.
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Affiliation(s)
- Ruth Leadbetter
- Department of Neurology, Wellington Hospital, Wellington, New Zealand.
| | - Mark Weatherall
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Luciana Pelosi
- Department of Neurology and Clinical Neurophysiology, Bay of Plenty District Health Board, Tauranga Hospital, Tauranga, New Zealand
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14
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Noto YI, Garg N, Li T, Timmins HC, Park SB, Shibuya K, Shahrizaila N, Huynh W, Matamala JM, Dharmadasa T, Yiannikas C, Vucic S, Kiernan MC. Comparison of cross-sectional areas and distal-proximal nerve ratios in amyotrophic lateral sclerosis. Muscle Nerve 2018; 58:777-783. [PMID: 30019401 DOI: 10.1002/mus.26301] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 07/04/2018] [Accepted: 07/08/2018] [Indexed: 12/23/2022]
Abstract
INTRODUCTION This study explored potential diagnostic markers of nerve ultrasound in differentiating amyotrophic lateral sclerosis (ALS) from mimic disorders. METHODS Ultrasound of the median, ulnar, and tibial nerves was conducted in 53 patients with ALS, 32 patients with ALS-mimic disorders, and 30 controls. Nerve cross-sectional area (CSA) and distal-proximal ratios were calculated. RESULTS The median nerve CSA in the upper arm was decreased (7.9 ± 1.3 mm2 vs. 9.0 ± 1.4 mm2 , P < 0.05), and the median nerve wrist-upper arm ratio was increased in ALS patients compared with controls (1.3 ± 0.4 vs. 1.1 ± 0.2; P < 0.01). In differentiating ALS from mimic presentations, assessment of median nerve CSA in the upper arm and comparison of a median and ulnar nerve CSA distal-proximal ratio provide diagnostic potential. DISCUSSION Assessment of nerve CSA combined with calculation of nerve CSA distal-proximal ratio provides a useful marker to aid in the diagnosis of ALS. Muscle Nerve 58:777-783, 2018.
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Affiliation(s)
- Yu-Ichi Noto
- Brain and Mind Centre, Sydney Medical School, University of Sydney, 94 Mallett Street, Camperdown, Sydney, New South Wales, 2040, Australia.,Royal Prince Alfred Hospital Sydney, Sydney, New South Wales, Australia
| | - Nidhi Garg
- Brain and Mind Centre, Sydney Medical School, University of Sydney, 94 Mallett Street, Camperdown, Sydney, New South Wales, 2040, Australia.,Royal Prince Alfred Hospital Sydney, Sydney, New South Wales, Australia
| | - Tiffany Li
- Brain and Mind Centre, Sydney Medical School, University of Sydney, 94 Mallett Street, Camperdown, Sydney, New South Wales, 2040, Australia.,Royal Prince Alfred Hospital Sydney, Sydney, New South Wales, Australia
| | - Hannah C Timmins
- Brain and Mind Centre, Sydney Medical School, University of Sydney, 94 Mallett Street, Camperdown, Sydney, New South Wales, 2040, Australia.,Royal Prince Alfred Hospital Sydney, Sydney, New South Wales, Australia
| | - Susanna B Park
- Brain and Mind Centre, Sydney Medical School, University of Sydney, 94 Mallett Street, Camperdown, Sydney, New South Wales, 2040, Australia.,Royal Prince Alfred Hospital Sydney, Sydney, New South Wales, Australia
| | - Kazumoto Shibuya
- Brain and Mind Centre, Sydney Medical School, University of Sydney, 94 Mallett Street, Camperdown, Sydney, New South Wales, 2040, Australia.,Royal Prince Alfred Hospital Sydney, Sydney, New South Wales, Australia
| | - Nortina Shahrizaila
- Brain and Mind Centre, Sydney Medical School, University of Sydney, 94 Mallett Street, Camperdown, Sydney, New South Wales, 2040, Australia.,Royal Prince Alfred Hospital Sydney, Sydney, New South Wales, Australia
| | - William Huynh
- Brain and Mind Centre, Sydney Medical School, University of Sydney, 94 Mallett Street, Camperdown, Sydney, New South Wales, 2040, Australia.,Royal Prince Alfred Hospital Sydney, Sydney, New South Wales, Australia
| | - José M Matamala
- Brain and Mind Centre, Sydney Medical School, University of Sydney, 94 Mallett Street, Camperdown, Sydney, New South Wales, 2040, Australia.,Royal Prince Alfred Hospital Sydney, Sydney, New South Wales, Australia
| | - Thanuja Dharmadasa
- Brain and Mind Centre, Sydney Medical School, University of Sydney, 94 Mallett Street, Camperdown, Sydney, New South Wales, 2040, Australia.,Royal Prince Alfred Hospital Sydney, Sydney, New South Wales, Australia
| | - Con Yiannikas
- Brain and Mind Centre, Sydney Medical School, University of Sydney, 94 Mallett Street, Camperdown, Sydney, New South Wales, 2040, Australia.,Royal Prince Alfred Hospital Sydney, Sydney, New South Wales, Australia
| | - Steve Vucic
- Western Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Matthew C Kiernan
- Brain and Mind Centre, Sydney Medical School, University of Sydney, 94 Mallett Street, Camperdown, Sydney, New South Wales, 2040, Australia.,Royal Prince Alfred Hospital Sydney, Sydney, New South Wales, Australia
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15
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Abstract
Learning to recognize the various clinical and electrodiagnostic patterns of peripheral neuropathy enables a targeted approach to etiologic investigation, and subsequently guides patient discussions of self-management, disease course, and prognosis. Moreover, as advancements in neuropathology and pharmacotherapy inform the many etiologies of polyneuropathy, it is imperative for clinicians to identify the underlying etiology to appropriately guide treatment options and prevent complications.
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Affiliation(s)
- Michele L Arnold
- Physical Medicine and Rehabilitation, Swedish Health Services, 1600 E. Jefferson, Suite 300, Seattle, WA 98122, USA.
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16
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Nerve ultrasound findings differentiate Charcot-Marie-Tooth disease (CMT) 1A from other demyelinating CMTs. Clin Neurophysiol 2018; 129:2259-2267. [PMID: 30216910 DOI: 10.1016/j.clinph.2018.08.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 08/04/2018] [Accepted: 08/21/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Ulnar/median motor nerve conduction velocity (MNCV) is ≤38 m/s in demyelinating Charcot-Marie-Tooth disease (CMT). Previous nerve high resolution ultrasound (HRUS) studies explored demyelinating CMT assuming it as a homogeneous genetic/pathological entity or focused on CMT1A. METHODS To explore the spectrum of nerve HRUS findings in demyelinating CMTs, we recruited patients with CMT1A (N = 44), CMT1B (N = 9), CMTX (N = 8) and CMT4C (N = 4). They underwent nerve conduction study (NCS) and HRUS of the median, ulnar, peroneal nerve, and the brachial plexus. RESULTS Median, ulnar and peroneal MNCV significantly differed across CMT subtypes. Cross sectional area (CSA) was markedly and diffusely enlarged at all sites, except entrapment ones, in CMT1A, while it was slightly enlarged or within normal range in the other CMTs. No significant right-to-left difference was found. Age had limited effect on CSA. CSAs of some CMT1A patients largely overlapped with those of other demyelinating CMTs. A combination of three median CSA measures could separate CMT1A from other demyelinating CMTs. CONCLUSIONS Nerve HRUS findings are heterogeneous in demyelinating CMTs. SIGNIFICANCE Nerve HRUS may separate CMT1A from other demyelinating CMTs. The large demyelinating CMTs HRUS spectrum may be related to its pathophysiological variability.
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17
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Pelosi L, Mulroy E, Leadbetter R, Kilfoyle D, Chancellor AM, Mossman S, Wing L, Wu TY, Roxburgh RH. Peripheral nerves are pathologically small in cerebellar ataxia neuropathy vestibular areflexia syndrome: a controlled ultrasound study. Eur J Neurol 2018; 25:659-665. [PMID: 29316033 DOI: 10.1111/ene.13563] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 12/27/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Sensory neuronopathy is a cardinal feature of cerebellar ataxia neuropathy vestibular areflexia syndrome (CANVAS). Having observed that two patients with CANVAS had small median and ulnar nerves on ultrasound, we set out to examine this finding systematically in a cohort of patients with CANVAS, and compare them with both healthy controls and a cohort of patients with axonal neuropathy. We have previously reported preliminary findings in seven of these patients with CANVAS and seven healthy controls. METHODS We compared the ultrasound cross-sectional area of median, ulnar, sural and tibial nerves of 14 patients with CANVAS with 14 healthy controls and 14 age- and gender-matched patients with acquired primarily axonal neuropathy. We also compared the individual nerve cross-sectional areas of patients with CANVAS and neuropathy with the reference values of our laboratory control population. RESULTS The nerve cross-sectional area of patients with CANVAS was smaller than that of both the healthy controls and the neuropathy controls, with highly significant differences at most sites (P < 0.001). Conversely, the nerve cross-sectional areas in the upper limb were larger in neuropathy controls than healthy controls (P < 0.05). On individual analysis, the ultrasound abnormality was sufficiently characteristic to be detected in all but one patient with CANVAS. DISCUSSION Small nerves in CANVAS probably reflect nerve thinning from loss of axons due to ganglion cell loss. This is distinct from the ultrasound findings in axonal neuropathy, in which nerve size was either normal or enlarged. Our findings indicate a diagnostic role for ultrasound in CANVAS sensory neuronopathy and in differentiating neuronopathy from neuropathy.
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Affiliation(s)
- L Pelosi
- Department of Neurology and Clinical Neurophysiology, Bay of Plenty District Health Board, Tauranga
| | - E Mulroy
- Auckland District Health Board, Auckland
| | - R Leadbetter
- Capital and Coast District Health Board, Wellington
| | - D Kilfoyle
- Auckland District Health Board, Auckland
| | - A M Chancellor
- Department of Neurology and Clinical Neurophysiology, Bay of Plenty District Health Board, Tauranga
| | - S Mossman
- Capital and Coast District Health Board, Wellington
| | - L Wing
- Department of Endocrinology, Bay of Plenty District Health Board, Tauranga
| | - T Y Wu
- Christchurch Hospital, Christchurch
| | - R H Roxburgh
- Auckland District Health Board, Auckland.,Department of Medicine, University of Auckland, Auckland, New Zealand
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18
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Fabrizi GM, Tamburin S, Cavallaro T, Cabrini I, Ferrarini M, Taioli F, Magrinelli F, Zanette G. The spectrum of Charcot-Marie-Tooth disease due to myelin protein zero: An electrodiagnostic, nerve ultrasound and histological study. Clin Neurophysiol 2017; 129:21-32. [PMID: 29136549 DOI: 10.1016/j.clinph.2017.09.117] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 09/13/2017] [Accepted: 09/29/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Nerve ultrasound (US) data on myelin protein zero (MPZ)-related Charcot-Marie-Tooth disease (CMT) are lacking. To offer a comprehensive perspective on MPZ-related CMTs, we combined nerve US with clinics, electrodiagnosis and histopathology. METHODS We recruited 36 patients (12 MPZ mutations), and correlated nerve US to clinical, electrodiagnostic measures, and sural nerve biopsy. RESULTS According to motor nerve conduction velocity (MNCV) criteria, nine patients were categorized as "demyelinating" CMT1B, 17 as "axonal" CMT2I/J, and 10 as dominant "intermediate" CMTDID. Sural nerve biopsy showed hypertrophic de-remyelinating neuropathy with numerous complex onion bulbs in one patient, de-remyelinating neuropathy with scanty/absent onion bulbs in three, axonal neuropathy in two, mixed demyelinating-axonal neuropathy in five. Electrodiagnosis significantly differed in CMT1B vs. CMT2I/J and CMTDID subgroups. CMT1B had slightly enlarged nerve cross sectional area (CSA) especially at proximal upper-limb (UL) sites. CSA was negatively correlated to UL MNCV and not increased at entrapment sites. Major sural nerve pathological patterns were uncorrelated to UL nerve US and MNCV. CONCLUSIONS Sural nerve biopsy confirmed the wide pathological spectrum of MPZ-CMT. UL nerve US identified two major patterns corresponding to the CMT1B and CMT2I/J-CMTDID subgroups. SIGNIFICANCE Nerve US phenotype of MPZ-CMT diverged from those in other demyelinating peripheral neuropathies and may have diagnostic value.
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Affiliation(s)
- Gian Maria Fabrizi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy; Neurology Division, Department of Neuroscience, AOUI Verona, Verona, Italy
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy; Neurology Division, Department of Neuroscience, AOUI Verona, Verona, Italy.
| | - Tiziana Cavallaro
- Neurology Division, Department of Neuroscience, AOUI Verona, Verona, Italy
| | - Ilaria Cabrini
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy; Neurology Division, Department of Neuroscience, AOUI Verona, Verona, Italy
| | - Moreno Ferrarini
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy; Neurology Division, Department of Neuroscience, AOUI Verona, Verona, Italy
| | - Federica Taioli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy; Neurology Division, Department of Neuroscience, AOUI Verona, Verona, Italy
| | - Francesca Magrinelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy; Neurology Division, Department of Neuroscience, AOUI Verona, Verona, Italy
| | - Giampietro Zanette
- Neurology Division, Pederzoli Hospital, Peschiera del Garda, Verona, Italy
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19
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Misirlioglu TO, Ozyemisci Taskiran O. Reliability of sonographic muscle thickness measurements of the thenar and hypothenar muscles. Muscle Nerve 2017; 57:E14-E17. [PMID: 28662294 DOI: 10.1002/mus.25735] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 06/12/2017] [Accepted: 06/24/2017] [Indexed: 12/13/2022]
Abstract
Introduction This study was undertaken to assess the intra- and interrater reliability of sonographic thickness measurements of the thenar and hypothenar muscles. METHODS The thickness of the thenar and hypothenar muscles of both hands of 15 volunteers (7 male, 8 female) were evaluated with a 4-13-MHz linear probe by 2 examiners who were blinded to each other's measurements. Interrater reliability was then evaluated. To assess intrarater reliability, the first examiner also performed a second measurement after an interval of at least 1 day. RESULTS Mean age of the subjects was 31.1 ± 9.0 years. Test-retest reliability showed excellent intrarater reliability (intraclass correlation coefficient range: 0.889-0.963) and substantial to excellent results for interrater reliability (intraclass correlation coefficient range: 0.692-0.937). DISCUSSION We found that ultrasound is a reliable method for thickness measurements of the thenar and hypothenar muscles. Muscle Nerve 57: E14-E17, 2018.
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Affiliation(s)
- Tugce Ozekli Misirlioglu
- Department of Physical Medicine and Rehabilitation, Koc University School of Medicine, Istanbul, Turkey
| | - Ozden Ozyemisci Taskiran
- Department of Physical Medicine and Rehabilitation, Koc University School of Medicine, Istanbul, Turkey
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20
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Hommel AL, Cartwright MS, Walker FO. The use of ultrasound in neuromuscular diagnoses. Neurol Clin Pract 2017; 7:266-273. [PMID: 30107010 DOI: 10.1212/cpj.0000000000000368] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Purpose of review The use of ultrasonography for diagnosis of neuromuscular disorders is a relatively new but rapidly expanding field. This review covers key ultrasound findings in primary disease of muscle and nerve. Recent findings Ultrasonography is used routinely for evaluation of entrapment neuropathies, hereditary and inflammatory neuropathies, polyneuropathies, myopathies, and motor neuron disease. When used in association with other electrodiagnostic testing, ultrasound has allowed physicians to increase the yield of clinical evaluation in diagnostic laboratories. Summary While ultrasonography has not yet replaced the need for electrodiagnostic studies, it has become a useful accompaniment.
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21
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Podnar S, Omejec G, Bodor M. Nerve conduction velocity and cross-sectional area in ulnar neuropathy at the elbow. Muscle Nerve 2017; 56:E65-E72. [DOI: 10.1002/mus.25655] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Simon Podnar
- Institute of Clinical Neurophysiology; University Medical Center Ljubljana; SI-1525 Ljubljana Slovenia
| | - Gregor Omejec
- Institute of Clinical Neurophysiology; University Medical Center Ljubljana; SI-1525 Ljubljana Slovenia
| | - Marko Bodor
- Department of Physical Medicine and Rehabilitation; University of California Davis; Sacramento California USA
- Department of Neurological Surgery; University of California San Francisco; San Francisco California USA
- Interventional Spine and Sports Medicine; Napa California USA
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22
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de Carvalho M, Swash M. Lower motor neuron dysfunction in ALS. Clin Neurophysiol 2016; 127:2670-81. [DOI: 10.1016/j.clinph.2016.03.024] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 02/08/2016] [Accepted: 03/01/2016] [Indexed: 12/11/2022]
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23
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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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24
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Ebadi H, Siddiqui H, Ebadi S, Ngo M, Breiner A, Bril V. Peripheral Nerve Ultrasound in Small Fiber Polyneuropathy. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:2820-2826. [PMID: 26318562 DOI: 10.1016/j.ultrasmedbio.2015.06.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 06/11/2015] [Accepted: 06/16/2015] [Indexed: 06/04/2023]
Abstract
Routine nerve conduction studies are normal in patients with small fiber neuropathy (SFN), and a definitive diagnosis is based on skin biopsy revealing reduced intra-epidermal nerve fiber density (IENFD). In large fiber polyneuropathy, ultrasound (US) parameters indicate enlargement in cross-sectional area (CSA). This study was aimed at determining if similar changes in large fibers on US are apparent in patients with SFN. Twenty-five patients with SFN diagnosed by reduced IENFD and 25 age- and body mass index (BMI)-matched healthy controls underwent US studies of sural and superficial peroneal sensory nerves. The mean CSA of the sural nerve in SFN patients was 3.2 ± 0.8 mm(2), and in controls, 2.7 ± 0.6 mm(2) (p < 0.0070), and this was independent of sex. There was no difference in the thickness-to-width ratio or echogenicity of the nerves. US of the sural nerve in patients diagnosed with small fiber neuropathy reveals an enlarged cross-sectional area similar to that in large fiber polyneuropathy.
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Affiliation(s)
- Hamid Ebadi
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Hafsah Siddiqui
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sepehr Ebadi
- Division of Engineering Science, Faculty of Applied Sciences and Engineering, University of Toronto, Toronto, Ontario, Canada
| | - MyLan Ngo
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ari Breiner
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vera Bril
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
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25
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26
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Ultrasonographic Evaluation of the Median and Sciatic Nerves in Hemiplegic Patients After Stroke. Am J Phys Med Rehabil 2015; 94:429-35. [DOI: 10.1097/phm.0000000000000207] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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27
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Schreiber S, Abdulla S, Debska-Vielhaber G, Machts J, Dannhardt-Stieger V, Feistner H, Oldag A, Goertler M, Petri S, Kollewe K, Kropf S, Schreiber F, Heinze HJ, Dengler R, Nestor PJ, Vielhaber S. Peripheral nerve ultrasound in amyotrophic lateral sclerosis phenotypes. Muscle Nerve 2015; 51:669-75. [PMID: 25155020 DOI: 10.1002/mus.24431] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2014] [Indexed: 12/22/2022]
Abstract
INTRODUCTION In this study we sought to determine the cross-sectional area (CSA) of peripheral nerves in patients with distinct subtypes of amyotrophic lateral sclerosis (ALS). METHODS Ulnar and median nerve ultrasound was performed in 78 ALS patients [classic, n = 21; upper motor neuron dominant (UMND), n = 14; lower motor neuron dominant (LMND), n = 20; bulbar, n = 15; primary lateral sclerosis (PLS), n = 8] and 18 matched healthy controls. RESULTS Compared with controls, ALS patients had significant, distally pronounced reductions of ulnar CSA (forearm/wrist level) across all disease groups, except for PLS. Median nerve CSA (forearm/wrist level) did not differ between controls and ALS. CONCLUSION Ulnar nerve ultrasound in ALS subgroups revealed significant differences in distal CSA values, which suggests it has value as a marker of LMN involvement. Its potential was particularly evident in the UMND and PLS groups, which can be hard to separate clinically, yet their accurate separation has major prognostic implications.
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Affiliation(s)
- Stefanie Schreiber
- Department of Neurology, Otto-von-Guericke University, Germany; German Center for Neurodegenerative Diseases, Helmholtz Association, Magdeburg, Germany
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28
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Merkies ISJ, Faber CG, Lauria G. Advances in diagnostics and outcome measures in peripheral neuropathies. Neurosci Lett 2015; 596:3-13. [PMID: 25703220 DOI: 10.1016/j.neulet.2015.02.038] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 02/05/2015] [Accepted: 02/17/2015] [Indexed: 12/13/2022]
Abstract
Peripheral neuropathies are a group of acquired and hereditary disorders presenting with different distribution and nerve fiber class involvement. The overall prevalence is 2.4%, increasing to 8% in the elderly population. However, the frequency may vary depending on the underlying pathogenesis and association with systemic diseases. Distal symmetric polyneuropathy is the most common form, though multiple mononeuropathies, non-length dependent neuropathy and small fiber neuropathy can occur and may require specific diagnostic tools. The use of uniform outcome measures in peripheral neuropathies is important to improve the quality of randomized controlled trials, enabling comparison between studies. Recent developments in defining the optimal set of outcome measures in inflammatory neuropathies may serve as an example for other conditions. Diagnostic and outcome measure advances in peripheral neuropathies will be discussed.
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Affiliation(s)
- Ingemar S J Merkies
- Department of Neurology, Spaarne Hospital, Hoofddorp, The Netherlands; Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Catharina G Faber
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Giuseppe Lauria
- 3rd Neurology Unit, IRCCS Foundation "Carlo Besta" Neurological Institute, Milan, Italy.
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29
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Grimm A, Décard BF, Axer H, Fuhr P. The Ultrasound pattern sum score - UPSS. A new method to differentiate acute and subacute neuropathies using ultrasound of the peripheral nerves. Clin Neurophysiol 2015; 126:2216-25. [PMID: 25691156 DOI: 10.1016/j.clinph.2015.01.011] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 12/21/2014] [Accepted: 01/27/2015] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Ultrasound differentiation of neuropathies is a great challenge. We, therefore, suggest a standardized score to operationalize differentiation between several acute and subacute onset neuropathies. METHOD We retrospectively analyzed the ultrasound data of 61 patients with acute or subacute neuropathies, e.g. chronic immune-mediated neuropathies, Guillain-Barré syndrome (GBS), and axonal/vasculitic neuropathies. We compared these data to 28 healthy controls. Based on these results an ultrasound pattern sum score (UPSS) with three sub-scores (UPS-A for the sensorimotor nerves, UPS-B for the cervical roots and the vagal nerve and UPS-C for the sural nerve) was developed. Afterwards, the applicability of the score was prospectively validated in 10 patients with chronic neuropathies and in 14 patients with unknown acute and subacute PNP before performing additional tests. RESULTS UPS-A and UPSS were significantly higher in CIDP than in other neuropathies and controls (p<0.001). UPS-B was significantly more often pathologic in GBS than in CIDP and other neuropathies (p<0.001). Using receiver operation characteristics curve analysis boundary values for each score were defined. Positive predictive value (PPV) of these scores for CIDP and GBS was >85%. Vasculitic neuropathies showed an intermediate type of UPSS compared to other axonal neuropathies (p<0.001). In the prospective application the pattern score could be used with good accuracy in several types of neuropathy. CONCLUSION UPS-A and UPSS operationalize to diagnose acute and subacute-onset CIDP and its variants with high sensitivity, specificity, and PPV. An increased UPS-B with normal UPSS and other sub scores may point to the diagnosis of GBS with high PPV and enables the differentiation from CIDP. SIGNIFICANCE Using the UPSS and its sub-scores gives a new diagnostic power to the method of the peripheral nerve ultrasound.
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Affiliation(s)
- Alexander Grimm
- Department of Neurology, Basel University Hospital, Basel, Switzerland.
| | - Bernhard F Décard
- Department of Neurology, Basel University Hospital, Basel, Switzerland
| | - Hubertus Axer
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Peter Fuhr
- Department of Neurology, Basel University Hospital, Basel, Switzerland
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30
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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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31
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Hobson-Webb LD, Padua L. Small steps … and leaps … toward big science: Multicenter studies in neuromuscular ultrasound. Clin Neurophysiol 2014; 125:2326-7. [DOI: 10.1016/j.clinph.2014.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 05/06/2014] [Accepted: 05/09/2014] [Indexed: 12/12/2022]
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Di Lazzaro V, Giambattistelli F, Pravatà E, Assenza G. Brachial palsy after deep sleep. J Neurol Neurosurg Psychiatry 2014; 85:1409-10. [PMID: 24623793 DOI: 10.1136/jnnp-2013-306637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Vincenzo Di Lazzaro
- Institute of Neurology Campus Bio-Medico University Via Alvaro del Portillo, Rome, Italy Fondazione Alberto Sordi, Research Institute for Ageing, Rome, Italy
| | | | - Emanuele Pravatà
- Neurocenter of Southern Switzerland, via Tesserete 46, Lugano, Switzerland
| | - Giovanni Assenza
- Institute of Neurology Campus Bio-Medico University Via Alvaro del Portillo, Rome, Italy
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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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Dengler R. Ultrasound assessment of nerve and nerve root thickness. Do they contribute to the diagnosis of ALS? Clin Neurophysiol 2014; 125:1719-20. [DOI: 10.1016/j.clinph.2014.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 02/12/2014] [Accepted: 02/13/2014] [Indexed: 12/12/2022]
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Gallardo E, Sedano MJ, Orizaola P, Sánchez-Juan P, González-Suárez A, García A, Terán-Villagrá N, Ruiz-Soto M, Álvaro RL, Berciano MT, Lafarga M, Berciano J. Spinal nerve involvement in early Guillain-Barré syndrome: a clinico-electrophysiological, ultrasonographic and pathological study. Clin Neurophysiol 2014; 126:810-9. [PMID: 25213352 DOI: 10.1016/j.clinph.2014.06.051] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 06/17/2014] [Accepted: 06/20/2014] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Although prevailing spinal nerve involvement has been recognized in a few detailed Guillain-Barré syndrome (GBS) autopsy reports, imaging studies addressing this question in cervical nerves are lacking. METHODS We describe clinical, electrophysiological, ultrasonographic (US) and pathological findings in six consecutive early GBS patients, evaluated within 10 days of onset. RESULTS Patients' ages ranged from 37 to 80 years. Five patients required mechanical ventilation, two of them having died 9 and 28 days after onset. Upper- and lower-limb nerve US showed abnormal findings in just 8.8% of scanned peripheral nerves. In comparison with 46 aged-matched control subjects, US of the fifth to seventh cervical nerves showed changes in four cases, which consisted of significant nerve enlargement, blurred boundaries of the corresponding ventral rami, or both. Autopsy study in one case demonstrated that pathology, consisting of demyelination and endoneurial inflammatory oedema, mainly involved cervical and lumbar nerves. CONCLUSIONS In early GBS inflammatory oedema of spinal nerves is a pathogenically relevant feature to understanding the mechanism of ascending paralysis, particularly when conventional electrophysiological studies are normal or not diagnostic. SIGNIFICANCE Findings advocate the use of cervical nerve US in early GBS.
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Affiliation(s)
- Elena Gallardo
- Service of Radiology, University Hospital "Marqués de Valdecilla", "Instituto de Investigación Marqués de Valdecilla (IDIVAL)", University of Cantabria (UC) and "Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED)", Santander, Spain
| | - María J Sedano
- Service of Neurology, University Hospital "Marqués de Valdecilla", IDIVAL, UC and CIBERNED, Santander, Spain
| | - Pedro Orizaola
- Service of Clinical Neurophysiology, University Hospital "Marqués de Valdecilla", IDIVAL, UC and CIBERNED, Santander, Spain
| | - Pascual Sánchez-Juan
- Service of Neurology, University Hospital "Marqués de Valdecilla", IDIVAL, UC and CIBERNED, Santander, Spain
| | - Andrea González-Suárez
- Service of Neurology, University Hospital "Marqués de Valdecilla", IDIVAL, UC and CIBERNED, Santander, Spain
| | - Antonio García
- Service of Clinical Neurophysiology, University Hospital "Marqués de Valdecilla", IDIVAL, UC and CIBERNED, Santander, Spain
| | - Nuria Terán-Villagrá
- Service of Pathology, University Hospital "Marqués de Valdecilla", Santander, Spain
| | - María Ruiz-Soto
- Department of Anatomy and Cell Biology, UC, IDIVAL and CIBERNED, Santander, Spain
| | - Rosa Landeras Álvaro
- Service of Radiology, University Hospital "Marqués de Valdecilla", "Instituto de Investigación Marqués de Valdecilla (IDIVAL)", University of Cantabria (UC) and "Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED)", Santander, Spain
| | - María T Berciano
- Department of Anatomy and Cell Biology, UC, IDIVAL and CIBERNED, Santander, Spain
| | - Miguel Lafarga
- Department of Anatomy and Cell Biology, UC, IDIVAL and CIBERNED, Santander, Spain
| | - José Berciano
- Service of Neurology, University Hospital "Marqués de Valdecilla", IDIVAL, UC and CIBERNED, Santander, Spain.
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Granata G, Luigetti M, Coraci D, Del Grande A, Romano A, Bisogni G, Bramanti P, Rossini PM, Sabatelli M, Padua L. Ultrasound evaluation in transthyretin-related amyloid neuropathy. Muscle Nerve 2014; 50:372-6. [PMID: 24395461 DOI: 10.1002/mus.24168] [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: 10/25/2013] [Revised: 12/30/2013] [Accepted: 01/05/2014] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Familial amyloid polyneuropathy is a rare condition caused by mutations of the transthyretin gene (TTR). We assessed the pattern of nerve ultrasound (US) abnormalities in patients with TTR-related neuropathy. METHODS Seven patients with TTR-related neuropathy (TTR-N) and 5 asymptomatic TTR-mutation carriers (TTR-C) underwent neurological examination, nerve conduction studies, and US evaluation. RESULTS Multifocal US abnormalities were identified in 6 of 7 TTR-N patients. A single patient with only a mild sensory polyneuropathy had normal nerves on US evaluation. In the TTR-C, we only detected an enlarged ulnar nerve at the elbow. Interestingly, disease severity correlated with number of nerves affected on US evaluation. CONCLUSIONS No specific pattern of US abnormalities was identified in this cohort. However, in TTR-related amyloid neuropathy, US may be a helpful tool in monitoring disease progression, and/or clinical response to pharmacological treatment.
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Affiliation(s)
- Giuseppe Granata
- Institute of Neurology, Catholic University of Sacred Heart, Largo F. Vito 1, 00168, Rome, Italy
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Karakis I, Liew W, Darras BT, Jones HR, Kang PB. Referral and diagnostic trends in pediatric electromyography in the molecular era. Muscle Nerve 2014; 50:244-9. [DOI: 10.1002/mus.24152] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Revised: 12/11/2013] [Accepted: 12/18/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Ioannis Karakis
- Department of Neurology; Boston Children's Hospital, Harvard Medical School; 300 Longwood Avenue Boston Massachusetts 02115 USA
- Department of Neurology; Lahey Clinic Burlington Massachusetts USA
- Department of Neurology; Emory University School of Medicine; Atlanta Georgia USA
| | - Wendy Liew
- Department of Neurology; Boston Children's Hospital, Harvard Medical School; 300 Longwood Avenue Boston Massachusetts 02115 USA
| | - Basil T. Darras
- Department of Neurology; Boston Children's Hospital, Harvard Medical School; 300 Longwood Avenue Boston Massachusetts 02115 USA
| | - H. Royden Jones
- Department of Neurology; Boston Children's Hospital, Harvard Medical School; 300 Longwood Avenue Boston Massachusetts 02115 USA
- Department of Neurology; Lahey Clinic Burlington Massachusetts USA
| | - Peter B. Kang
- Department of Neurology; Boston Children's Hospital, Harvard Medical School; 300 Longwood Avenue Boston Massachusetts 02115 USA
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Nodera H, Takamatsu N, Shimatani Y, Mori A, Sato K, Oda M, Terasawa Y, Izumi Y, Kaji R. Thinning of cervical nerve roots and peripheral nerves in ALS as measured by sonography. Clin Neurophysiol 2014; 125:1906-11. [PMID: 24657162 DOI: 10.1016/j.clinph.2014.01.033] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 12/20/2013] [Accepted: 01/11/2014] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Progressive atrophy and loss of motor axons is a hallmark of amyotrophic lateral sclerosis (ALS). Limited sonographic data are available on potential detection of atrophy of peripheral nerves and nerve roots in ALS. METHODS Patients with either definite or probable ALS and control subjects underwent sonographic evaluation of the cervical roots (C5, C6, and C7) and peripheral nerves (median and ulnar nerves) on the right. These diameters and cross-sectional areas (C6, median, and ulnar nerves) were compared. RESULTS The diameters and cross-sectional areas were consistently smaller in ALS than in controls. No correlation was present between the sonographic parameters and the disease severity, disease duration, age, or gender. The overall sensitivity and specificity tended to be greater in the cervical nerve roots than in the peripheral nerves. CONCLUSIONS This study shows atrophy of cervical nerve roots and peripheral nerves in ALS detected by sonography. Cervical nerve roots might be more appropriate to detect motor axon loss than peripheral nerves. SIGNIFICANCE Sonographic evaluation of nerve roots and peripheral nerves may be a useful disease marker in ALS to confirm the diagnosis and to potentially monitor the disease progression.
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Affiliation(s)
- Hiroyuki Nodera
- Department of Neurology, Tokushima University, Tokushima, Japan.
| | - Naoko Takamatsu
- Department of Neurology, Tokushima University, Tokushima, Japan; Department of Neurology, Vihara Hananosato Hospital, Hiroshima, Japan
| | | | - Atsuko Mori
- Department of Neurology, Tokushima University, Tokushima, Japan
| | - Kenta Sato
- Department of Neurology, Tokushima University, Tokushima, Japan
| | - Masaya Oda
- Department of Neurology, Vihara Hananosato Hospital, Hiroshima, Japan
| | - Yuka Terasawa
- Department of Neurology, Tokushima University, Tokushima, Japan
| | - Yuishin Izumi
- Department of Neurology, Tokushima University, Tokushima, Japan; Department of Neurology, Vihara Hananosato Hospital, Hiroshima, Japan.
| | - Ryuji Kaji
- Department of Neurology, Tokushima University, Tokushima, Japan
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