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Magnetic resonance neurography in diagnosing childhood chronic inflammatory demyelinating polyradiculoneuropathy. Brain Dev 2021; 43:352-356. [PMID: 33433331 DOI: 10.1016/j.braindev.2020.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/30/2020] [Accepted: 10/01/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Peripheral nerve imaging is increasingly recognized as a powerful tool to evaluate nerve hypertrophy in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and Charcot-Marie-Tooth diseases (CMT), whereas data in pediatric patients are limited. CASE DESCRIPTION We describe the case of a 15-year-old Japanese girl with asymmetric demyelinating polyneuropathy, who, at the age of 10 years, was initially diagnosed with a demyelinating form of CMT. Fluorescence in situ hybridization for peripheral myelin 22 was negative, and already-known pathogenic variants were not detected by whole-genome sequencing, and nerve conduction studies revealed multifocal conduction blocks. Over the next 5 years, the patient showed gradual improvement in muscle weakness and sensory disturbance without immunological treatment and was referred to our hospital. RESULTS At the age of 15 years, magnetic resonance (MR) neurography showed asymmetric multifocal fusiform enlargement of nerve roots, brachial and lumbosacral plexuses, and intermediated nerve trunks, as well as cranial nerves. Based on the MR neurography findings and multifocal nerve conduction blocks, she was diagnosed as having multifocal CIDP (multifocal demyelinating sensory and motor neuropathy [MADSAM]) according to the European Federation of Neurological Societies/Peripheral Nerve Society diagnostic criteria. DISCUSSION Clinical diagnosis of childhood CIDP is challenging because its neurological manifestations and nerve conduction study findings occasionally resemble those of inherited demyelinating neuropathies. MR neurography is helpful for the assessment of patterns of nerve hypertrophy; MADSAM-CIDP is characterized by multiple fusiform nerve enlargement, whereas CMT shows symmetric and diffuse nerve hypertrophy. CONCLUSION The MR neurography patterns would help in diagnosing pediatric demyelinating neuropathies.
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Maeda T, Kawai M, Ishiguchi E, Omoto M, Ogasawara JI, Kanda T. [Chronic inflammatory demyelinating polyradiculoneuropathy with myelopathy due to massively enlarged nerve roots]. Rinsho Shinkeigaku 2020; 60:603-608. [PMID: 32779595 DOI: 10.5692/clinicalneurol.cn-001416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report a 77-year-old man who presented with numbness and weakness of the feet bilaterally, that had progressed over 13 years. He was diagnosed with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) on the basis of nerve conduction studies and a sural nerve biopsy; however, he was inadequately treated and his weakness had progressed. At 76 years of age, he developed spasticity in the legs as well as bladder and rectal incontinences. Gd-enhanced MRI revealed severe compression of the cervical cord by massively enlarged nerve roots. A cervical laminectomy was performed to decompress the cervical cord. A fascicular biopsy of the C5 dorsal root showed a prominent lymphocyte infiltration and edema. Repeated methylprednisolone pulse therapy and IVIg ameliorated the weakness. We concluded that the main cause of nerve root hypertrophy in this patient was active inflammation.
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Affiliation(s)
- Toshihiko Maeda
- Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine
| | - Motoharu Kawai
- Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine
| | - Eri Ishiguchi
- Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine
| | - Masatoshi Omoto
- Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine
| | - Jun-Ichi Ogasawara
- Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine
| | - Takashi Kanda
- Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine
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Su X, Kong X, Lu Z, Zhou M, Wang J, Liu X, Kong X, Zhang H, Zheng C. Use of Magnetic Resonance Neurography for Evaluating the Distribution and Patterns of Chronic Inflammatory Demyelinating Polyneuropathy. Korean J Radiol 2020; 21:483-493. [PMID: 32193896 PMCID: PMC7082655 DOI: 10.3348/kjr.2019.0739] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 12/19/2019] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To evaluate the distribution and characteristics of peripheral nerve abnormalities in chronic inflammatory demyelinating polyneuropathy (CIDP) using magnetic resonance neurography (MRN) and to examine the diagnostic efficiency. MATERIALS AND METHODS Thirty-one CIDP patients and 21 controls underwent MR scans. Three-dimensional sampling perfections with application-optimized contrasts using different flip-angle evolutions and T1-/T2- weighted turbo spin-echo sequences were performed for neurography of the brachial and lumbosacral (LS) plexus and cauda equina, respectively. Clinical data and scores of the inflammatory Rasch-built overall disability scale (I-RODS) in CIDP were obtained. RESULTS The bilateral extracranial vagus (n = 11), trigeminal (n = 12), and intercostal nerves (n = 10) were hypertrophic. Plexus hypertrophies were observed in the brachial plexus of 19 patients (61.3%) and in the LS plexus of 25 patients (80.6%). Patterns of hypertrophy included uniform hypertrophy (17 [54.8%] brachial plexuses and 21 [67.7%] LS plexuses), and multifocal fusiform hypertrophy (2 [6.5%] brachial plexuses and 4 [12.9%] LS plexuses) was present. Enlarged and/or contrast-enhanced cauda equina was found in 3 (9.7%) and 13 (41.9%) patients, respectively. Diameters of the brachial and LS nerve roots were significantly larger in CIDP than in controls (p < 0.001). The largest AUC was obtained for the L5 nerve. There were no significant differences in the course duration, I-RODS score, or diameter between patients with and without hypertrophy. CONCLUSION MRN is useful for the assessment of distribution and characteristics of the peripheral nerves in CIDP. Compared to other regions, LS plexus neurography is more sensitive for CIDP.
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Affiliation(s)
- Xiaoyun Su
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Xiangquan Kong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Zuneng Lu
- Department of Neurology, Renming Hospital of Wuhan University, Wuhan, China
| | - Min Zhou
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Jing Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Xiaoming Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Xiangchuang Kong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Huiting Zhang
- MR Scientific Marketing, Siemens Healthineers, Shanghai, China
| | - Chuansheng Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China.
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Gilmore KJ, Fanous J, Doherty TJ, Kimpinski K, Rice CL. Nerve dysfunction leads to muscle morphological abnormalities in chronic inflammatory demyelinating polyneuropathy assessed by MRI. Clin Anat 2019; 33:77-84. [DOI: 10.1002/ca.23473] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/05/2019] [Accepted: 09/15/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Kevin J. Gilmore
- School of Kinesiology, Faculty of Health Science London Ontario Canada
| | - Jacob Fanous
- School of Kinesiology, Faculty of Health Science London Ontario Canada
| | - Timothy J. Doherty
- Department of Clinical Neurological Sciences Schulich School of Medicine and Dentistry, The University of Western Ontario London Ontario Canada
- Department of Physical Medicine and Rehabilitation Schulich School of Medicine and Dentistry, The University of Western Ontario London Ontario Canada
| | - Kurt Kimpinski
- School of Kinesiology, Faculty of Health Science London Ontario Canada
- Department of Clinical Neurological Sciences Schulich School of Medicine and Dentistry, The University of Western Ontario London Ontario Canada
| | - Charles L. Rice
- School of Kinesiology, Faculty of Health Science London Ontario Canada
- Department of Anatomy and Cell Biology Schulich School of Medicine and Dentistry, The University of Western Ontario London Ontario Canada
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Fargeot G, Viala K, Theaudin M, Labeyrie MA, Costa R, Léger JM, Adams D, Vandendries C, Labeyrie C. Diagnostic usefulness of plexus magnetic resonance imaging in chronic inflammatory demyelinating polyradiculopathy without electrodiagnostic criteria of demyelination. Eur J Neurol 2018; 26:631-638. [PMID: 30431216 DOI: 10.1111/ene.13868] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 11/05/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE The usefulness of plexus magnetic resonance imaging (MRI) in the diagnosis of chronic inflammatory demyelinating polyradiculopathy (CIDP) without definite European Federation of Neurological Societies/Peripheral Nerve Society (EFNS/PNS) electrodiagnostic criteria is currently unclear. METHODS Data from consecutive patients with clinical manifestations suggesting CIDP, with or without (CIDP-D and CIDP-ND, respectively) definite EFNS/PNS electrodiagnostic criteria, and referred for plexus MRI in our imaging centre were retrospectively analysed. An expert committee of neurologists compared the level of suspicion of CIDP in CIDP-ND patients to the blinded/unblinded MRI findings. Plexus MRI was reviewed by a neuroradiologist blinded to the final diagnosis. RESULTS In all, 38 patients were assessed with suspected CIDP-ND [7/38 (18%) probable; 13/38 (34%) possible; 18/38 (47%), no EFNS/PNS electrodiagnostic criteria], plus 10 with CIDP-D. Thirty-six of the 38 (95%) fulfilled clinical criteria of CIDP variants, including pure sensory neuropathy in 22/36 (61%). Plexus MRI showed abnormalities in 22/38 (58%) patients including increased nerve signal intensity on T2-weighted images in 22/22 (100%), nerve enlargement in 20/22 (91%) and contrast enhancement in 8/22 (36%). Plexus MRI enabled the expert committee's final diagnosis to be adjusted in 7/38 (18%) patients, and in conjunction with nerve conduction studies was a supportive criterion to classify 7/24 (29%) patients as definite CIDP. MRI abnormalities were more asymmetrical (P = 0.03) and less diffuse (P = 0.1) in CIDP-ND than in CIDP-D. CONCLUSIONS Our observations suggest that plexus MRI makes a valuable contribution to the diagnosis of CIDP-ND patients. Further studies are needed to investigate inter-rater reliability of clinical and imaging criteria of CIDP in these patients, and the impact on outcomes.
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Affiliation(s)
- G Fargeot
- CRMR Neuropathies Amyloïdes Familiales et autres Neuropathies Périphériques Rares, INSERM U1195, Hôpital Bicêtre, APHP, Le Kremlin Bicêtre, France
| | - K Viala
- Département de Neurophysiologie Clinique, Hôpital Pitié Salpêtrière, Paris, France
| | - M Theaudin
- Département des Neurosciences Cliniques, Service de Neurologie, CHUV, Lausanne, Switzerland
| | - M-A Labeyrie
- Département de Neuroradiologie Interventionnelle, Hôpital Lariboisière, Paris, France
| | - R Costa
- Centre National de Référence Maladies Neuromusculaires Rares, Hôpital Pitié Salpêtrière et Université Paris VI, Paris, France
| | - J M Léger
- Centre National de Référence Maladies Neuromusculaires Rares, Hôpital Pitié Salpêtrière et Université Paris VI, Paris, France
| | - D Adams
- CRMR Neuropathies Amyloïdes Familiales et autres Neuropathies Périphériques Rares, INSERM U1195, Hôpital Bicêtre, APHP, Le Kremlin Bicêtre, France
| | - C Vandendries
- Service d'Imagerie, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France.,Centre d'imagerie RMX, 80 avenue Félix Faure, Paris, France
| | - C Labeyrie
- CRMR Neuropathies Amyloïdes Familiales et autres Neuropathies Périphériques Rares, INSERM U1195, Hôpital Bicêtre, APHP, Le Kremlin Bicêtre, France
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Hiwatashi A, Togao O, Yamashita K, Kikuchi K, Momosaka D, Nakatake H, Yamasaki R, Ogata H, Yoneyama M, Kira JI, Honda H. Simultaneous MR neurography and apparent T2 mapping in brachial plexus: Evaluation of patients with chronic inflammatory demyelinating polyradiculoneuropathy. Magn Reson Imaging 2018; 55:112-117. [PMID: 30266626 DOI: 10.1016/j.mri.2018.09.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 09/03/2018] [Accepted: 09/24/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE MR neurography is known to be useful to evaluate nerve pathology. The purpose of this study was to evaluate the usefulness of simultaneous apparent T2 mapping and neurography with nerve-sheath signal increased with inked rest-tissue rapid acquisition of relaxation enhancement imaging (SHINKEI) to distinguish patients with chronic inflammatory demyelinating polyneuropathy (CIDP) from healthy subjects. MATERIALS AND METHODS This retrospective study included 13 patients with CIDP and five healthy subjects from 2015 to 2017. The T2 relaxation time and the size of the cervical ganglia and roots of the brachial plexus were measured. Statistical analyses were performed with the Mann-Whitney U test and receiver operating characteristics (ROC) analysis. RESULTS The T2 relaxation times of the ganglia and roots were longer in patients with CIDP (119.31 ± 35.53 msec and 111.15 ± 33.82 msec) than in healthy subjects (101.42 ± 26.42 msec and 85.29 ± 13.22 msec, P = 0.0007 and P < 0.0001, respectively). The sizes of the ganglia and the roots were larger in patients with CIDP (6.25 ± 1.56 mm and 4.37 ± 1.71 mm) than in healthy subjects (5.59 ± 1.08 mm and 3.50 ± 0.62 mm, P = 0.0114 and P = 0.0014, respectively). ROC analysis revealed that T2 relaxation time of the roots was best at distinguishing CIDP patients from healthy subjects (the area under the curve = 0.748). CONCLUSION Patients with CIDP could be distinguished from healthy subjects using simultaneous apparent T2 mapping and neurography with SHINKEI.
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Affiliation(s)
- Akio Hiwatashi
- Departments of Molecular Imaging & Diagnosis, Graduate School of Medical Sciences, Kyushu University, Japan.
| | - Osamu Togao
- Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Koji Yamashita
- Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Kazufumi Kikuchi
- Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Daichi Momosaka
- Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Hiroshi Nakatake
- Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Ryo Yamasaki
- Neurology, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Hidenori Ogata
- Neurology, Graduate School of Medical Sciences, Kyushu University, Japan
| | | | - Jun-Ichi Kira
- Neurology, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Hiroshi Honda
- Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Japan
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Matsumoto H, Hanajima R, Terao Y, Hamada M, Shirota Y, Yugeta A, Nakatani-Enomoto S, Hashida H, Ugawa Y. A significant correlation between cauda equina conduction time and cerebrospinal fluid protein in chronic inflammatory demyelinating polyradiculoneuropathy. J Neurol Sci 2018; 384:7-9. [PMID: 29249382 DOI: 10.1016/j.jns.2017.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 10/29/2017] [Accepted: 11/05/2017] [Indexed: 10/18/2022]
Abstract
We investigated the relationship between the involvement of the cauda equina in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and the increment of cerebrospinal fluid (CSF) protein. We measured cauda equina conduction time (CECT) in 14 CIDP patients using magnetic stimulation with a MATS coil. Statistical analysis revealed that CECT and CSF protein had a significant positive linear correlation. Conduction time of the peripheral nerve trunk, in contrast, had no significant linear correlation with CSF protein. We revealed that the involvement of the cauda equina and increment of CSF protein are closely related. In CIDP cases with elevated CSF protein, spinal nerves including the cauda equina are very likely involved.
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Affiliation(s)
- Hideyuki Matsumoto
- Department of Neurology, Japanese Red Cross Medical Center, Tokyo, Japan; Department of Neurology, The University of Tokyo, Tokyo, Japan.
| | - Ritsuko Hanajima
- Department of Brain and Neurosciences, Division of Neurology, Faculty of Medicine, Tottori University, Japan
| | - Yasuo Terao
- Department of Cell Physiology, University of Kyorin, Japan
| | - Masashi Hamada
- Department of Neurology, The University of Tokyo, Tokyo, Japan
| | | | - Akihiro Yugeta
- Department of Neurology, The University of Tokyo, Tokyo, Japan
| | - Setsu Nakatani-Enomoto
- Department of Neurology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Hideji Hashida
- Department of Neurology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Yoshikazu Ugawa
- Department of Neurology, School of Medicine, Fukushima Medical University, Fukushima, Japan
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Hiwatashi A, Togao O, Yamashita K, Kikuchi K, Kamei R, Momosaka D, Ogata H, Yamasaki R, Yoneyama M, Kira JI, Honda H. Lumbar plexus in patients with chronic inflammatory demyelinating polyneuropathy: Evaluation with 3D nerve-sheath signal increased with inked rest-tissue rapid acquisition of relaxation enhancement imaging (3D SHINKEI). Eur J Radiol 2017; 93:95-99. [DOI: 10.1016/j.ejrad.2017.05.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 05/19/2017] [Accepted: 05/23/2017] [Indexed: 01/09/2023]
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Hiwatashi A, Togao O, Yamashita K, Kikuchi K, Ogata H, Yamasaki R, Yoneyama M, Kira JI, Honda H. Evaluation of chronic inflammatory demyelinating polyneuropathy: 3D nerve-sheath signal increased with inked rest-tissue rapid acquisition of relaxation enhancement imaging (3D SHINKEI). Eur Radiol 2016; 27:447-453. [DOI: 10.1007/s00330-016-4406-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 03/14/2016] [Accepted: 05/12/2016] [Indexed: 10/21/2022]
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Stoll SS, Rakocevic G. Severe acute inflammatory demyelinating polyradiculoneuropathy with persistent weakness associated with tumor-like nerve root enlargement. J Clin Neuromuscul Dis 2015; 16:220-222. [PMID: 25996968 DOI: 10.1097/cnd.0000000000000076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We report a 23-year-old woman with rapid onset of proximal and distal limb weakness and areflexia, associated with tumor-like spinal nerve root enlargement and markedly elevated cerebrospinal fluid protein. Our patient developed the inability to walk within days, without preceding illness. Within two weeks, she had near-complete bilateral wrist and foot drop. Her cranial nerves and respiratory function remained intact. She received intravenous immunoglobulin early on for suspected Guillain-barre syndrome but remained wheelchair-bound until 6 Plasma exchange sessions were completed. After that, she continued to improve with intravenous immunoglobulin dosed every 3-4 weeks. Prominent demyelinating features were found on NCS, with cerebrospinal fluid protein of 415 mg/dL. Comprehensive infectious work-up was negative. Magnetic resonance imaging of lumbosacral and cervical spine showed tumor-like masses mistaken for neurofibromatosis (axial diameter, 7.5-10 mm). Repeated magnetic resonance imaging 6 months later showed persistent nerve root enlargement, despite the patient's improved functional status.
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Affiliation(s)
- Sharon S Stoll
- *Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, PA; and †Department of Neurology, Thomas Jefferson University, Philadelphia, PA
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Cejas C, Escobar I, Serra M, Barroso F. High resolution neurography of the lumbosacral plexus on 3T magnetic resonance imaging. RADIOLOGIA 2015. [DOI: 10.1016/j.rxeng.2014.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Cejas C, Escobar I, Serra M, Barroso F. Neurografía de alta resolución del plexo lumbosacro en resonancia magnética 3T. RADIOLOGIA 2015; 57:22-34. [DOI: 10.1016/j.rx.2014.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 07/03/2014] [Accepted: 07/21/2014] [Indexed: 01/08/2023]
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Ambrosetto P, Nicolini F, Zoli M, Cirillo L, Feraco P, Bacci A. Ophthalmoplegic migraine: from questions to answers. Cephalalgia 2014; 34:914-9. [PMID: 24567117 DOI: 10.1177/0333102414523843] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The International Classification of Headache Disorders classifies ophthalmoplegic migraine (OM) under "cranial neuralgias and central causes of facial pain." OM is diagnosed when all the following criteria are satisfied: A. At least two attacks fulfilling criterion B. B. Migraine-like headache accompanied or followed within four days of its onset by paresis of one or more of the III, IV and/or VI cranial nerves. C. Parasellar orbital fissure and posterior fossa lesions ruled out by appropriate investigations. In children the syndrome is rare and magnetic resonance (MR) shows strongly enhancing thickened nerve at the root entry zone (REZ). METHOD The authors review the literature focusing on pathogenesis theories. RESULTS The authors suggest that ischemic reversible breakdown of the blood-nerve barrier is the most probable cause of OM and to include MR findings in the hallmarks of the disease. CONCLUSION OM is the same disease in adulthood and childhood, even if in adults the MR imaging findings are negative. In the authors' opinion, OM should be classified as migraine.
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Affiliation(s)
- Paolo Ambrosetto
- Department of Diagnostic Imaging, Villalba Hospital, GVM, Care and Research, Italy
| | - Francesca Nicolini
- Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | - Matteo Zoli
- Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | - Luigi Cirillo
- Department of Neuroradiology, IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy Department of Experimental, Diagnostic and Speciality Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Paola Feraco
- Department of Radiology, Ospedale Santa Chiara, Trento, Italy
| | - Antonella Bacci
- Department of Neuroradiology, IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
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Van den Bergh PY, Rajabally YA. Chronic inflammatory demyelinating polyradiculoneuropathy. Presse Med 2013; 42:e203-15. [DOI: 10.1016/j.lpm.2013.01.056] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 01/25/2013] [Accepted: 01/25/2013] [Indexed: 12/12/2022] Open
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15
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Beydoun SR, Muir J, Apelian RG, Go JL, Lin FP. Clinical and imaging findings in three patients with advanced inflammatory demyelinating polyradiculoneuropathy associated with nerve root hypertrophy. J Clin Neuromuscul Dis 2012; 13:105-112. [PMID: 22538304 DOI: 10.1097/cnd.0b013e318224850f] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES Chronic inflammatory demyelinating polyradiculoneuropathy is a treatable neuropathy that is challenging to diagnose and has a broad spectrum of presentations. We report the clinical, electrodiagnostic, and radiographic presentations in three patients whose workup revealed hypertrophic nerve roots. METHODS We retrospectively reviewed the clinical, electrodiagnostic, and imaging data for patients diagnosed with chronic inflammatory demyelinating polyradiculoneuropathy over a 3-year period. RESULTS All patients had features of proximal and distal neuropathy with progressive or recurrent courses. Diagnosis and management were significantly altered by the concomitant clinical findings and/or radiographic findings. CONCLUSIONS Our cases highlight the use of magnetic resonance imaging to evaluate for nerve root hypertrophy as an additional tool to electrodiagnostic testing in the setting of refractory or atypical neuropathy condition. Awareness of the radiographic features will assist in confirmation of the diagnosis, institution of the appropriate therapy, and prevention of inadequate or delay of treatment.
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Affiliation(s)
- Said R Beydoun
- Department of Neurology, University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
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Computed tomography and magnetic resonance imaging findings in ophthalmoplegic migraine. Pediatr Neurol 2010; 42:434-6. [PMID: 20472197 DOI: 10.1016/j.pediatrneurol.2010.02.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Accepted: 02/22/2010] [Indexed: 11/23/2022]
Abstract
A patient with ophthalmoplegic migraine is described, and his computed tomography and magnetic resonance imaging findings are discussed. According to our results, triad migraine, third nerve palsy, and focal enhancement of an enlarged third cranial nerve at the root exit zone should be considered pathognomonic of the disease, and further examinations should be avoided. Pathogenetic theories of the disease are discussed, and we suggest a new pathogenetic theory.
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Matsumoto H, Hanajima R, Terao Y, Yugeta A, Hamada M, Shirota Y, Ohminami S, Nakatani-Enomoto S, Tsuji S, Ugawa Y. Prominent cauda equina involvement in patients with chronic inflammatory demyelinating polyradiculoneuropathy. J Neurol Sci 2010; 290:112-4. [DOI: 10.1016/j.jns.2009.10.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Accepted: 10/13/2009] [Indexed: 11/16/2022]
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Abstract
MRI has become the modality of choice for imaging the peripheral nervous system. When technically optimized and customized for individual clinical problems, MRI can provide insight into the underlying causes of neoplastic, inflammatory, and other diseases affecting peripheral nerves with a high degree of accuracy and effectively distinguish benign from malignant processes. With high-resolution imaging techniques targeted fascicular biopsy can be planned to improve diagnostic yield and decrease the risk of surgically sampling primary nerve pathology.
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Affiliation(s)
- Kimberly K Amrami
- Department of Radiology, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA.
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19
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Tazawa KI, Matsuda M, Yoshida T, Shimojima Y, Gono T, Morita H, Kaneko T, Ueda H, Ikeda SI. Spinal nerve root hypertrophy on MRI: clinical significance in the diagnosis of chronic inflammatory demyelinating polyradiculoneuropathy. Intern Med 2008; 47:2019-24. [PMID: 19043253 DOI: 10.2169/internalmedicine.47.1272] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To investigate the clinical usefulness of measuring diameters of spinal nerve roots on magnetic resonance imaging (MRI) in patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) with regard to the diagnosis and estimation of neurofunctional impairment. PATIENTS AND METHODS Fourteen patients with CIDP (mean age, 38.9+/-19.2 years) and 10 controls were enrolled in this study. Diameters of cervical and lumbosacral spinal nerve roots were determined on the short tau inversion recovery image of MRI. Correlations between these diameters and clinical indices, including the conduction velocity of median and tibial nerves, were examined. RESULTS Mean diameters of cervical and lumbosacral spinal nerve roots in CIDP patients were 6.0 to 6.8 mm and 7.3 to 10.4 mm, respectively. CIDP patients showed higher values of the diameter in C5 (p<0.05), C6 (p<0.05), C7 (p<0.005) and C8 (p<0.01) than controls. C7 and C8 showed significantly negative correlations between diameters of spinal nerve roots and the F-wave conduction velocity (FWCV) (p<0.05). In the lumbosacral region, L3, L4 and S1 showed significantly negative correlations between diameters of spinal nerve roots and FWCV (p<0.005, p<0.0005 and p<0.005, respectively). The latency-time difference between F- and M-waves increased with diameters of spinal nerve roots, and there were significantly positive correlations between them in L3 (p<0.05) and L4 (p<0.005). CONCLUSION Hypertrophy of spinal nerve roots shown on MRI may be useful as a clue to the diagnosis of CIDP and also as a clinical marker suggesting impairment of peripheral nerve conduction, particularly FWCV.
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Affiliation(s)
- Ko-ichi Tazawa
- Department of Internal Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto
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20
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Bradley LJ, Wilhelm T, King RHM, Ginsberg L, Orrell RW. Brachial plexus hypertrophy in chronic inflammatory demyelinating polyradiculoneuropathy. Neuromuscul Disord 2006; 16:126-31. [PMID: 16427285 DOI: 10.1016/j.nmd.2005.11.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2005] [Revised: 10/27/2005] [Accepted: 11/14/2005] [Indexed: 11/16/2022]
Abstract
We present the clinical, imaging and neuropathological findings in three patients with predominant brachial plexus neuropathy. MR scanning was key to determining the brachial plexus involvement. Biopsy of the brachial plexus was performed in one patient. The appearances of the brachial plexus on MRI, in conjunction with the clinical presentations of these patients, suggest that they are unusual variants within the spectrum of chronic inflammatory demyelinating polyradiculoneuropathy.
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Affiliation(s)
- Lloyd J Bradley
- Department of Clinical Neurosciences, Royal Free and University College Medical School, University College London, Rowland Hill Street, London NW3 2PF, UK
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21
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Allen DC, Smallman CA, Mills KR. Multifocal acquired demyelinating sensory and motor neuropathy presenting as a peripheral nerve tumor. Muscle Nerve 2006; 34:373-9. [PMID: 16609974 DOI: 10.1002/mus.20552] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A man with multifocal acquired demyelinating sensory and motor neuropathy (MADSAM), or Lewis-Sumner syndrome, presented with a progressive left lumbosacral plexus lesion resembling a neurofibroma. After 7 years he developed a left ulnar nerve lesion with conduction block in its upper segment. Treatment with intravenous immunoglobulin improved the symptoms and signs of both lesions. We conclude that inflammatory neuropathy must be considered in the differential diagnosis of peripheral nerve tumors, and that unifocal lesions may precede multifocal involvement in MADSAM by several years. In addition, we discuss the clinical features in 9 patients attending a specialist peripheral nerve clinic and review the literature.
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Affiliation(s)
- David C Allen
- Department of Clinical Neurophysiology, Kings College Hospital, Denmark Hill Campus, London SE5 9RS, UK.
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22
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Freitas MRGD, Nascimento OJM, Soares CN, Brito AR, Domingues RC. Chronic inflammatory demyelinating polyradiculoneuropathy: two cases with cervical spinal cord compression. ARQUIVOS DE NEURO-PSIQUIATRIA 2005; 63:666-9. [PMID: 16172720 DOI: 10.1590/s0004-282x2005000400021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a peripheral nerve disorder probably due to an immunological disturb. It evolves either in a steadily progressive or in a relapsing and fluctuating course. Weakness is mainly in the lower limbs proximally and distally. The electromyography is demyelinating. The cerebral spinal fluid protein is most of times elevated. Sometimes enlarged nerves are found. There are few cases described with spinal cord compression due to hypertrophic spinal nerve roots. Two patients (females, 66 and 67 years old) with diagnosis of a long standing CIDP are described. In the first one, the evolution was characterized by remission and relapsing course. The second patient had a chronic and progressive course. These patients presented after a long evolution a cervical spinal cord compression syndrome due to hypertrophic cervical roots. Neurologists must be aware of the possibility of development of spinal cord compression by enlarged spinal roots in patients with a long standing CIDP.
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Affiliation(s)
- Marcos R G de Freitas
- Department of Neurology, Hospital Universitário Antonio Pedro, Universidade Federal Fluminense, Niterói, RJ, Brazil.
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23
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Ishida K, Wada Y, Tsunemi T, Kanda T, Mizusawa H. Marked hypertrophy of the cauda equina in a patient with chronic inflammatory demyelinating polyradiculoneuropathy presenting as lumbar stenosis. J Neurol 2005; 252:239-40. [PMID: 15729537 DOI: 10.1007/s00415-005-0632-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2004] [Revised: 06/21/2004] [Accepted: 07/08/2004] [Indexed: 12/26/2022]
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24
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Matsuoka N, Kohriyama T, Ochi K, Nishitani M, Sueda Y, Mimori Y, Nakamura S, Matsumoto M. Detection of cervical nerve root hypertrophy by ultrasonography in chronic inflammatory demyelinating polyradiculoneuropathy. J Neurol Sci 2004; 219:15-21. [PMID: 15050432 DOI: 10.1016/j.jns.2003.11.011] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2003] [Revised: 10/28/2003] [Accepted: 11/28/2003] [Indexed: 12/20/2022]
Abstract
Several studies have demonstrated abnormal MRI findings in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), especially hypertrophy and abnormal enhancement of spinal nerve roots, but there have been few reports on ultrasonographic findings of spinal nerve roots in CIDP. To determine whether ultrasonography (US) enables detection of hypertrophy of the cervical nerve roots, how frequently hypertrophy occurs in CIDP, and whether US findings correlate with any clinical and laboratory features, US of cervical nerve roots was performed using a 7.5-MHz linear-array transducer in 13 CIDP patients and 35 control subjects. A coronal oblique plane with a transducer placed on the lateral side of the neck was used to visualize the cervical nerve roots just after their point of exit from the cervical foramina, and their diameters were measured. US demonstrated hypertrophy of the cervical nerve roots in 9 (69%) of the 13 CIDP patients as compared with findings in control subjects. The degree of hypertrophy was significantly associated with the level of CSF protein (chi2=5.8, p<0.05, logistic simple regression analysis) but not with other clinical features. US is considered to be a useful method for evaluating cervical nerve root hypertrophy, which is frequently seen in patients with CIDP, particularly in patients with elevated level of CSF protein.
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Affiliation(s)
- Naoki Matsuoka
- Department of Clinical Neuroscience and Therapeutics, Division of Integrated Medical Science, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3, Kasumi, Hiroshima, 734-8551, Japan.
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25
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Kretzer RM, Burger PC, Tamargo RJ. Hypertrophic Neuropathy of the Cauda Equina: Case Report. Neurosurgery 2004; 54:515-8; discussion 518-9. [PMID: 14744300 DOI: 10.1227/01.neu.0000103492.19663.ef] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2003] [Accepted: 10/07/2003] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE AND IMPORTANCE
Hypertrophic neuropathy of the cauda equina (HNCE) is a rare form of peripheral neuropathy. The diagnosis is complicated by an insidious clinical presentation and complex radiographic images. We present a case of HNCE caused by chronic inflammatory demyelinating polyneuropathy with symptomatic improvement after decompressive lumbar laminectomy and dural expansion.
CLINICAL PRESENTATION
A 54-year-old woman with a history of back pain since she was in her 20s presented with low back and radicular pain that had increased during a period of 6 months, bilateral lower-extremity weakness, and sensory loss in the right thigh. Magnetic resonance imaging of the lumbosacral spine revealed multiple, poorly enhancing mass lesions and apparent intrathecal nerve root thickening from L1 to L5.
INTERVENTION
An L1-L5 decompressive laminectomy, performed with continuous somatosensory evoked potential and electromyographic monitoring, revealed multiple segmentally enlarged nerve roots. One nerve root that did not respond to high levels of stimulation was identified. This root was resected and submitted for pathological analysis. The dura was expanded with an 11-cm-long dural patch. The pathological examination revealed hypertrophic neuropathy, with extensive S-100-positive “onion bulb” formation. The patient's symptoms improved postoperatively.
CONCLUSION
HNCE is a rare disorder that can cause radicular pain and lower-extremity weakness, sensory loss, and hyporeflexia. One possible cause is demyelinating polyneuropathy. Although medical management is typically effective in the treatment of demyelinating polyneuropathy, it has little effect on compressive symptoms caused by intradural nerve root enlargement. As this case demonstrates, surgical management of symptomatic radiculopathy by lumbar laminectomy is a reasonable and effective approach to the treatment of HNCE.
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Affiliation(s)
- Ryan M Kretzer
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Meyer 8-181, 600 N. Wolfe Street, Baltimore, MD 21287, USA
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26
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Oguz B, Oguz KK, Cila A, Tan E. Diffuse spinal and intercostal nerve involvement in chronic inflammatory demyelinating polyradiculoneuropathy: MRI findings. Eur Radiol 2003; 13 Suppl 6:L230-4. [PMID: 16440223 DOI: 10.1007/s00330-003-1996-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2002] [Revised: 04/15/2003] [Accepted: 06/02/2003] [Indexed: 10/26/2022]
Abstract
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an uncommon demyelinating disorder with a relapsing and remitting or continuously progressive course. Hypertrophic nerve roots, sometimes associated with gadolinium enhancement, has been reported more commonly in lumbar spine and less commonly in the brachial plexus and cervical roots; however, diffuse involvement of intercostal nerves bilaterally has never been reported previously. We present MRI findings which include diffuse enlargement and mild enhancement of roots and extraforaminal segments of nerves in all segments except a short segment between T12-L2 as well as all the intercostal nerves in a case of CIPD with a 10-year history.
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Affiliation(s)
- Berna Oguz
- Department of Radiology, Hacettepe University Faculty of Medicine, Sihhiye, 06100, Ankara, Turkey
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27
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Abstract
Oculomotor ophthalmoplegic migraine is a rare episodic childhood condition in which a unilateral oculomotor palsy is preceded by headache. I describe six new cases that had magnetic resonance imaging signal abnormalities during the acute phase, consisting of a thickened and enhancing ipsilateral oculomotor nerve at its exit from the midbrain. During the quiescent phase, when the headache had resolved, the signal abnormalities were still present but less dramatic. Seventeen similar cases have been previously reported. The pathophysiology may be a trigeminovascular migraine epiphenomenon that is dependent on the unique oculomotor nerve anatomy and porous blood-nerve barrier at the emergence of the oculomotor nerve from the brainstem and the sequelae of demyelination. Early high-dose corticosteroid treatment is recommended to rapidly resolve an acute episode and to potentially prevent permanent abnormal oculomotor nerve signs.
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Affiliation(s)
- Thomas J Carlow
- School of Medicine, University of New Mexico, 302 Juniper Hill Road, Albuquerque, NM 87122, USA.
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28
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Lindenbaum Y, Kissel JT, Mendell JR. Treatment approaches for Guillain-Barré syndrome and chronic inflammatory demyelinating polyradiculoneuropathy. Neurol Clin 2001; 19:187-204. [PMID: 11471764 DOI: 10.1016/s0733-8619(05)70012-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
GBS and CIDP are important treatable forms of acquired peripheral neuropathies. GBS is a heterogeneous disorder representing at least five different entities. Three are predominantly motor: AIDP, AMSAN, and AMAN. Fisher syndrome and acute panautonomic neuropathy are other variants. Treatment for all of these conditions is the same and includes either plasma exchange or intravenous immunoglobulin. There is no indication that Guillain-Barré patients respond to corticosteroids. At the present time, it is uncertain if CIDP represents one or more disorders. Evidence favors a syndrome composed of more than one entity accounting for (1) clinical variations from subject-to-subject, ranging from symmetrical to focal neurologic deficits; (2) course variations from slowly progressive to step-wise, to relapsing; and, (3) laboratory variations in nerve conduction studies, spinal fluid protein, and nerve biopsy findings. CIDP patients respond to corticosteroids in contrast to those with GBS. CIDP improves with intravenous immunoglobulin and plasma exchange, paralleling the findings in GBS. Specific regimens of treatment for both GBS and CIDP are presented in this article and considerations that might influence one treatment regimen over another are discussed.
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Affiliation(s)
- Y Lindenbaum
- Department of Neurology, The Ohio State University, College of Medicine, Columbus 43210, USA
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29
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Abstract
Isolated reports have documented enhancement and/or enlargement of spinal nerve roots on magnetic resonance imaging (MRI) in patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). This work examines those findings in a consecutive series of 16 patients with CIDP, with blinded comparison to MRI in 13 disease controls, including five patients with Charcot-Marie-Tooth disease type 1A. MRI sequences consisted of T1 weighted sagittal and axial views, before and after administration of gadolinium. Blinded MRI interpretation was performed independently by two neuroradiologists. MRI results were correlated with data collected from chart review. Enhancement of the cauda equina was seen in 11 of 16 CIDP patients (69%), and in none of 13 control subjects. Nerve roots were enlarged, most significantly in the extraforaminal region, in three CIDP patients, and in one patient with Charcot-Marie-Tooth type 1A. MRI findings did not correlate with disease activity and severity, nor with any clinical or laboratory features in patients with CIDP.
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Affiliation(s)
- G Midroni
- Department of Neurology, Neurophysiology - 9V, St. Michael's Hospital, 30 Bond Street, Toronto, Canada
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30
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Duggins AJ, McLeod JG, Pollard JD, Davies L, Yang F, Thompson EO, Soper JR. Spinal root and plexus hypertrophy in chronic inflammatory demyelinating polyneuropathy. Brain 1999; 122 ( Pt 7):1383-90. [PMID: 10388803 DOI: 10.1093/brain/122.7.1383] [Citation(s) in RCA: 149] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
MRI was performed on the spinal roots, brachial and lumbar plexuses of 14 patients with chronic inflammatory demyelinating polyneuropathy (CIDP). Hypertrophy of cervical roots and brachial plexus was demonstrated in eight cases, six of whom also had hypertrophy of the lumbar plexus. Of 11 patients who received gadolinium, five of six cases with hypertrophy and one of five without hypertrophy demonstrated enhancement. All patients with hypertrophy had a relapsing-remitting course and a significantly longer disease duration. Gross onion-bulb formations were seen in a biopsy of nerve from the brachial plexus in one case with clinically evident nodular hypertrophy. We conclude that spinal root and plexus hypertrophy may be seen on MRI, particularly in cases of CIDP of long duration, and gadolinium enhancement may be present in active disease.
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Affiliation(s)
- A J Duggins
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital and University of Sydney, Sydney, NSW, Australia
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31
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Mizuno K, Nagamatsu M, Hattori N, Yamamoto M, Goto H, Kuniyoshi K, Sobue G. Chronic inflammatory demyelinating polyradiculoneuropathy with diffuse and massive peripheral nerve hypertrophy: distinctive clinical and magnetic resonance imaging features. Muscle Nerve 1998; 21:805-8. [PMID: 9585338 DOI: 10.1002/(sici)1097-4598(199806)21:6<805::aid-mus16>3.0.co;2-r] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We present 3 patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) with extensive and diffuse hypertrophy of the nerve roots and peripheral nerves. They exhibited slowly progressive sensory impairment and distally predominant limb weakness and muscular atrophy, and markedly enlarged palpable nerve trunks. They responded beneficially to corticosteroid. Magnetic resonance imaging demonstrated diffuse and extensive hypertrophy of the peripheral nerves in the four limbs and the spinal nerve roots, with gadolinium enhancement in the nerve roots but not in the peripheral nerves. These patients were considered to have a hypertrophic variant of CIDP.
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Affiliation(s)
- K Mizuno
- Department of Neurology, Nagoya University School of Medicine, Japan
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32
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Schady W, Goulding PJ, Lecky BR, King RH, Smith CM. Massive nerve root enlargement in chronic inflammatory demyelinating polyneuropathy. J Neurol Neurosurg Psychiatry 1996; 61:636-40. [PMID: 8971116 PMCID: PMC486663 DOI: 10.1136/jnnp.61.6.636] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To report three patients with chronic inflammatory demyelinating polyneuropathy (CIDP) presenting with symptoms suggestive of cervical (one patient) and lumbar root disease. METHODS Nerve conduction studies, EMG, and nerve biopsy were carried out, having found the nerve roots to be very enlarged on MRI, CT myelography, and at surgery. RESULTS Clinically, peripheral nerve thickening was slight or absent. Subsequently one patient developed facial nerve hypertrophy. This was mistaken for an inner ear tumour and biopsied, with consequent facial palsy. Neurophysiological tests suggested a demyelinating polyneuropathy. Sural nerve biopsy showed in all cases some loss of myelinated fibres, inflammatory cell infiltration, and a few onion bulbs. Hypertrophic changes were much more prominent on posterior nerve root biopsy in one patient: many fibres were surrounded by several layers of Schwann cell cytoplasm. There was an excellent response to steroids in two patients but not in the third (most advanced) patient, who has benefited only marginally from intravenous immunoglobulin therapy. CONCLUSIONS MRI of the cauda equina may be a useful adjunct in the diagnosis of CIDP.
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Affiliation(s)
- W Schady
- Department of Neurology, Manchester Royal Infirmary, UK
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33
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Goldstein JM, Parks BJ, Mayer PL, Kim JH, Sze G, Miller RG. Nerve root hypertrophy as the cause of lumbar stenosis in chronic inflammatory demyelinating polyradiculoneuropathy. Muscle Nerve 1996; 19:892-6. [PMID: 8965844 DOI: 10.1002/(sici)1097-4598(199607)19:7<892::aid-mus12>3.0.co;2-l] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Two patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) developed signs of lumbar stenosis. Radiologic, intraoperative, and pathologic findings demonstrated lumbar stenosis secondary to nerve root hypertrophy. This syndrome has been demonstrated in hereditary but not acquired demyelinating neuropathies. CIDP should be considered in the differential diagnosis of sciatica and nerve root hypertrophy.
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Affiliation(s)
- J M Goldstein
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
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34
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Matsuda M, Ikeda S, Sakurai S, Nezu A, Yanagisawa N, Inuzuka T. Hypertrophic neuritis due to chronic inflammatory demyelinating polyradiculoneuropathy (CIDP): a postmortem pathological study. Muscle Nerve 1996; 19:163-9. [PMID: 8559164 DOI: 10.1002/(sici)1097-4598(199602)19:2<163::aid-mus6>3.0.co;2-c] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A postmortem pathological study of a 65-year-old woman with hypertrophic neuritis associated with hand tremor and limb ataxia is described. There were many onion bulbs and loss of myelinated nerve fibers in the peripheral nerves, including the facial and subserosal visceral nerves. The hypertrophic neuritis was caused by chronic inflammatory demyelinating neuropathy (CIDP), in which interstitial amorphous substances in the endoneurium and onion bulb formation might contribute to nerve swelling. We speculate that visceral autonomic nerves as well as somatic peripheral nerves are involved in patients with a long clinical CIDP course and that peripheral nerve pathology in this disorder shows more heterogeneous changes than previously recognized.
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Affiliation(s)
- M Matsuda
- Department of Medicine (Neurology), Shinshu University School of Medicine, Matsumoto, Japan
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