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Neuropatie ereditarie da ipersensibilità alla pressione (neuropatia tomaculare o allantoidea). Neurologia 2018. [DOI: 10.1016/s1634-7072(18)41292-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Hereditary neuropathy with liability to pressure palsy presenting as a bilateral brachial plexopathy. NEUROLOGÍA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.nrleng.2015.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Morgado J, Sousa AP, Alves P, Medeiros L. Hereditary neuropathy with liability to pressure palsy presenting as a bilateral brachial plexopathy. Neurologia 2016; 32:626-629. [PMID: 26874568 DOI: 10.1016/j.nrl.2015.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Revised: 10/26/2015] [Accepted: 11/30/2015] [Indexed: 10/22/2022] Open
Affiliation(s)
- J Morgado
- Servicio de Neurología, Centro Hospitalar Lisboa Central, Lisboa, Portugal.
| | - A P Sousa
- Servicio de Neurología, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - P Alves
- Servicio de Radiología, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - L Medeiros
- Servicio de Neurofisiología, Centro Hospitalar Lisboa Central, Lisboa, Portugal
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Cruz-Martínez A, Bort S, Arpa J, Duarte J, Palau F. Clinical, genetic and electrophysiologic correlation in hereditary neuropathy with liability to pressure palsies with involvement of PMP22 gene at chromosome 17p11.2. Eur J Neurol 2011. [DOI: 10.1111/j.1468-1331.1997.tb00347.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Beydoun SR, Sykes SN, Ganguly G, Lee TS. Hereditary neuropathy with liability to pressure palsies: description of seven patients without known family history. Acta Neurol Scand 2008; 117:266-72. [PMID: 17922888 DOI: 10.1111/j.1600-0404.2007.00935.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Hereditary neuropathy with liability to pressure palsies (HNPP) is an inherited disorder resulting in a polyneuropathy with particular involvement at sites of entrapment, and is often underdiagnosed or misdiagnosed. We report findings on seven patients referred for evaluation of focal mononeuropathies or polyneuropathies of undetermined etiology, in whom we established a diagnosis of HNPP. MATERIALS AND METHODS We retrospectively reviewed clinical, electrophysiological and laboratory data for patients diagnosed with HNPP over a 4-year period at our institution. RESULTS All patients had transient or recurrent neurological symptoms, some with residual deficits. No patients had a family history of any neuropathy. Electrodiagnostic studies revealed abnormal conduction findings at symptomatic and asymptomatic sites. Testing for the Peripheral Myelin Protein (PMP22) deletion was positive in all patients. CONCLUSIONS A high index of clinical suspicion and thorough electrodiagnostic evaluation can lead to correct diagnosis of HNPP, despite the absence of a positive family history.
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Affiliation(s)
- S R Beydoun
- Department of Neurology, Keck School of Medicine at University of Southern California, Los Angeles, CA, USA.
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Chance PF. Inherited focal, episodic neuropathies: hereditary neuropathy with liability to pressure palsies and hereditary neuralgic amyotrophy. Neuromolecular Med 2007; 8:159-74. [PMID: 16775374 DOI: 10.1385/nmm:8:1:159] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2005] [Revised: 12/22/2005] [Accepted: 12/30/2005] [Indexed: 12/16/2022]
Abstract
Hereditary neuropathy with liability to pressure palsies (HNPP; also called tomaculous neuropathy) is an autosomal-dominant disorder that produces a painless episodic, recurrent, focal demyelinating neuropathy. HNPP generally develops during adolescence, and may cause attacks of numbness, muscular weakness, and atrophy. Peroneal palsies, carpal tunnel syndrome, and other entrapment neuropathies may be frequent manifestations of HNPP. Motor and sensory nerve conduction velocities may be reduced in clinically affected patients, as well as in asymptomatic gene carriers. The histopathological changes observed in peripheral nerves of HNPP patients include segmental demyelination and tomaculous or "sausage-like" formations. Mild overlap of clinical features with Charcot-Marie-Tooth (CMT) disease type 1 (CMT1) may lead patients with HNPP to be misdiagnosed as having CMT1. HNPP and CMT1 are both demyelinating neuropathies, however, their clinical, pathological, and electrophysiological features are quite distinct. HNPP is most frequently associated with a 1.4-Mb pair deletion on chromosome 17p12. A duplication of the identical region leads to CMT1A. Both HNPP and CMT1A result from a dosage effect of the PMP22 gene, which is contained within the deleted/duplicated region. This is reflected in reduced mRNA and protein levels in sural nerve biopsy samples from HNPP patients. Treatment for HNPP consists of preventative and symptom-easing measures. Hereditary neuralgic amyotrophy (HNA; also called familial brachial plexus neuropathy) is an autosomal-dominant disorder causing episodes of paralysis and muscle weakness initiated by severe pain. Individuals with HNA may suffer repeated episodes of intense pain, paralysis, and sensory disturbances in an affected limb. The onset of HNA is at birth or later in childhood with prognosis for recovery usually favorable; however, persons with HNA may have permanent residual neurological dysfunction following attack(s). Episodes are often triggered by infections, immunizations, the puerperium, and stress. Electrophysiological studies show normal or mildly prolonged motor nerve conduction velocities distal to the affected brachial plexus. Pathological studies have found axonal degeneration in nerves examined distal to the plexus abnormality. In some HNA pedigrees there are characteristic facial features, including hypotelorism. The prognosis for recovery of normal function of affected limbs in HNA is good, although recurrent episodes may cause residual deficits. HNA is genetically linked to chromosome 17q25, where mutations in the septin-9 (SEPT9) gene have been found.
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Affiliation(s)
- Phillip F Chance
- Division of Genetics and Developmental Medicine, Children's Hospital and Regional Medical Center, Department of Pediatrics, University of Washington School of Medicine, Box 356320, Room RR247, Seattle, Washington 98195, USA.
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KUMAR NEERAJ, COLE JULIE, PARRY GARETHJ. Variability of Presentation in Hereditary Neuropathy with Liability to Pressure Palsy Results in Underrecognition. Ann N Y Acad Sci 2006; 883:344-350. [DOI: 10.1111/j.1749-6632.1999.tb08596.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Affiliation(s)
- Philip F Chance
- Division of Genetics and Congenital Defects, Department of Pediatrics, Box 356320, University of Washington School of Medicine, Seattle, Washington 98195, USA
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Chance PF. Chapter 24 Genetic evaluation of inherited motor/sensory neuropathy. ADVANCES IN CLINICAL NEUROPHYSIOLOGY, PROCEEDINGS OF THE 27TH INTERNATIONAL CONGRESS OF CLINICAL NEUROPHYSIOLOGY, AAEM 50TH ANNIVERSARY AND 57TH ANNUAL MEETING OF THE ACNS JOINT MEETING 2004; 57:228-42. [PMID: 16106622 DOI: 10.1016/s1567-424x(09)70360-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Inherited disorders of peripheral nerves represent a common group of neurologic diseases. Charcot-Marie-Tooth neuropathy type 1 (CMT1) is a genetically heterogeneous group of chronic demyelinating polyneuropathies with loci mapping to chromosome 17 (CMT1A), chromosome 1 (CMT1B), chromosome 16 (CMT1C) and chromosome 10 (CMT1D). CMT1A is most often associated with a tandem 1.5-megabase (Mb) duplication in chromosome 17p11.2-p12. In rare patients it may result from a point mutation in the peripheral myelin protein-22 (PMP22) gene. CMT1B is associated with point mutations in the myelin protein zero (Po or MPZ) gene. Mutations in the SIMPLE gene cause CMT1C, and CMT1D is the result of mutations in the early response 2 (ERG2 or Krox-20) gene. An X-linked form of CMT1 (CMT1X) maps to Xq13 and is associated with mutations in the connexin32 (Cx32) gene. Charcot-Marie-Tooth neuropathy type 2 (CMT2) is an axonal neuropathy that maps to chromosome 1p35-p36 (CMT2A), chromosome 3q13-q22 (CMT2B), chromosome 7p14 (CMT2D), chromosome 8p21 (CMT2E), chromosome 1q22-q23 (CMT2F) or chromosome 3q13 (CMT2G). Two X-linked forms of CMT2 have been reported (CMT2XA and CMT2XB), but the genes remain unidentified. An area that has recently expanded is the identification of autosomal recessive forms of CMT type 1 and 2. Of the eight recessive forms of CMT1 that have been identified to date, only two have been fully characterized at the molecular level (CMT1 AR B 1 and CMT1 AR D). Point mutations were found in the myotubularin-related protein-2 (MTM2) gene for CMT1 AR B1. CMT1 AR D is the result of point mutations in the N-myc downstream-regulated gene 1 (NDRG1). Dejerine-Sottas disease (DSD), also called hereditary motor and sensory neuropathy type III (HMSNIII), is a severe, infantile-onset demyelinating polyneuropathy syndrome that may be associated with point mutations in either the PMP22 gene, PO gene, EGR2 gene or the PRX gene (for the recessive form). It shares considerable clinical and pathological features with CMT1. Hereditary neuropathy with liability to pressure palsies (HNPP) is an autosomal dominant disorder that results in a recurrent, episodic demyelinating neuropathy. HNPP is associated with a 1.5-Mb deletion in chromosome 17p11.2-p12 that results in reduced expression of the PMP22 gene. CMT1A and HNPP are reciprocal duplication/deletion syndromes that originate from unequal crossover during germ cell meiosis. Other rare forms of demyelinating peripheral neuropathies map to chromosome 8q, 10q and 11q.
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Affiliation(s)
- Phillip F Chance
- Neurogenetics Laboratory, Division of Genetics and Developmental Medicine, Box 356320, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA 98195, USA.
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Kumar N, Muley S, Pakiam A, Parry GJ. Phenotypic Variability Leads to Under-recognition of HNPP. J Clin Neuromuscul Dis 2002; 3:106-112. [PMID: 19078663 DOI: 10.1097/00131402-200203000-00002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To determine the range of phenotypic expression in individuals with hereditary neuropathy with liability to pressure palsy (HNPP) with the chromosome 17 deletion. METHODS Twenty-one patients from 10 families were studied. Genetic testing was performed in at least one member of each family. Every patient was examined clinically, electrophysiological data was available in 18 patients, and a sural nerve biopsy was performed on 4 patients. In addition, a patient symptom questionnaire was administered over the telephone to identify symptomatic individuals from the at-risk population. RESULTS The identified phenotypes were those of compressive neuropathy, symmetric peripheral neuropathy (often misdiagnosed as Charcot-Marie-Tooth neuropathy), acute brachial paralysis, and confluent mononeuropathy multiplex. Many individuals were oligosymptomatic and these formed the majority of undiagnosed patients. CONCLUSIONS The presence of mild symptoms and the marked phenotypic variability of the disease result in underdiagnosis of HNPP.
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Affiliation(s)
- Neeraj Kumar
- From the Department of Neurology, University of Minnesota, Minneapolis, Minnesota
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Ørstavik K, Skard Heier M, Young P, Stögbauer F. Brachial plexus involvement as the only expression of hereditary neuropathy with liability to pressure palsies. Muscle Nerve 2001; 24:1093-6. [PMID: 11439387 DOI: 10.1002/mus.1116] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Hereditary neuropathy with liability to pressure palsies (HNPP) is an autosomal-dominant focal neuropathy characterized by recurrent entrapment neuropathies. Single members of families with HNPP and brachial plexus involvement have been reported previously. We describe a family with three affected members and in which the only symptom of entrapment was recurrent brachial plexopathy. The diagnosis of HNPP in this family was confirmed by both neurophysiological methods and DNA analysis. The distinction between HNPP and hereditary neuralgic amyotrophy is discussed.
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Affiliation(s)
- K Ørstavik
- Department of Neurology, Ullevål Hospital, 0407 Oslo, Norway.
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Abstract
Hereditary neuropathy with liability to pressure palsy (HNPP) is typified as isolated nerve palsies caused by trivial compression or trauma. It rarely presents in two extremities and even more infrequently affects all four limbs simultaneously. We present a patient who concurrently experienced right shoulder, left hand, and bilateral foot weakness mimicking several multifocal conditions. Electromyography suggested HNPP and subsequent nerve biopsy and genetic testing were confirmatory. The case demonstrates that HNPP can present in a fulminant manner and should be included in the differential diagnosis of acute multiple mononeuropathies. The possible causes for such a rapid clinical course in our patient are discussed.
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Affiliation(s)
- B A Crum
- Department of Neurology, Mayo Clinic, Rochester, Minnesota 55905, USA
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Abstract
Inherited disorders of peripheral nerves represent a common group of neurologic diseases. Charcot-Marie-Tooth neuropathy type 1 (CMT1) is a genetically heterogeneous group of chronic demyelinating polyneuropathies with loci mapping to chromosome 17 (CMT1A), chromosome 1 (CMT1B) and to another unknown autosome (CMT1C). CMT1A is most often associated with a tandem 1.5-megabase (Mb) duplication in chromosome 17p11.2-12, or in rare patients may result from a point mutation in the peripheral myelin protein-22 (PMP22) gene. CMT1B is associated with point mutations in the myelin protein zero (P0 or MPZ) gene. The molecular defect in CMT1C is unknown. X-linked Charcot-Marie-Tooth neuropathy (CMTX), which has clinical features similar to CMT1, is associated with mutations in the connexin32 gene. Charcot-Marie-Tooth neuropathy type 2 (CMT2) is an axonal neuropathy, also of undetermined cause. One form of CMT2 maps to chromosome 1p36 (CMT2A), another to chromosome 3p (CMT2B) and another to 7p (CMT2D). Dejerine-Sottas disease (DSD), also called hereditary motor and sensory neuropathy type III (HMSNIII), is a severe, infantile-onset demyelinating polyneuropathy syndrome that may be associated with point mutations in either the PMP22 gene or the P0 gene and shares considerable clinical and pathological features with CMT1. Hereditary neuropathy with liability to pressure palsies (HNPP) is an autosomal dominant disorder that results in a recurrent, episodic demyelinating neuropathy. HNPP is associated with a 1.5-Mb deletion in chromosome 17p11.2-12 and results from reduced expression of the PMP22 gene. CMT1A and HNPP are reciprocal duplication/deletion syndromes originating from unequal crossover during germ cell meiosis. Other rare forms of demyelinating peripheral neuropathies map to chromosome 8q, 10q and 11q. Hereditary neuralgic amyotrophy (familial brachial plexus neuropathy) is an autosomal dominant disorder causing painful, recurrent brachial plexopathies and maps to chromosome 17q25.
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Affiliation(s)
- M P Keller
- Department of Pediatrics, University of Washington School of Medicine, Seattle, USA
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Stögbauer F, Young P, Kerschensteiner M, Ringelstein EB, Assmann G, Funke H. Recurrent brachial plexus palsies as the only clinical expression of hereditary neuropathy with liability to pressure palsies associated with a de novo deletion of the peripheral myelin protein-22 gene. Muscle Nerve 1998; 21:1199-201. [PMID: 9703447 DOI: 10.1002/(sici)1097-4598(199809)21:9<1199::aid-mus12>3.0.co;2-n] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
There is phenotypic heterogeneity in patients with hereditary neuropathy with liability to pressure palsies. In rare cases, recurrent brachial plexopathy is the only expression of the disease. We describe a patient with three episodes of plexus brachialis palsy and a de novo deletion of the peripheral myelin protein-22 gene. We conclude that DNA analysis is a key issue not only for the differentiation of peripheral neuropathies but also in the diagnosis of recurrent plexopathies.
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Affiliation(s)
- F Stögbauer
- Klinik und Poliklinik für Neurologie, Westfälische Wilhelms Universität Münster, Germany
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Martinelli P, Macrì S, Scaglione C, Stumpo M, Poppi M. Acute brachial plexus neuropathy as a presenting sign of peripheral nervous system involvement in paraproteinaemia. Acta Neurol Scand 1997; 95:319-20. [PMID: 9188910 DOI: 10.1111/j.1600-0404.1997.tb00218.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Mancardi GL, Mandich P, Nassani S, Schenone A, James R, Defferrari R, Bellone E, Giunchedi M, Ajmar F, Abbruzzese M. Progressive sensory-motor polyneuropathy with tomaculous changes is associated to 17p11.2 deletion. J Neurol Sci 1995; 131:30-4. [PMID: 7561944 DOI: 10.1016/0022-510x(95)00042-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We examined for the presence of 17p11.2 deletion, by Southern blotting and fluorescent in situ hybridization, 3 cases with progressive sensory-motor polyneuropathy and diffuse tomaculous changes at sural nerve biopsy. We demonstrated in all the cases the 17p11.2 deletion, previously reported in hereditary neuropathy with pressure palsy, an inherited disorder of the peripheral nervous system with similar pathologic changes but a different clinical phenotype. The molecular study of the 17p11.2 region should be considered as a non invasive method for differential diagnosis in selected cases of progressive polyneuropathy.
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Affiliation(s)
- G L Mancardi
- Institute of Neurology, University of Genoa, Italy
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Rizzuto N, Moretto G, Galiazzo Rizzuto S. Clinical spectrum of the tomaculous neuropathies. Report of 60 cases and review of the literature. ITALIAN JOURNAL OF NEUROLOGICAL SCIENCES 1993; 14:609-17. [PMID: 8125763 DOI: 10.1007/bf02339245] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Tomaculous neuropathy has a distinctive pathological pattern of myelin thickenings in a high proportion of internodes but no specific pattern of nerve degeneration. We have analyzed the variable clinical expression of this disorder in a large series of patients. Different phenotypes have been recognized: the majority of our patients (52 cases) had hereditary neuropathy with liability to pressure palsy (HNPP) showing wide variability of clinical progression and of severity of the single episodes. 3 patients suffered from familial recurrent brachial plexus neuropathy (FBPN); 5 patients had a symmetrical progressive sensorimotor involvement of the limbs (SSMN), predominantly in the distal portions and leading to permanent disability. The explanation for this clinical variability does not emerge from our data or from the literature. Segmental demyelination is the major change correlating with the episodes of nerve palsy; axonal degeneration might be rarely associated. The myelin sausages are the markers of a selective vulnerability of the nerve fibers either to mechanical injury or to some other unknown event.
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Affiliation(s)
- N Rizzuto
- Istituto di Neurologia, Università degli Studi di Verona
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Verhagen WI, Gabreëls-Festen AA, van Wensen PJ, Joosten EM, Vingerhoets HM, Gabreëls FJ, de Graaf R. Hereditary neuropathy with liability to pressure palsies: a clinical, electroneurophysiological and morphological study. J Neurol Sci 1993; 116:176-84. [PMID: 8393091 DOI: 10.1016/0022-510x(93)90323-q] [Citation(s) in RCA: 78] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Clinical, electroneurographic and myographic studies were performed on 99 patients of 13 families having hereditary neuropathy with liability to pressure palsies (HNPP) and on 116 relatives. Diagnosis was confirmed in all families by a nerve biopsy of the index case. Large focal myelin thickenings (tomacula) were found in nerve biopsies of affected persons, whether or not pressure palsies had occurred. By using three electroneurographical parameters it was possible to discriminate between asymptomatic patients and unaffected relatives. Complaints sometimes mentioned in literature as being associated with HNPP such as low back pain, brachialgia and short lasting paraesthesia are not related to HNPP. The hereditary transmission is autosomal dominant with total penetration but variable expression.
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Affiliation(s)
- W I Verhagen
- Institute of Neurology, St. Radboud University Hospital, University of Nijmegen, The Netherlands
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Kulisevsky J, Martí-Fàbregas J, Escartin A, Pradas J. Brachial plexus palsy associated with spasmodic torticollis in a patient with tomaculous neuropathy. Mov Disord 1992; 7:186-7. [PMID: 1584242 DOI: 10.1002/mds.870070217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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