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Daeschler SC, Bourget MH, Derakhshan D, Sharma V, Asenov SI, Gordon T, Cohen-Adad J, Borschel GH. Rapid, automated nerve histomorphometry through open-source artificial intelligence. Sci Rep 2022; 12:5975. [PMID: 35396530 PMCID: PMC8993871 DOI: 10.1038/s41598-022-10066-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 03/21/2022] [Indexed: 12/23/2022] Open
Abstract
We aimed to develop and validate a deep learning model for automated segmentation and histomorphometry of myelinated peripheral nerve fibers from light microscopic images. A convolutional neural network integrated in the AxonDeepSeg framework was trained for automated axon/myelin segmentation using a dataset of light-microscopic cross-sectional images of osmium tetroxide-stained rat nerves including various axonal regeneration stages. In a second dataset, accuracy of automated segmentation was determined against manual axon/myelin labels. Automated morphometry results, including axon diameter, myelin sheath thickness and g-ratio were compared against manual straight-line measurements and morphometrics extracted from manual labels with AxonDeepSeg as a reference standard. The neural network achieved high pixel-wise accuracy for nerve fiber segmentations with a mean (± standard deviation) ground truth overlap of 0.93 (± 0.03) for axons and 0.99 (± 0.01) for myelin sheaths, respectively. Nerve fibers were identified with a sensitivity of 0.99 and a precision of 0.97. For each nerve fiber, the myelin thickness, axon diameter, g-ratio, solidity, eccentricity, orientation, and individual x -and y-coordinates were determined automatically. Compared to manual morphometry, automated histomorphometry showed superior agreement with the reference standard while reducing the analysis time to below 2.5% of the time needed for manual morphometry. This open-source convolutional neural network provides rapid and accurate morphometry of entire peripheral nerve cross-sections. Given its easy applicability, it could contribute to significant time savings in biomedical research while extracting unprecedented amounts of objective morphologic information from large image datasets.
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Affiliation(s)
- Simeon Christian Daeschler
- SickKids Research Institute, Neuroscience and Mental Health Program, Hospital for Sick Children (SickKids), Toronto, ON, Canada.
| | - Marie-Hélène Bourget
- NeuroPoly Laboratory, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
| | | | - Vasudev Sharma
- NeuroPoly Laboratory, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada.,University of Toronto, Toronto, ON, Canada
| | - Stoyan Ivaylov Asenov
- NeuroPoly Laboratory, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
| | - Tessa Gordon
- SickKids Research Institute, Neuroscience and Mental Health Program, Hospital for Sick Children (SickKids), Toronto, ON, Canada.,Division of Plastic and Reconstructive Surgery, the Hospital for Sick Children, Toronto, ON, Canada
| | - Julien Cohen-Adad
- NeuroPoly Laboratory, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada.,Functional Neuroimaging Unit, CRIUGM, University of Montreal, Montreal, QC, Canada.,Mila - Quebec AI Institute, Montreal, QC, Canada
| | - Gregory Howard Borschel
- SickKids Research Institute, Neuroscience and Mental Health Program, Hospital for Sick Children (SickKids), Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada.,Division of Plastic and Reconstructive Surgery, the Hospital for Sick Children, Toronto, ON, Canada.,Indiana University School of Medicine, Indianapolis, IN, USA
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2
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Qian M, Qin L, Shen K, Guan H, Ren H, Zhao Y, Guan Y, Zhou D, Peng B, Li J, Chen L. Light-Chain Amyloidosis With Peripheral Neuropathy as an Initial Presentation. Front Neurol 2021; 12:707134. [PMID: 34650504 PMCID: PMC8505956 DOI: 10.3389/fneur.2021.707134] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 08/24/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: This study aimed to better understand the clinical, electrophysiological, pathological features and prognosis of peripheral nerve involvements in primary immunoglobulin light-chain (AL) amyloidosis. Methods: We retrospectively reviewed the clinical data of eight AL amyloidosis patients with peripheral neuropathy as the initial presentation including clinical features, histopathological findings and treatment. Results: There were seven males and one female aged from 52 to 66 years. Initial symptoms included symmetrical lower extremity numbness, lower extremity pain and carpal tunnel syndrome. Seven patients suffered from severe pain and required pain management. Six patients had predominant autonomic dysfunction. Six patients had cardiac involvement, and one patient had renal involvement. Monoclonal proteins were found in all patients, with IgA λ in one, IgG λ in two, λ alone in three, κ alone in one and IgM κ in one. Sural nerve biopsies were performed in 7 cases, all of which showed amyloid deposition in the endoneurium (in the perivascular region in some cases), in addition to moderate to severe myelinated fiber loss with axonal degeneration. Six patients were treated with combined chemotherapy. In three patients who began chemotherapy earlier (6-10 months after onset), two achieved a hematological complete response, and one achieved a partial response. three patients who had delayed chemotherapy (36 months after onset) died between 5 and 12 months after diagnosis. Conclusion: Early recognition of AL amyloidosis with peripheral neuropathy as the initial symptom is very important. Nerve biopsy can help to make the diagnosis. Early diagnosis and chemotherapy are critical to achieve better outcomes.
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Affiliation(s)
- Min Qian
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences Beijing, Beijing, China
| | - Lan Qin
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA, United States
| | - Kaini Shen
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences Beijing, Beijing, China
| | - Hongzhi Guan
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences Beijing, Beijing, China
| | - Haitao Ren
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences Beijing, Beijing, China
| | - Yanhuan Zhao
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences Beijing, Beijing, China
| | - Yuzhou Guan
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences Beijing, Beijing, China
| | - Daobin Zhou
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences Beijing, Beijing, China
| | - Bin Peng
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences Beijing, Beijing, China
| | - Jian Li
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences Beijing, Beijing, China
| | - Lin Chen
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences Beijing, Beijing, China
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3
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Sommer C, Carroll AS, Koike H, Katsuno M, Ort N, Sobue G, Vucic S, Spies JM, Doppler K, Kiernan MC. Nerve biopsy in acquired neuropathies. J Peripher Nerv Syst 2021; 26 Suppl 2:S21-S41. [PMID: 34523188 DOI: 10.1111/jns.12464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 06/02/2021] [Accepted: 08/24/2021] [Indexed: 11/29/2022]
Abstract
A diagnosis of neuropathy can typically be determined through clinical assessment and focused investigation. With technological advances, including significant progress in genomics, the role of nerve biopsy has receded over recent years. However, making a specific and, in some cases, tissue-based diagnosis is essential across a wide array of potentially treatable acquired peripheral neuropathies. When laboratory investigations do not suggest a definitive diagnosis, nerve biopsy remains the final step to ascertain the etiology of the disease. The present review highlights the utility of nerve biopsy in confirming a diagnosis, while further illustrating the importance of a tissue-based diagnosis in relation to treatment strategies, particularly when linked to long-term immunosuppressive therapies.
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Affiliation(s)
- Claudia Sommer
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | - Antonia S Carroll
- Brain and Mind Centre, Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia.,Westmead Clinical School, The University of Sydney, Camperdown, New South Wales, Australia.,Department of Neurology and Neurophysiology, St Vincent's Hospital, The University of NSW, Sydney, New South Wales, Australia
| | - Haruki Koike
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nora Ort
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | - Gen Sobue
- Brain and Mind Research Center, Nagoya University, Nagoya, Japan.,Aichi Medical University, Nagakute, Japan
| | - Steve Vucic
- Westmead Clinical School, The University of Sydney, Camperdown, New South Wales, Australia
| | - Judith M Spies
- Brain and Mind Centre, Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia.,Department of Neurology, Royal Prince Alfred Hospital, The University of Sydney, Camperdown, New South Wales, Australia
| | - Kathrin Doppler
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | - Matthew C Kiernan
- Brain and Mind Centre, Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia.,Department of Neurology, Royal Prince Alfred Hospital, The University of Sydney, Camperdown, New South Wales, Australia
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4
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Puffer RC, Spinner RJ, Bi H, Sharma R, Wang Y, Theis JD, McPhail ED, Poterucha JJ, Niu Z, Klein CJ. Fatal TTR amyloidosis with neuropathy from domino liver p.Val71Ala transplant. NEUROLOGY-GENETICS 2019; 5:e351. [PMID: 31517060 PMCID: PMC6705621 DOI: 10.1212/nxg.0000000000000351] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 07/01/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Ross C Puffer
- Department of Neurosurgery (R.C.P., R.J.S.); Department of Neurology (H.B., R.S., C.J.K.), Mayo Clinic, Rochester, MN; Department of Neurology (H.B.), China Friendship Hospital, Beijing; Hematology and Oncology (Y.W.); Laboratory Medicine and Pathology (J.D.T., E.D.M.); Gastroenterology and Hepatology (J.P.P.); Laboratory Genetics and Genomics (Z.N., C.J.K.), Mayo Clinic, Rochester, MN
| | - Robert J Spinner
- Department of Neurosurgery (R.C.P., R.J.S.); Department of Neurology (H.B., R.S., C.J.K.), Mayo Clinic, Rochester, MN; Department of Neurology (H.B.), China Friendship Hospital, Beijing; Hematology and Oncology (Y.W.); Laboratory Medicine and Pathology (J.D.T., E.D.M.); Gastroenterology and Hepatology (J.P.P.); Laboratory Genetics and Genomics (Z.N., C.J.K.), Mayo Clinic, Rochester, MN
| | - Hongyan Bi
- Department of Neurosurgery (R.C.P., R.J.S.); Department of Neurology (H.B., R.S., C.J.K.), Mayo Clinic, Rochester, MN; Department of Neurology (H.B.), China Friendship Hospital, Beijing; Hematology and Oncology (Y.W.); Laboratory Medicine and Pathology (J.D.T., E.D.M.); Gastroenterology and Hepatology (J.P.P.); Laboratory Genetics and Genomics (Z.N., C.J.K.), Mayo Clinic, Rochester, MN
| | - Rishi Sharma
- Department of Neurosurgery (R.C.P., R.J.S.); Department of Neurology (H.B., R.S., C.J.K.), Mayo Clinic, Rochester, MN; Department of Neurology (H.B.), China Friendship Hospital, Beijing; Hematology and Oncology (Y.W.); Laboratory Medicine and Pathology (J.D.T., E.D.M.); Gastroenterology and Hepatology (J.P.P.); Laboratory Genetics and Genomics (Z.N., C.J.K.), Mayo Clinic, Rochester, MN
| | - Yucai Wang
- Department of Neurosurgery (R.C.P., R.J.S.); Department of Neurology (H.B., R.S., C.J.K.), Mayo Clinic, Rochester, MN; Department of Neurology (H.B.), China Friendship Hospital, Beijing; Hematology and Oncology (Y.W.); Laboratory Medicine and Pathology (J.D.T., E.D.M.); Gastroenterology and Hepatology (J.P.P.); Laboratory Genetics and Genomics (Z.N., C.J.K.), Mayo Clinic, Rochester, MN
| | - Jason D Theis
- Department of Neurosurgery (R.C.P., R.J.S.); Department of Neurology (H.B., R.S., C.J.K.), Mayo Clinic, Rochester, MN; Department of Neurology (H.B.), China Friendship Hospital, Beijing; Hematology and Oncology (Y.W.); Laboratory Medicine and Pathology (J.D.T., E.D.M.); Gastroenterology and Hepatology (J.P.P.); Laboratory Genetics and Genomics (Z.N., C.J.K.), Mayo Clinic, Rochester, MN
| | - Ellen D McPhail
- Department of Neurosurgery (R.C.P., R.J.S.); Department of Neurology (H.B., R.S., C.J.K.), Mayo Clinic, Rochester, MN; Department of Neurology (H.B.), China Friendship Hospital, Beijing; Hematology and Oncology (Y.W.); Laboratory Medicine and Pathology (J.D.T., E.D.M.); Gastroenterology and Hepatology (J.P.P.); Laboratory Genetics and Genomics (Z.N., C.J.K.), Mayo Clinic, Rochester, MN
| | - John J Poterucha
- Department of Neurosurgery (R.C.P., R.J.S.); Department of Neurology (H.B., R.S., C.J.K.), Mayo Clinic, Rochester, MN; Department of Neurology (H.B.), China Friendship Hospital, Beijing; Hematology and Oncology (Y.W.); Laboratory Medicine and Pathology (J.D.T., E.D.M.); Gastroenterology and Hepatology (J.P.P.); Laboratory Genetics and Genomics (Z.N., C.J.K.), Mayo Clinic, Rochester, MN
| | - Zhiyv Niu
- Department of Neurosurgery (R.C.P., R.J.S.); Department of Neurology (H.B., R.S., C.J.K.), Mayo Clinic, Rochester, MN; Department of Neurology (H.B.), China Friendship Hospital, Beijing; Hematology and Oncology (Y.W.); Laboratory Medicine and Pathology (J.D.T., E.D.M.); Gastroenterology and Hepatology (J.P.P.); Laboratory Genetics and Genomics (Z.N., C.J.K.), Mayo Clinic, Rochester, MN
| | - Christopher J Klein
- Department of Neurosurgery (R.C.P., R.J.S.); Department of Neurology (H.B., R.S., C.J.K.), Mayo Clinic, Rochester, MN; Department of Neurology (H.B.), China Friendship Hospital, Beijing; Hematology and Oncology (Y.W.); Laboratory Medicine and Pathology (J.D.T., E.D.M.); Gastroenterology and Hepatology (J.P.P.); Laboratory Genetics and Genomics (Z.N., C.J.K.), Mayo Clinic, Rochester, MN
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5
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Rosenbaum E, Marks D, Raza S. Diagnosis and management of neuropathies associated with plasma cell dyscrasias. Hematol Oncol 2017; 36:3-14. [PMID: 28397326 DOI: 10.1002/hon.2417] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 02/14/2017] [Accepted: 03/06/2017] [Indexed: 12/16/2022]
Abstract
Neuropathies associated with plasma cell dyscrasias are a major cause of morbidity for patients managed by medical oncologists. Because of similarities in clinical presentation and on nerve conduction studies, identifying the underlying disease leading to a paraproteinemic neuropathy can often be difficult. In addition, the degree of neurologic deficit does not strictly correlate with the extent of abnormalities on common clinical laboratory testing. Fortunately, with increasing understanding into the biologic mechanisms of underlying hematologic diseases, additional biomarkers have recently been developed, thus improving our diagnostic capacity. Neuropathies associated with plasma cells dyscrasias are seen with Monoclonal gammopathy of undetermined significance (MGUS) particularly IgM subtype, followed by IgG and IgA MGUS, multiple myeloma, Waldenström's macroglobulinemia, amyloid, Castleman's disease, and POEMS syndrome. The mechanisms of neuronal injury associated with plasma cell dyscrasia vary based on underlying diagnosis and include malignant infiltration, immune-mediated antibody deposition, or local compression of nerve roots. The polyneuropathies are frequently demyelinating, although axonal and mixed neuropathies can also be seen. As demonstrated by the cases included in this review, patients frequently present with symmetric sensory disturbance, followed by progressive motor weakness. Unfortunately, because of the complexity of diagnostic testing, patients are frequently examined late, often after receiving several ineffective therapies. The aim of this case-based review is to provide clinicians with insight on how to properly recognize these atypical neuropathies and send the appropriate diagnostic work, increasing the likelihood of accurately classify the patient's underlying hematologic disorder.
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Affiliation(s)
- Evan Rosenbaum
- Division of Hematology & Oncology, Columbia University Medical Center, New York, NY, USA
| | - Douglas Marks
- Division of Hematology & Oncology, Columbia University Medical Center, New York, NY, USA
| | - Shahzad Raza
- Division of Hematology & Oncology, Columbia University Medical Center, New York, NY, USA
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6
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Kollmer J, Hund E, Hornung B, Hegenbart U, Schönland SO, Kimmich C, Kristen AV, Purrucker J, Röcken C, Heiland S, Bendszus M, Pham M. In vivo detection of nerve injury in familial amyloid polyneuropathy by magnetic resonance neurography. ACTA ACUST UNITED AC 2014; 138:549-62. [PMID: 25526974 PMCID: PMC4339768 DOI: 10.1093/brain/awu344] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
See Morrow and Reilly (doi:10.1093/awu396) for a scientific commentary on this article. Transthyretin familial amyloid polyneuropathy is a rare, autosomal-dominant multisystem disorder. Kollmer et al. show that high-resolution MR-neurography can quantify and localize lower limb nerve injury in vivo, both in symptomatic patients and in asymptomatic mutation carriers. Lesions appear at thigh-level and are predominantly proximal, although symptoms start and prevail distally. Transthyretin familial amyloid polyneuropathy is a rare, autosomal-dominant inherited multisystem disorder usually manifesting with a rapidly progressive, axonal, distally-symmetric polyneuropathy. The detection of nerve injury by nerve conduction studies is limited, due to preferential involvement of small-fibres in early stages. We investigated whether lower limb nerve-injury can be detected, localized and quantified in vivo by high-resolution magnetic resonance neurography. We prospectively included 20 patients (12 male and eight female patients, mean age 47.9 years, range 26–66) with confirmed mutation in the transthyretin gene: 13 with symptomatic polyneuropathy and seven asymptomatic gene carriers. A large age- and sex-matched cohort of healthy volunteers served as controls (20 male and 20 female, mean age 48.1 years, range 30–73). All patients received detailed neurological and electrophysiological examinations and were scored using the Neuropathy Impairment Score–Lower Limbs, Neuropathy Deficit and Neuropathy Symptom Score. Magnetic resonance neurography (3 T) was performed with large longitudinal coverage from proximal thigh to ankle-level and separately for each leg (140 axial slices/leg) by using axial T2-weighted (repetition time/echo time = 5970/55 ms) and dual echo (repetition time 5210 ms, echo times 12 and 73 ms) turbo spin echo 2D sequences with spectral fat saturation. A 3D T2-weighted inversion-recovery sequence (repetition time/echo time 3000/202 ms) was acquired for imaging of the spinal nerves and lumbar plexus (50 axial slice reformations). Precise manual segmentation of the spinal/sciatic/tibial/common peroneal nerves was performed on each slice. Histogram-based normalization of nerve–voxel signal intensities was performed using the age- and sex-matched control group as normative reference. Nerve-voxels were subsequently classified as lesion-voxels if a threshold of >1.2 (normalized signal-intensity) was exceeded. At distal thigh level, where a predominant nerve–lesion–voxel burden was observed, signal quantification was performed by calculating proton spin density and T2-relaxation time as microstructural markers of nerve tissue integrity. The total number of nerve–lesion voxels (cumulated from proximal-to-distal) was significantly higher in symptomatic patients (20 405 ± 1586) versus asymptomatic gene carriers (12 294 ± 3199; P = 0.036) and versus controls (6536 ± 467; P < 0.0001). It was also higher in asymptomatic carriers compared to controls (P = 0.043). The number of nerve–lesion voxels was significantly higher at thigh level compared to more distal levels (lower leg/ankle) of the lower extremities (f-value = 279.22, P < 0.0001). Further signal-quantification at this proximal site (thigh level) revealed a significant increase of proton-density (P < 0.0001) and T2-relaxation-time (P = 0.0011) in symptomatic patients, whereas asymptomatic gene-carriers presented with a significant increase of proton-density only. Lower limb nerve injury could be detected and quantified in vivo on microstructural level by magnetic resonance neurography in symptomatic familial amyloid polyneuropathy, and also in yet asymptomatic gene carriers, in whom imaging detection precedes clinical and electrophysiological manifestation. Although symptoms start and prevail distally, the focus of predominant nerve injury and injury progression was found proximally at thigh level with strong and unambiguous lesion-contrast. Imaging of proximal nerve lesions, which are difficult to detect by nerve conduction studies, may have future implications also for other distally-symmetric polyneuropathies.
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Affiliation(s)
- Jennifer Kollmer
- 1 Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany 2 Amyloidosis Centre Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Ernst Hund
- 2 Amyloidosis Centre Heidelberg, University of Heidelberg, Heidelberg, Germany 3 Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Benjamin Hornung
- 1 Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany
| | - Ute Hegenbart
- 2 Amyloidosis Centre Heidelberg, University of Heidelberg, Heidelberg, Germany 4 Medical Department V, University of Heidelberg, Heidelberg, Germany
| | - Stefan O Schönland
- 2 Amyloidosis Centre Heidelberg, University of Heidelberg, Heidelberg, Germany 4 Medical Department V, University of Heidelberg, Heidelberg, Germany
| | - Christoph Kimmich
- 2 Amyloidosis Centre Heidelberg, University of Heidelberg, Heidelberg, Germany 4 Medical Department V, University of Heidelberg, Heidelberg, Germany
| | - Arnt V Kristen
- 2 Amyloidosis Centre Heidelberg, University of Heidelberg, Heidelberg, Germany 5 Medical Department III, University of Heidelberg, Heidelberg, Germany
| | - Jan Purrucker
- 2 Amyloidosis Centre Heidelberg, University of Heidelberg, Heidelberg, Germany 3 Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Christoph Röcken
- 6 Department of Pathology, University Hospital Kiel, Kiel, Germany
| | - Sabine Heiland
- 1 Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany 7 Division of Experimental Radiology, Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany
| | - Martin Bendszus
- 1 Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany
| | - Mirko Pham
- 1 Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany 2 Amyloidosis Centre Heidelberg, University of Heidelberg, Heidelberg, Germany
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7
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Evaluation of simultaneous muscle and nerve biopsies for the diagnosis of neuromuscular diseases. Ann Diagn Pathol 2014; 18:282-5. [DOI: 10.1016/j.anndiagpath.2014.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 08/04/2014] [Indexed: 11/23/2022]
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8
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Kanta M, Ehler E, Kohout A, Habalová J, Hanáček R, Vyšata O, Brtková J, Řehák S, Vališ M. Rare case of a localized radial nerve amyloid neuropathy. J Clin Neuromuscul Dis 2014; 16:20-23. [PMID: 25137512 DOI: 10.1097/cnd.0000000000000050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We report the case of a 55-year-old woman with a 6-month history of progressive paresis of the right radial nerve. Perioperative imaging detected a spindle-shaped expansion of the radial nerve caused by an isolated local deposit of amyloid (amyloidoma). The deposit was resected in 2 phases and the resulting defect was bridged by a sural nerve autograft. Overall internal and hematological examination did not reveal systemic amyloidosis or lymphoproliferative disorder. The reason for our report is that localized forms of amyloid neuropathy are very rare.
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Affiliation(s)
- Martin Kanta
- *Department of Neurosurgery, Faculty of Medicine, University Hospital Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic; †Department of Neurology, Pardubice Regional Hospital, Pardubice, Czech Republic; ‡The Fingerland Department of Pathology, Faculty of Medicine, University Hospital Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic; and Departments of §Neurology, and ¶Radiology, Faculty of Medicine, University Hospital Hradec Králové, Charles University in Prague, Hradec Kralove, Czech Republic
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9
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Jiménez Caballero P. Polineuropatía de larga evolución como forma de inicio de amiloidosis sistémica primaria. Neurologia 2012; 27:447-8. [DOI: 10.1016/j.nrl.2011.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 10/24/2011] [Accepted: 10/28/2011] [Indexed: 10/14/2022] Open
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10
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Jiménez Caballero P. Long standing polyneuropathy as a form of presentation of primary systemic amyloidosis. NEUROLOGÍA (ENGLISH EDITION) 2012. [DOI: 10.1016/j.nrleng.2011.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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11
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Bayat E, Kelly JJ. Neurological complications in plasma cell dyscrasias. HANDBOOK OF CLINICAL NEUROLOGY 2012; 105:731-46. [PMID: 22230530 DOI: 10.1016/b978-0-444-53502-3.00020-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Elham Bayat
- Department of Neurology, The George Washington University, Washington, DC, USA
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12
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Bhupathi SS, Chalasani S, Rokey R. Stiff heart syndrome. Clin Med Res 2011; 9:92-9. [PMID: 20852084 PMCID: PMC3134435 DOI: 10.3121/cmr.2010.899] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Revised: 06/25/2010] [Accepted: 08/04/2010] [Indexed: 11/18/2022]
Abstract
Isolated cardiac amyloidosis, or "Stiff Heart Syndrome," is a rare manifestation of amyloidosis. Some degree of cardiac amyloid deposition is common in elderly patients, as reported in prior post-mortem studies; however, isolated cardiac involvement with predominantly cardiac symptoms and no evidence of systemic disease is a rare presentation. Establishing the correct diagnosis, even with the use of extensive testing including amyloid typing, understanding the clinical significance, and management can be challenging in such cases.
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Affiliation(s)
- Satya S. Bhupathi
- Department of General Internal Medicine, Marshfield Clinic, Marshfield, Wisconsin USA
| | - Sreelatha Chalasani
- Department of General Internal Medicine, Marshfield Clinic, Marshfield, Wisconsin USA
| | - Roxann Rokey
- Department of Cardiology, Marshfield Clinic, Marshfield, Wisconsin USA
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13
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Tracy JA, Dyck PJ, Dyck PJB. Primary amyloidosis presenting as upper limb multiple mononeuropathies. Muscle Nerve 2010; 41:710-5. [PMID: 20405503 DOI: 10.1002/mus.21561] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Peripheral neuropathy in primary (AL) amyloidosis is usually lower-limb predominant, length-dependent, symmetrical, and affects small (pain and autonomic) fibers, as much or more than large fibers. We report a patient with stepwise progressive, multiple upper limb mononeuropathies that were due to nerve biopsy-proven primary amyloidosis (lambda light chain), with no systemic or autonomic features. Recognition that light chain amyloidosis may be the cause of a multiple mononeuropathy pattern adds to the differential diagnosis of this clinical phenotype.
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Affiliation(s)
- Jennifer A Tracy
- Peripheral Neuropathy Research Laboratory, Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
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Liu YT, Lee YC, Yang CC, Chen ML, Lin KP. Transthyretin Ala97Ser in Chinese–Taiwanese patients with familial amyloid polyneuropathy: Genetic studies and phenotype expression. J Neurol Sci 2008; 267:91-9. [DOI: 10.1016/j.jns.2007.10.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2007] [Revised: 09/02/2007] [Accepted: 10/04/2007] [Indexed: 12/22/2022]
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Stojkovic T. Neuropathie, gammapathie monoclonale et auto-anticorps : comment établir un lien ? Rev Neurol (Paris) 2007. [DOI: 10.1016/s0035-3787(07)92159-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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16
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Dispenzieri A, Kyle RA. Neurological aspects of multiple myeloma and related disorders. Best Pract Res Clin Haematol 2005; 18:673-88. [PMID: 16026744 DOI: 10.1016/j.beha.2005.01.024] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The spectrum of neurologic complications of multiple myeloma (MM) and related conditions is as diverse as the conditions themselves. Complications range from direct compression (radiculopathy, spinal cord compression, base-of-the-skull tumor) to the infiltrative (amyloid, peripheral neuropathies, and numb chin syndrome of myeloma), the metabolic (slowed mentation from hyperviscosity, hypercalcemia, or uremia), and to autoimmune or cytokine-mediated (peripheral neuropathy). The two most common presentations are the compressive radiculopathy one sees in multiple myeloma and the peripheral neuropathies associated with many of the other disorders. The authors will review the neurologic complications of MM, monoclonal gammopathy of undetermined significance (MGUS), Waldenström macroglobulinemia (WM), POEMS syndrome, amyloidosis, and cryoglobulinemia.
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Vital C, Vital A, Bouillot-Eimer S, Brechenmacher C, Ferrer X, Lagueny A. Amyloid neuropathy: a retrospective study of 35 peripheral nerve biopsies. J Peripher Nerv Syst 2005; 9:232-41. [PMID: 15574136 DOI: 10.1111/j.1085-9489.2004.09405.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We performed a retrospective study of 35 peripheral nerve biopsies (PNBs) with amyloid deposits in the endoneurium. In every case, nerve lesions were studied on paraffin-embedded fragments (PEFs) and by ultrastructural examination (USE). In addition, muscle fragments were taken and embedded in paraffin. Immunohistochemistry was performed with anti-transthyretin (TTR) serum on 19 nerve and 15 muscle PEFs. Direct immunofluorescence with anti-light-chain sera was performed on frozen nerve fragments in 19 cases. Endoneurial amyloid deposits were easily identified on routine PEF in 26 cases, after Congo red or thioflavine staining in three, and by USE in six. A dramatic myelinated fiber loss was evidenced in 34 cases (77-2970 per mm2), and features of axonal degeneration were present in every case. Segmental demyelination was observed in 10 cases. A mutation in the TTR gene was present in 14 cases, with Met30 mutation in 10 and Ala49 in four members of the same family. Amyloid deposits were strongly marked by the anti-TTR serum in 11 other cases, twice in the endoneurium, five around muscle fibers, and four in both locations. In eight patients, light-chain positivity was evidenced in endoneurial deposits, lambda in six and kappa in two. Two other patients with monoclonal gammopathy did not present any light-chain fixation. In 17 cases, amyloidosis was disclosed by PNB and 13 had a TTR pathology; eight of them, over 65 years old, correspond to a late-onset form of familial amyloid polyneuropathy which is an underdiagnosed condition.
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Affiliation(s)
- Claude Vital
- Neuropathology Laboratory, Victor Segalen University, Bordeaux, France.
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Abstract
The cardiovascular system is a common target of amyloidosis. This review presents the current clinical and diagnostic approach to amyloidosis, with the emphasis on cardiovascular involvement. It summarises recent nomenclature, classification, and pathogenesis of amyloidosis. In addition, non-invasive possibilities are discussed, together with endomyocardial biopsies in the diagnosis of cardiac amyloidosis. Finally, recent advances in treatment and prognostic implications are presented.
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Affiliation(s)
- I Kholová
- Department of Pathology, Vrije Universiteit Medical Centre, De Boelelaan 1117, 1007 MB Amsterdam, The Netherlands
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Sousa MM, Saraiva MJ. Neurodegeneration in familial amyloid polyneuropathy: from pathology to molecular signaling. Prog Neurobiol 2004; 71:385-400. [PMID: 14757117 DOI: 10.1016/j.pneurobio.2003.11.002] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Familial amyloid polyneuropathy (FAP) is an autosomal dominant neurodegenerative disorder related to the systemic deposition of mutated transthyretin (TTR) amyloid fibrils, particularly in peripheral nervous system (PNS). TTR fibrils are diffusely distributed in the PNS of FAP patients, involving nerve trunks, plexuses and ganglia. In peripheral nerves, amyloid deposits are prominent in the endoneurium, near blood vessels, Schwann cells and collagen fibrils. Fiber degeneration is axonal, beginning in the unmyelinated and low diameter myelinated fibers. Several hypotheses have been raised to explain axonal and neuronal loss: (i) compression of the nervous tissue by amyloid; however, a cause-effect relationship between amyloid deposition, structural nerve changes and degeneration was never clearly made; (ii) role of nerve ischemia secondary to lesions caused by perivascular amyloid, which is also doubtful as compromised blood flow was never demonstrated; (iii) lesions in the dorsal root ganglia neurons or Schwann cells. Recently, evidence for the presence of toxic non-fibrillar TTR aggregates early in FAP nerves constituted a first step to unravel molecular signaling related to neurodegeneration in FAP. The toxic nature of TTR non-fibrillar aggregates, and not mature TTR fibrils, was evidenced by their ability to induce the expression of oxidative stress and inflammation-related molecules in neuronal cells, driving them into apoptotic pathways. How these TTR aggregates exert their effects is debatable; interaction with cellular receptors, namely, the receptor for advanced glycation endproducts (RAGE), is a probable candidate mechanism. The pathology and the yet unknown molecular signaling mechanisms responsible for neurodegeneration in FAP are discussed.
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Affiliation(s)
- Mónica Mendes Sousa
- Molecular Neurobiology, Instituto de Biologia Molecular e Celular, Porto, Portugal
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Beekman R, Slooff WBM, Van Oosterhout MFM, Lammens M, Van Den Berg LH. Bilateral intraneural perineurioma presenting as ulnar neuropathy at the elbow. Muscle Nerve 2004; 30:239-43. [PMID: 15266642 DOI: 10.1002/mus.20052] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We describe a 36-year-old woman with progressive bilateral ulnar neuropathy. Sonographic and magnetic resonance imaging studies revealed extensive focal ulnar nerve enlargement at the elbow. Histological studies gave evidence of an intraneural perineurioma. Because intraneural perineurioma usually appears as a single mass lesion at sites other than typical entrapment sites, this mode of presentation is unusual. We discuss the nature of this benign tumor and the differential diagnosis of nerve enlargement. Knowledge of possible causes of nerve thickening is crucial when performing imaging in patients with neuropathies.
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Affiliation(s)
- Roy Beekman
- Department of Neurology, Academic Medical Centre, Utrecht, The Netherlands.
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