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Niu J, Zhang L, Hu N, Cui L, Liu M. The distribution pattern of nerve enlargement in clinical subtypes of chronic inflammatory demyelinating polyneuropathy. J Neuroimaging 2024; 34:127-137. [PMID: 37823703 DOI: 10.1111/jon.13162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/28/2023] [Accepted: 10/02/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND AND PURPOSE We aim to investigate nerve enlargement patterns and their correlation with clinical subtypes and treatment response using nerve ultrasound in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). METHODS Between March 2015 and December 2021, 135 CIDP patients were recruited. Nerve ultrasound and electrophysiological studies were performed on the median and ulnar nerves. The responses to intravenous immunoglobulin (IVIg) or prednisone were evaluated with the disability score. RESULTS There were 99 typical CIDP cases, 10 Lewis-Sumner syndrome (LSS) cases, 15 distal acquired demyelinating symmetric neuropathy (DADS) cases, nine pure motor CIDP cases, and two pure sensory CIDP cases. Sixty (61%) typical CIDP and seven (78%) pure motor CIDP patients had moderately increased or normal cross-sectional area (CSA), and 10 (67%) DADS and seven (70%) LSS patients had significantly increased CSA. The peripheral nerve showed a diffuse enlargement pattern in 46 (51%) typical CIDP, five (50%) LSS, three (25%) DADS, and three (33%) pure motor CIDP patients and a proximal regional enlargement pattern in 11 (12%) typical CIDP, one (10%) LSS, six (50%) DADS, and four (44%) pure motor CIDP patients. Patients with diffusely moderate enlargement patterns and those with proximal regional enlargement showed a higher response rate to glucocorticoids than to IVIg. CONCLUSIONS Various distribution patterns of nerve enlargement existed in CIDP. Although almost all patterns could be detected in each CIDP subtype, diffusely moderate enlargement was more common in typical CIDP and LSS, while proximal regional enlargement was more common in DADS and pure motor CIDP. Different enlargement patterns might indicate different treatment responses.
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Affiliation(s)
- Jingwen Niu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Lei Zhang
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Nan Hu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Liying Cui
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Mingsheng Liu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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2
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Roll SC, Takata SC, Yao B, Kysh L, Mack WJ. Sonographic reference values for median nerve cross-sectional area: A meta-analysis of data from healthy individuals. J Diagn Med Sonogr 2023; 39:492-506. [PMID: 37654772 PMCID: PMC10468154 DOI: 10.1177/87564793231176009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Objective Establish median nerve CSA reference values and identify patient-level factors impacting diagnostic thresholds. Methods Studies were identified through a robust search of multiple databases, and quality assessment was conducted using a modified version of the National Institute of Health Study Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. A meta-analysis was performed to identify normative values stratified by anatomic location. A meta-regression was conducted to examine heterogeneity effects of age, sex, and laterality. Results The meta-analysis included 73 studies; 41 (56.2%) were high quality. The median nerve CSA [95% CI] was 6.46mm2 [6.09-6.84], 8.68mm2 [8.22-9.13], and 8.60mm2 [8.23-8.97] at the proximal forearm, the carpal tunnel inlet, and the proximal carpal tunnel, respectively. Age was positively associated with CSA at the level of proximal carpal tunnel (β=0.03mm2, p=0.047). Men (9.42mm2, [8.06-10.78]) had statistically larger proximal tunnel CSA (p = 0.03) as compared to women (7.71mm2, [7.01-8.42]). No difference was noted in laterality. Conclusion A reference value for median nerve CSA in the carpal tunnel is 8.60mm2. Adjustments may be required in pediatrics or older adults. The diagnostic threshold of 10.0mm2 for male patients should be cautiously applied as the upper limit of normative averages surpasses this threshold.
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Affiliation(s)
- Shawn C. Roll
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Sandy C. Takata
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Buwen Yao
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Lynn Kysh
- Institute for Nursing and Interprofessional Research, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Wendy J. Mack
- Division of Population and Public Health, University of Southern California, Los Angeles, CA, USA
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3
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Tóth M, Szőke A, Arányi Z. Nerve ultrasonographic findings in diabetes mellitus are determined by anatomical location and type of diabetes. Clin Neurophysiol Pract 2023; 8:115-122. [PMID: 38152244 PMCID: PMC10751747 DOI: 10.1016/j.cnp.2023.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 04/04/2023] [Accepted: 04/08/2023] [Indexed: 12/29/2023] Open
Abstract
Objective A prospective ultrasound study to analyze nerve size and its modifying factors in type 1 and type 2 diabetes mellitus. Methods The cross-sectional areas (CSAs) of motor and sensory nerves in both upper and lower limbs were measured at 14 measurement points, using high resolution ultrasound in 26 patients with type 1 and 76 patients with type 2 diabetes, and in 50 control subjects. All diabetic patients underwent electrophysiological assessment to check for the presence of polyneuropathy. Results Significant mild/moderate diffuse nerve enlargement was demonstrated in type 2 diabetes, more pronounced at compression sites versus non-compression sites, and on the upper limbs versus lower limbs (p value for pooled DM2 v. control group: <0.001). In type 1 diabetes, nerve enlargement was found only at one compression site (median nerve wrist; p = 0.002). No significant difference was found between patients with or without polyneuropathy. Conclusions The primary predictors of nerve size in diabetes are anatomical location (i.e. compression sites versus non-compression sites, upper versus lower limbs) and type of diabetes. Changes occur before the electrophysiological signs of polyneuropathy are detected. Significance Nerve ultrasound may contribute to early recognition of the neuropathic complications of diabetes.
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Affiliation(s)
- Marianna Tóth
- Dept. of Neurology, Vaszary Kolos Hospital, Esztergom, Hungary
| | - Annamária Szőke
- Dept. of Neurology, Vaszary Kolos Hospital, Esztergom, Hungary
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Yun CJ, Crump N, Puckett M, Cartwright MS. Focused Neuromuscular Ultrasound Approach for the Diagnosis of Chronic Inflammatory Demyelinating Polyneuropathy. J Clin Neurophysiol 2023; 40:378-381. [PMID: 37143208 DOI: 10.1097/wnp.0000000000000905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Previous ultrasonographic studies of individuals with chronic inflammatory demyelinating polyneuropathy (CIDP) have shown nerve enlargement at several sites. This prospective study compares only the bilateral median and ulnar nerves of individuals with CIDP with reference values to determine the clinical usefulness of this focused approach as a diagnostic tool. METHODS The cross-sectional area, echogenicity, and vascularity of the bilateral median and ulnar nerves of 25 subjects with CIDP were measured using ultrasound. Nineteen had typical CIDP based on the European Federation of Neurological Societies and the Peripheral Nerve Society guidelines, whereas six had atypical CIDP and were diagnosed based on clinical impression. RESULTS Focal nerve enlargement was found in at least one segment in all subjects. Subjects with typical CIDP had larger cross-sectional areas compared with subjects with atypical CIDP. CONCLUSION A focused ultrasound study, involving only the median and ulnar nerves, is sensitive for the detection of nerve enlargement in CIDP. Measuring the cross-sectional area of the median and ulnar nerves is clinically feasible and may help establish the diagnosis of CIDP.
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Affiliation(s)
- Chelsea J Yun
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A
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Rozevska M, Rots D, Gailite L, Linde R, Mironovs S, Timcenko M, Linovs V, Locmele D, Micule I, Lace B, Kenina V. The most common European HINT1 neuropathy variant phenotype and its case studies. Front Neurol 2023; 14:1084335. [PMID: 36873433 PMCID: PMC9981799 DOI: 10.3389/fneur.2023.1084335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 01/31/2023] [Indexed: 02/19/2023] Open
Abstract
HINT1 is an ubiquitous homodimeric purine phosphoramidase belonging to the histidine-triad superfamily. In neurons, HINT1 stabilizes the interaction of different receptors and regulates the effects of their signaling disturbances. Changes in HINT1 gene are associated with autosomal recessive axonal neuropathy with neuromyotonia. Aim of the study was detailed description of patients' phenotype with HINT1 homozygous NM_005340.7: c.110G>C (p.Arg37Pro) variant. Seven homozygous and three compound heterozygous patients were recruited and evaluated using standardized tests for CMT patients, in four patients' nerve ultrasonography was performed. The median age of symptom onset was 10 years (range 1-20), with initial complaints being distal lower limb weakness with gait impairment, combined with muscle stiffness, more pronounced in the hands than in the legs and worsened by cold. Arm muscles became involved later, presenting with distal weakness and hypotrophy. Neuromyotonia was present in all reported patients and is thus a diagnostic hallmark. Electrophysiological studies demonstrated axonal polyneuropathy. Impaired mental performance was observed in six out of ten cases. In all patients with HINT1 neuropathy, ultrasound examination showed significantly reduced muscle volume as well as spontaneous fasciculations and fibrillations. The nerve cross-sectional areas of the median and ulnar nerves were closer to the lower limits of the normal values. None of the investigated nerves had structural changes. Our findings broaden the phenotype of HINT1-neuropathy and have implications for diagnostics and ultrasonographic evaluation of HINT1-neuropathy patients.
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Affiliation(s)
- Marija Rozevska
- Medical Genetics and Prenatal Diagnostics Clinic, Children's Clinical University Hospital, Riga, Latvia
| | - Dmitrijs Rots
- Medical Genetics and Prenatal Diagnostics Clinic, Children's Clinical University Hospital, Riga, Latvia.,Scientific Laboratory of Molecular Genetics, Riga Stradins University, Riga, Latvia
| | - Linda Gailite
- Scientific Laboratory of Molecular Genetics, Riga Stradins University, Riga, Latvia
| | - Ronalds Linde
- Rare Neurological Disease Department, Pauls' Stradins University Hospital, Riga, Latvia
| | - Stanislavs Mironovs
- Rare Neurological Disease Department, Pauls' Stradins University Hospital, Riga, Latvia
| | | | | | - Dzintra Locmele
- Medical Genetics and Prenatal Diagnostics Clinic, Children's Clinical University Hospital, Riga, Latvia
| | - Ieva Micule
- Medical Genetics and Prenatal Diagnostics Clinic, Children's Clinical University Hospital, Riga, Latvia
| | - Baiba Lace
- Medical Genetics and Prenatal Diagnostics Clinic, Children's Clinical University Hospital, Riga, Latvia
| | - Viktorija Kenina
- Medical Genetics and Prenatal Diagnostics Clinic, Children's Clinical University Hospital, Riga, Latvia.,Scientific Laboratory of Molecular Genetics, Riga Stradins University, Riga, Latvia.,Rare Neurological Disease Department, Pauls' Stradins University Hospital, Riga, Latvia
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Härtig K, Kronlage C, Wittlinger J, Hauser T, Grimm A. Ultrasound of cervical nerve root enlargement in polyneuropathy is not confounded by neuroforaminal stenoses. Clin Neurophysiol 2022. [DOI: 10.1016/j.clinph.2022.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/21/2022] [Accepted: 06/25/2022] [Indexed: 11/22/2022]
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Bae DW, An JY. Cross-sectional area reference values for high-resolution ultrasonography of the lower extremity nerves in healthy Korean adults. Medicine (Baltimore) 2022; 101:e29842. [PMID: 35777005 PMCID: PMC9239665 DOI: 10.1097/md.0000000000029842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The cross-sectional area (CSA) reference values of the lower extremity nerves in Asians have been rarely reported. For this study, 107 sex- and age-matched, healthy subjects with a mean age of 46 years (range, 24-75 years) were recruited. All subjects underwent standardized nerve conduction studies of the upper and lower extremities. The CSA was measured unilaterally at 12 sites in the lower extremity nerves, including the femoral, lateral femoral cutaneous, sciatic, common peroneal, superficial peroneal, deep peroneal, tibial, and sural nerves. The CSA significantly correlated with height, weight, and body mass index. The CSA was significantly larger in males than females at most nerves except for the lateral femoral cutaneous, common peroneal (fibular head), and superficial peroneal nerves (distal calf). There was no statistically significant difference between the age groups except for the tibial nerve (ankle). The results of this study provide CSA reference values for the lower extremity nerves including small branches and the values can be useful in the ultrasonographic investigation of various peripheral neuropathies in East Asian populations.
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Affiliation(s)
- Dae Woong Bae
- Department of Neurology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Young An
- Department of Neurology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- *Correspondence: Jae Young An, Department of Neurology, St. Vincent’s Hospital, The Catholic University of Korea, 93-6, Ji-dong, Paldal-gu, Suwon, Gyeonggi-do 442-723, Korea (e-mail: )
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Crump NH, Cartwright MS. A Retrospective Study of Ultrasound Accuracy for the Diagnosis of Chronic Inflammatory Demyelinating Polyneuropathy. J Clin Neurophysiol 2022; 39:312-316. [PMID: 33009042 DOI: 10.1097/wnp.0000000000000782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Ultrasound is emerging as a useful tool for the evaluation of immune-mediated neuropathies because it can provide high-resolution anatomic information to complement electrodiagnostic data. Nerve enlargements are commonly found in chronic inflammatory demyelinating polyneuropathy (CIDP), and their presence likely useful in diagnosis, particularly if multifocal. METHODS In this study, the authors undertook a retrospective chart review to identify ultrasound findings in patients with CIDP previously studied in a single busy neurodiagnostic laboratory. RESULTS Of the 50 cases identified from 2000 to 2017, individuals with a confirmed diagnosis of CIDP (21 cases) were more likely to have multiple sites of enlargement, as well as more pronounced nerve enlargement, than patients who were subsequently found to have an alternate cause of neuropathy (22 cases). The presence of any moderately enlarged nerve segment predicted definite CIDP with sensitivity of 81% and specificity 77%. CONCLUSION This study demonstrates that ultrasound can be of diagnostic utility in patients with suspected CIDP, even when conducted in a nonstandardized real-world setting.
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Affiliation(s)
- Nicholas H Crump
- Departments of Neurology and Medicine, Austin Health and University of Melbourne, Victoria, Australia ; and
| | - Michael S Cartwright
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A
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Seeliger T, Bönig L, Gingele S, Prenzler NK, Thiele T, Ernst D, Witte T, Stangel M, Skripuletz T, Körner S. Nerve ultrasound findings in Sjögren's syndrome-associated neuropathy. J Neuroimaging 2021; 31:1156-1165. [PMID: 34270142 DOI: 10.1111/jon.12907] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 06/30/2021] [Accepted: 06/30/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND PURPOSE The phenotype of Sjögren's syndrome-associated neuropathy has been better characterized in recent years. However, Sjögren's syndrome-associated neuropathy remains an underdiagnosed entity with only few insights considering the pathomechanisms of nerve damage. Nerve ultrasound has proven to be a useful and efficient tool in detecting nerve damage of autoimmune origin. We, therefore, aimed to evaluate this method for Sjögren's syndrome-associated neuropathy. METHODS Patients with Sjögren's syndrome and clinical signs of neuropathy underwent sonographic examination of both median and ulnar nerves. Nerve thickening was classified for cross-sectional areas of >12 mm² at the median nerve and for >10 mm² at the ulnar nerve. Fascicle thickening was documented for cross-sectional areas ≥5 mm² at the median and ≥3 mm² at the ulnar nerve. RESULTS Forty-three patients were included in the analysis (median age 60 years [interquartile range 53-73 years], female rate 60%). 31/43 patients (72%) showed abnormalities on nerve ultrasound, while nerve thickening was found more frequently than fascicle thickening (90% vs. 52% of patients with sonographic abnormalities, respectively). Abnormal findings were observed more frequently at the median nerve and in proximal localization. Abnormal findings on nerve conduction studies were evident in 36/43 patients (84%). Nerve conduction studies revealed a tendency of demyelinating nerve damage patterns being associated with abnormal findings on nerve ultrasound. CONCLUSIONS In addition to nerve conduction studies, nerve ultrasound may have a supporting role in the diagnosis of Sjögren's syndrome-associated neuropathy. Also, our data support an immune-mediated inflammatory demyelinating pathogenesis of Sjögren's syndrome-associated neuropathy.
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Affiliation(s)
- Tabea Seeliger
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Lena Bönig
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Stefan Gingele
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Nils K Prenzler
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany
| | - Thea Thiele
- Department of Rheumatology & Immunology, Hannover Medical School, Hannover, Germany
| | - Diana Ernst
- Department of Rheumatology & Immunology, Hannover Medical School, Hannover, Germany
| | - Torsten Witte
- Department of Rheumatology & Immunology, Hannover Medical School, Hannover, Germany
| | - Martin Stangel
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | | | - Sonja Körner
- Department of Neurology, Hannover Medical School, Hannover, Germany
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Abstract
Peripheral nerve imaging is a helpful and sometimes essential adjunct to clinical history, physical examination, and electrodiagnostic studies. Advances in imaging technology have allowed the visualization of nerve structures and their surrounding tissues. The clinical applications of ultrasound and magnetic resonance imaging (MRI) in the evaluation of peripheral nerve disorders are growing exponentially. This article reviews basics of ultrasound and MRI as they relate to nerve imaging, reviews advantages and limitations of each imaging modality, reviews the applications of ultrasound and MRI in disorders of peripheral nerve, and discusses emerging advances in the field.
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Affiliation(s)
- Natalia L Gonzalez
- Department of Neurology, Neuromuscular Division, Duke University, Duke University Hospital, 3403 DUMC, Duke South Clinic 1L, Durham, NC 27710, USA.
| | - Lisa D Hobson-Webb
- Department of Neurology, Neuromuscular Division, Duke University, Duke University Hospital, 3403 DUMC, Duke South Clinic 1L, Durham, NC 27710, USA
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Telleman JA, Herraets IJT, Goedee HS, van Asseldonk JT, Visser LH. Ultrasound scanning in the diagnosis of peripheral neuropathies. Pract Neurol 2021; 21:186-195. [DOI: 10.1136/practneurol-2020-002645] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2020] [Indexed: 12/13/2022]
Abstract
Nerve ultrasound scanning has become a valuable diagnostic tool in the routine workup of peripheral nerve disorders, effectively complementing conventional electrodiagnostic studies. The most relevant sonographic features are nerve size and structural integrity. Several peripheral neuropathies show characteristic and distinct patterns of nerve enlargement, allowing their early and accurate identification, and reducing test-burden and diagnostic delay for patients. In mononeuropathies such as carpal tunnel syndrome and ulnar neuropathy at the elbow, nerve enlargement develops only at specific sites of entrapment, while in polyneuropathy the nerve enlargement may be multifocal, regional or even diffuse. Nerve ultrasound scanning can reliably identify chronic inflammatory neuropathies, even when extensive electrodiagnostic studies fail, and it should therefore be embedded in routine diagnostic workup of peripheral neuropathies. In this paper we describe a potential diagnostic strategy to achieve this.
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Gonzalez NL, Hobson-Webb LD. Neuromuscular ultrasound in clinical practice: A review. Clin Neurophysiol Pract 2019; 4:148-163. [PMID: 31886438 PMCID: PMC6921231 DOI: 10.1016/j.cnp.2019.04.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 04/18/2019] [Accepted: 04/29/2019] [Indexed: 12/11/2022] Open
Abstract
Neuromuscular ultrasound (NMUS) is becoming a standard element in the evaluation of peripheral nerve and muscle disease. When obtained simultaneously to electrodiagnostic studies, it provides dynamic, structural information that can refine a diagnosis or identify a structural etiology. NMUS can improve patient care for those with mononeuropathies, polyneuropathy, motor neuron disease and muscle disorders. In this article, we present a practical guide to the basics of NMUS and its clinical application. Basic ultrasound physics, scanning techniques and clinical applications are reviewed, along with current challenges.
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Affiliation(s)
- Natalia L. Gonzalez
- Department of Neurology/Neuromuscular Division, Duke University Hospital, DUMC 3403, Durham, NC 27710, USA
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13
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Puma A, Azulay N, Grecu N, Suply C, Panicucci E, Cambieri C, Villa L, Raffaelli C, Sacconi S. Comparison of high-frequency and ultrahigh-frequency probes in chronic inflammatory demyelinating polyneuropathy. J Neurol 2019; 266:2277-2285. [PMID: 31175432 DOI: 10.1007/s00415-019-09392-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/17/2019] [Accepted: 05/20/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES High-frequency ultrasound (HFUS 18-20 MHz) performed on patients with chronic inflammatory demyelinating polyneuropathy (CIDP) shows a focal enlargement, particularly in the proximal segments of upper-arm motor nerves. Ultrahigh frequency ultrasound (UHFUS 30-70 MHz), having a higher spatial resolution, enables a better characterization of nerve structures. The aim of this study was to compare the two ultrasound probes in the evaluation of motor nerve characteristics in CIDP patients. METHODS Eleven patients with definite or probable CIDP underwent an ultrasound evaluation of median and ulnar nerves, bilaterally. Nerve and fascicle cross-sectional area (CSA), vascularization, and echogenicity were assessed. RESULTS Nerve and fascicle CSA were increased in the proximal segments, especially in the median nerve, in 9/11 patients and in 10/11 patients at the HFUS and UHFUS evaluations, respectively. A statistically significant difference between CSA values obtained with the two probes was found only for fascicle values. UHFUS allowed for a more precise estimation of fascicle size and number than the HFUS. We were able to identify nerve vascularization in 4/11 patients at UHFUS only. CONCLUSION UHFUS gives more detailed information on the changes in the internal nerve structure in CIDP patients. In particular, it permits to better characterize fascicle size and morphology, and to have a precise estimation of their number. Its frequency range also allows to evaluate nerve vascularization. SIGNIFICANCE Ultrasound evaluation could become an adjunctive diagnostic tool for CIDP. Further studies are needed to validate the examined parameters as biomarkers for the evaluation and follow-up of CIDP patients.
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Affiliation(s)
- Angela Puma
- Peripheral Nervous System, Muscle and ALS Department, CHU Nice, Université Côte D'Azur, Nice, France.
- UMR7370 CNRS, LP2M, Labex ICST, Faculty of Medicine, Université Nice Côte d'Azur, Nice, France.
| | - N Azulay
- Ultrasound Department, CHU Nice, Université Côte d'Azur, Nice, France
| | - N Grecu
- Peripheral Nervous System, Muscle and ALS Department, CHU Nice, Université Côte D'Azur, Nice, France
| | - C Suply
- Peripheral Nervous System, Muscle and ALS Department, CHU Nice, Université Côte D'Azur, Nice, France
| | - E Panicucci
- Peripheral Nervous System, Muscle and ALS Department, CHU Nice, Université Côte D'Azur, Nice, France
| | - C Cambieri
- Peripheral Nervous System, Muscle and ALS Department, CHU Nice, Université Côte D'Azur, Nice, France
- Department of Human Neuroscience, Centre of Rare Neuromuscular Diseases, Sapienza University of Rome, Rome, Italy
| | - L Villa
- Peripheral Nervous System, Muscle and ALS Department, CHU Nice, Université Côte D'Azur, Nice, France
- Pathology Department, CHU Nice, Université Côte d'Azur, Nice, France
| | - C Raffaelli
- Ultrasound Department, CHU Nice, Université Côte d'Azur, Nice, France
| | - S Sacconi
- Peripheral Nervous System, Muscle and ALS Department, CHU Nice, Université Côte D'Azur, Nice, France
- Institute for Research on Cancer and Aging of Nice (IRCAN), INSERM U1081, CNRS UMR 7284, Faculty of Medicine, Université Côte d'Azur (UCA), Nice, France
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Lee HL, Kim JS, Kim H, Kim IS, Kim JW, Kim YE, Koh SB. Ultrasonography and electrophysiological study of median nerve in patients with essential tremor. PLoS One 2019; 14:e0215750. [PMID: 31013299 PMCID: PMC6478317 DOI: 10.1371/journal.pone.0215750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 04/08/2019] [Indexed: 11/18/2022] Open
Abstract
Essential tremor (ET) is a common movement disorder characterized by postural or kinetic tremor. We aimed to evaluate median nerve enlargement in patients with ET using ultrasonography (USG). Thirty-eight hands from 19 patients with ET and 24 hands from 13 controls underwent nerve conduction studies (NCS) and USG at the wrist. Tremor severity was measured using the Fahn-Tolosa-Marin Tremor Rating Scale (FTM-TRS). The median nerve cross sectional area (mCSA) in USG and NCS parameters were compared using ANCOVA. We evaluated the correlation between mCSA and NCS parameters or FTM-TRS scores using linear regression analysis. mCSA was significantly larger (p<0.001) and NCS parameters were different in two groups. Also, mCSA was negatively correlated with part B and C scores of FTM-TRS (p<0.001 and p = 0.039, respectively). In conclusion, median nerve enlargement with the changes of NCS parameters was observed and correlated with the severity of tremor in patients with ET.
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Affiliation(s)
- Hye Lim Lee
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Ji-Sun Kim
- Department of Neurology, Mediplex Sejong Hospital, Incheon, Korea
| | - Hanjun Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Il Soo Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jae-Whan Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Ye-Eun Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seong-Beom Koh
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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15
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Chen J, Liu J, Zeng J, Wu S, Ren J. Ultrasonographic Reference Values for Assessing Normal Sciatic Nerve Ultrasonography in the Normal Population. J Med Ultrasound 2018; 26:85-89. [PMID: 30065525 PMCID: PMC6029205 DOI: 10.4103/jmu.jmu_6_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 07/26/2017] [Indexed: 12/02/2022] Open
Abstract
Objective: High-resolution ultrasonography (HRUS) has been used recently to characterize median and ulnar nerves but is seldom used to characterize the lower extremity nerves. The reference standard for normal the lower extremity nerves has not been established. Thus, this study measured the cross-sectional areas (CSAs) of the sciatic nerve of 200 healthy male or female volunteers, aged 18–80 using HRUS. These data provide basic clinical data for the use of high-resolution ultrasound for the future diagnosis, treatment, and prognostic evaluation of peripheral neuropathies. Methods: Two hundred healthy volunteers with 400 lower extremities were studied with HRUS. According to their age, the subjects were assigned to young group (18-30 years, n = 75), middle group. (31-60 years, n = 70), and old group(61-80 year, n = 55). Age, sex, height, weight were recorded and CSAs of sciatic nerve were obtained at every predetermined sites. Results: The mean CSAs of sciatic nerves at GS and MGPF were 0.527 ± 0.028 cm2 and 0.444 ± 0.026 cm2 respectively. Pearson's correlation analysis showed that the mean CSAs were correlated with height and weight. There was no difference in mean CSAs among the three groups (P > 0.05). Women had smaller CSAs of the normal Sciatic nerves than men in two measuring sites (GS, MGPF) (P < 0.05). Conclusion: Peripheral nerve ultrasonography is a reliable and reproducible diagnostic method in the hands of experienced examiners. Normal values for the sciatic nerve nerves are provided by our study. Thus, reference values of Sciatic nerve CSA of the lower extremity can facilitate the analysis of abnormal nerve conditions.
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Affiliation(s)
- Jun Chen
- Department of Neurology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou Province, China.,Department of Neurology, Lianshui County People's Hospital of Jiangsu Province, Huaian, Jiangsu Province, China
| | - Jiapeng Liu
- Department of Neurology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou Province, China
| | - Jiao Zeng
- Department of Neurology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou Province, China
| | - Shan Wu
- Department of Neurology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou Province, China
| | - Jun Ren
- Center for Cardiovascular Research and Alternative Medicine, University of Wyoming College of Health Sciences, Laramie, WY, United States
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16
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Abstract
CLINICAL/METHODICAL ISSUE For the diagnostics of nerve lesions an imaging method is necessary to visualize peripheral nerves and their surrounding structures for an etiological classification. STANDARD RADIOLOGICAL METHODS Clinical neurological and electrophysiological investigations provide functional information about nerve lesions. The information provided by a standard magnetic resonance imaging (MRI) examination is inadequate for peripheral nerve diagnostics; however, MRI neurography is suitable but on the other hand a resource and time-consuming method. METHODICAL INNOVATIONS Using ultrasonography for peripheral nerve diagnostics. PERFORMANCE With ultrasonography reliable diagnostics of entrapment neuropathies and traumatic nerve lesions are possible. The use of ultrasonography for neuropathies shows that a differentiation between different forms is possible. ACHIEVEMENTS Nerve ultrasonography is an established diagnostic tool. In addition to the clinical examination and clinical electrophysiology, structural information can be obtained, which results in a clear improvement in the diagnostics. Ultrasonography has become an integral part of the diagnostic work-up of peripheral nerve lesions in neurophysiological departments. PRACTICAL RECOMMENDATIONS Nerve ultrasonography is recommended for the diagnostic work-up of peripheral nerve lesions in addition to clinical and electrophysiological investigations. It should be used in the clinical work-up of entrapment neuropathies, traumatic nerve lesions and spacy-occupying lesions of nerves.
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Affiliation(s)
- T Bäumer
- Institut für Neurogenetik, Universität zu Lübeck (CBBM; Haus 66), Marie-Curie-Straße, 23562, Lübeck, Deutschland.
| | - A Grimm
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - T Schelle
- Neurologische Klinik, Städtisches Klinikum Dessau, Dessau, Deutschland
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17
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Telleman JA, Grimm A, Goedee S, Visser LH, Zaidman CM. Nerve ultrasound in polyneuropathies. Muscle Nerve 2018; 57:716-728. [PMID: 29205398 DOI: 10.1002/mus.26029] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 11/30/2017] [Accepted: 11/30/2017] [Indexed: 12/13/2022]
Abstract
Ultrasound can be used to visualize pathology in the peripheral nerves of patients with polyneuropathy. Nerve enlargement is the most frequent pathology, but other abnormalities, including abnormal nerve echogenicity and vascularity, are also encountered. This monograph presents an overview of the role of nerve ultrasound in the evaluation and management of both inherited and acquired polyneuropathies. A description of the sonographic techniques and common abnormalities is provided, followed by a presentation of typical findings in different neuropathies. Scoring systems for characterizing the presence and pattern of nerve abnormalities as they relate to different polyneuropathies are presented. Muscle Nerve 57: 716-728, 2018.
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Affiliation(s)
- Johan A Telleman
- Department of Neurology and Clinical Neurophysiology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.,Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, UMC Utrecht, Utrecht, The Netherlands
| | - Alexander Grimm
- Department Neurology, University Hospital Tuebingen, Germany
| | - Stephan Goedee
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, UMC Utrecht, Utrecht, The Netherlands
| | - Leo H Visser
- Department of Neurology and Clinical Neurophysiology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Craig M Zaidman
- Departments of Neurology and Pediatrics, Washington University St. Louis, Missouri, 660 South Euclid, Box 8111, St. Louis, Missouri, 63110-1093, USA
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18
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Décard BF, Pham M, Grimm A. Ultrasound and MRI of nerves for monitoring disease activity and treatment effects in chronic dysimmune neuropathies – Current concepts and future directions. Clin Neurophysiol 2018; 129:155-167. [DOI: 10.1016/j.clinph.2017.10.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 10/03/2017] [Accepted: 10/07/2017] [Indexed: 02/07/2023]
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19
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Herraets IJ, Goedee HS, Telleman JA, van Asseldonk JTH, Visser LH, van der Pol WL, van den Berg LH. High-resolution ultrasound in patients with Wartenberg’s migrant sensory neuritis, a case-control study. Clin Neurophysiol 2018; 129:232-237. [DOI: 10.1016/j.clinph.2017.10.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 10/07/2017] [Accepted: 10/22/2017] [Indexed: 12/13/2022]
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20
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Grimm A, Winter N, Rattay TW, Härtig F, Dammeier NM, Auffenberg E, Koch M, Axer H. A look inside the nerve - Morphology of nerve fascicles in healthy controls and patients with polyneuropathy. Clin Neurophysiol 2017; 128:2521-2526. [PMID: 28958781 DOI: 10.1016/j.clinph.2017.08.022] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 07/31/2017] [Accepted: 08/20/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Polyneuropathies are increasingly analyzed by ultrasound. Summarizing, diffuse enlargement is typical in Charcot-Marie Tooth type 1 (CMT1a), regional enlargement occurs in inflammatory neuropathies. However, a distinction of subtypes is still challenging. Therefore, this study focused on fascicle size and pattern in controls and distinct neuropathies. METHODS Cross-sectional area (CSA) of the median, ulnar and peroneal nerve (MN, UN, PN) was measured at predefined landmarks in 50 healthy controls, 15 CMT1a and 13 MMN patients. Additionally, largest fascicle size and number of visible fascicles was obtained at the mid-upper arm cross-section of the MN and UN and in the popliteal fossa cross-section of the PN. RESULTS Cut-off normal values for fascicle size in the MN, UN and PN were defined (<4.8mm2, <2.8mm2 and <3.5mm2). In CMT1a CSA and fascicle values are significantly enlarged in all nerves, while in MMN CSA and fascicles are regionally enlarged with predominance in the upper arm nerves. The ratio of enlarged fascicles and all fascicles was significantly increased in CMT1a (>50%) in all nerves (p<0.0001), representing diffuse fascicle enlargement, and moderately increased in MMN (>20%), representing differential fascicle enlargement (enlarged and normal fascicles at the same location) sparing the peroneal nerve (regional fascicle enlargement). Based on these findings distinct fascicle patterns were defined. CONCLUSION Normal values for fascicle size could be evaluated; while CMT1a features diffuse fascicle enlargement, MMN shows regional and differential predominance with enlarged fascicles as single pathology. SIGNIFICANCE Pattern analysis of fascicles might facilitate distinction of several otherwise similar neuropathies.
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Affiliation(s)
- Alexander Grimm
- Center for Neurology, Tübingen University Hospital and Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, Tübingen, Germany.
| | - Natalie Winter
- Center for Neurology, Tübingen University Hospital and Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, Tübingen, Germany.
| | - Tim W Rattay
- Center for Neurology, Tübingen University Hospital and Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, Tübingen, Germany; German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany.
| | - Florian Härtig
- Center for Neurology, Tübingen University Hospital and Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, Tübingen, Germany.
| | - Nele M Dammeier
- Center for Neurology, Tübingen University Hospital and Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, Tübingen, Germany.
| | - Eva Auffenberg
- Center for Neurology, Tübingen University Hospital and Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, Tübingen, Germany.
| | - Marilin Koch
- Center for Neurology, Tübingen University Hospital and Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, Tübingen, Germany.
| | - Hubertus Axer
- Hans Berger Department of Neurology, Jena University Hospital, Friedrich-Schiller University Jena, Jena, Germany.
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21
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Goedee HS, Jongbloed BA, van Asseldonk JTH, Hendrikse J, Vrancken AFJE, Franssen H, Nikolakopoulos S, Visser LH, van der Pol WL, van den Berg LH. A comparative study of brachial plexus sonography and magnetic resonance imaging in chronic inflammatory demyelinating neuropathy and multifocal motor neuropathy. Eur J Neurol 2017; 24:1307-1313. [PMID: 28762574 DOI: 10.1111/ene.13380] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 06/27/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE To compare the performance of neuroimaging techniques, i.e. high-resolution ultrasound (HRUS) and magnetic resonance imaging (MRI), when applied to the brachial plexus, as part of the diagnostic work-up of chronic inflammatory demyelinating neuropathy (CIDP) and multifocal motor neuropathy (MMN). METHODS Fifty-one incident, treatment-naive patients with CIDP (n = 23) or MMN (n = 28) underwent imaging of the brachial plexus using (i) a standardized MRI protocol to assess enlargement or T2 hyperintensity and (ii) bilateral HRUS to determine the extent of nerve (root) enlargement. RESULTS We found enlargement of the brachial plexus in 19/51 (37%) and T2 hyperintensity in 29/51 (57%) patients with MRI and enlargement in 37/51 (73%) patients with HRUS. Abnormal results were only found in 6/51 (12%) patients with MRI and 12/51 (24%) patients with HRUS. A combination of the two imaging techniques identified 42/51 (83%) patients. We found no association between age, disease duration or Medical Research Council sum-score and sonographic nerve size, MRI enlargement or presence of T2 hyperintensity. CONCLUSIONS Brachial plexus sonography could complement MRI in the diagnostic work-up of patients with suspected CIDP and MMN. Our results indicate that combined imaging studies may add value to the current diagnostic consensus criteria for chronic inflammatory neuropathies.
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Affiliation(s)
- H S Goedee
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - B A Jongbloed
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - J-T H van Asseldonk
- Department of Neurology and Clinical Neurophysiology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - J Hendrikse
- Department of Radiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - A F J E Vrancken
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - H Franssen
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - S Nikolakopoulos
- Department of Biostatistics, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - L H Visser
- Department of Neurology and Clinical Neurophysiology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - W L van der Pol
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - L H van den Berg
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands
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22
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Yoon JY, Kim MW, Do HJ, Jang DH, Lee HW. Sonographic Findings of Polyneuropathy Associated With Cerebrotendinous Xanthomatosis: A Case Report. Ann Rehabil Med 2017; 41:313-317. [PMID: 28503466 PMCID: PMC5426266 DOI: 10.5535/arm.2017.41.2.313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 06/07/2016] [Indexed: 11/05/2022] Open
Abstract
Cerebrotendinous xanthomatosis is a rare autosomal recessive disease that involves multiple organs, including the peripheral nervous system. The present study is the first to report the ultrasonographic findings of peripheral nerves in a patient with cerebrotendinous xanthomatosis. The patient presented with bilateral Achilles tendon enlargement and foot hypesthesia. Sonographic examination revealed hypoechoic, swollen peripheral nerves with enlarged bilateral Achilles tendons. Since the ultrasonographic findings revealed peripheral involvement, the diagnosis of cerebrotendinous xanthomatosis was established after laboratory and genetic studies along with clinical findings.
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Affiliation(s)
- Jung Yoon Yoon
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Min-Wook Kim
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Jung Do
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dae-Hyun Jang
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hee Won Lee
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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23
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Rasenack M, Décard BF, Schädelin S, Grimm A, Fischer D, Hafner P. Ultrasonographic reference values for peripheral nerves and nerve roots in the normal population of children and adolescents: study protocol for an observational-prospective trial. BMJ Open 2016; 6:e014662. [PMID: 27940636 PMCID: PMC5168681 DOI: 10.1136/bmjopen-2016-014662] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND High-resolution ultrasonography is a new and promising technique to evaluate peripheral and spinal nerves. Its validity as a diagnostic tool in neurological diseases has been demonstrated in adults. Up to now no reference values have been published in children and adolescents although this technique would be ideal in this population as it is fast and non-invasive. METHODS/DESIGN Our aim is to generate ultrasonographic reference values for several peripheral nerves (median, ulnar, radial, tibial, sural, peroneal and tibial nerve) as well as for the spinal nerves C5 and C6 and the vagus nerve in children and adolescents. In an observational prospective study, we will recruit 205 children and adolescents aged between ≥2 and ≤18 years without neuromuscular symptoms/signs and without a history of neuromuscular disease. After the collection of demographic and anthropometric data (height, weight, body mass index, age, gender and handedness) and a neurologic examination, a high-resolution ultrasonography of peripheral and spinal nerves at several anatomic landmarks will be performed. These data will be used to estimate age-dependent percentile curves and to evaluate inter-rater, intrarater and interequipment reliability of the measurements. ETHICS AND DISSEMINATION This study was approved by the local ethics committee (EKNZ 2015-210). The findings from this study will be disseminated through peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER NCT02570802, pre-results publication.
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Affiliation(s)
- Maria Rasenack
- Department of Neurology, Basel University Hospital, Basel, Switzerland
| | - Bernhard F Décard
- Department of Neurology, Basel University Hospital, Basel, Switzerland
| | - Sabine Schädelin
- Clinical Trial Unit, Basel University Hospital, Basel, Switzerland
| | - Alexander Grimm
- Department of Neurology, Tübingen University Hospital, Tübingen, Germany
| | - Dirk Fischer
- Division of Neuropaediatrics, University of Basel Children's Hospital, Basel, Switzerland
- Division of Neurology, Medical University Clinic, Kantonsspital Baselland, Bruderholz, Switzerland
| | - Patricia Hafner
- Division of Neuropaediatrics, University of Basel Children's Hospital, Basel, Switzerland
- Division of Neurology, Medical University Clinic, Kantonsspital Baselland, Bruderholz, Switzerland
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24
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Goedee HS, van der Pol WL, van Asseldonk JTH, Franssen H, Notermans NC, Vrancken AJFE, van Es MA, Nikolakopoulos S, Visser LH, van den Berg LH. Diagnostic value of sonography in treatment-naive chronic inflammatory neuropathies. Neurology 2016; 88:143-151. [PMID: 27927940 DOI: 10.1212/wnl.0000000000003483] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 10/04/2016] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To determine the diagnostic value of high-resolution ultrasound (HRUS) for detection of chronic inflammatory demyelinating polyneuropathy (CIDP), Lewis-Sumner syndrome (LSS), and multifocal motor neuropathy (MMN). METHODS Between January 2013 and January 2015, we enrolled 75 consecutive treatment-naive patients with chronic inflammatory neuropathies and 70 disease controls. We performed extensive nerve conduction and standardized HRUS studies bilaterally of large arm and leg nerves and brachial plexus. We determined optimal sonographic cutoff values of nerve size and used receiver operating characteristic analysis and logistic regression models to identify nerve combinations with optimal diagnostic performance. RESULTS Enlargement of median nerve at forearm >10 mm2, upper arm >13 mm2, and any trunk of brachial plexus >8 mm2 was 99% specific for chronic inflammatory neuropathies. A shortened HRUS protocol for detecting this abnormal nerve enlargement showed high sensitivity (83%-95%), positive predictive value (100%), and negative predictive value (98%) in discriminating CIDP, LSS, and MMN from clinical mimics. CONCLUSIONS Sonographic enlargement of proximal median nerve segments in the arms and brachial plexus is a key feature of chronic inflammatory neuropathies, which helps to reliably distinguish them from axonal neuropathies and amyotrophic lateral sclerosis. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that, in absence of clinical features that suggest a hereditary demyelinating neuropathy, sonographic enlargement of proximal median nerve segments and brachial plexus accurately identifies patients with chronic inflammatory neuropathies.
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Affiliation(s)
- H Stephan Goedee
- From the Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery (H.S.G., W.L.v.d.P., H.F., N.C.N., A.J.F.E.V., M.A.v.E., L.H.v.d.B.), and Department of Biostatistics, Julius Center for Health Sciences and Primary Care (S.N.), UMC Utrecht; and Department of Neurology and Clinical Neurophysiology (J-T.H.v.A., L.H.V.), St. Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands.
| | - W Ludo van der Pol
- From the Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery (H.S.G., W.L.v.d.P., H.F., N.C.N., A.J.F.E.V., M.A.v.E., L.H.v.d.B.), and Department of Biostatistics, Julius Center for Health Sciences and Primary Care (S.N.), UMC Utrecht; and Department of Neurology and Clinical Neurophysiology (J-T.H.v.A., L.H.V.), St. Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Jan-Thies H van Asseldonk
- From the Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery (H.S.G., W.L.v.d.P., H.F., N.C.N., A.J.F.E.V., M.A.v.E., L.H.v.d.B.), and Department of Biostatistics, Julius Center for Health Sciences and Primary Care (S.N.), UMC Utrecht; and Department of Neurology and Clinical Neurophysiology (J-T.H.v.A., L.H.V.), St. Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Hessel Franssen
- From the Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery (H.S.G., W.L.v.d.P., H.F., N.C.N., A.J.F.E.V., M.A.v.E., L.H.v.d.B.), and Department of Biostatistics, Julius Center for Health Sciences and Primary Care (S.N.), UMC Utrecht; and Department of Neurology and Clinical Neurophysiology (J-T.H.v.A., L.H.V.), St. Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Nicolette C Notermans
- From the Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery (H.S.G., W.L.v.d.P., H.F., N.C.N., A.J.F.E.V., M.A.v.E., L.H.v.d.B.), and Department of Biostatistics, Julius Center for Health Sciences and Primary Care (S.N.), UMC Utrecht; and Department of Neurology and Clinical Neurophysiology (J-T.H.v.A., L.H.V.), St. Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Alexander J F E Vrancken
- From the Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery (H.S.G., W.L.v.d.P., H.F., N.C.N., A.J.F.E.V., M.A.v.E., L.H.v.d.B.), and Department of Biostatistics, Julius Center for Health Sciences and Primary Care (S.N.), UMC Utrecht; and Department of Neurology and Clinical Neurophysiology (J-T.H.v.A., L.H.V.), St. Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Michael A van Es
- From the Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery (H.S.G., W.L.v.d.P., H.F., N.C.N., A.J.F.E.V., M.A.v.E., L.H.v.d.B.), and Department of Biostatistics, Julius Center for Health Sciences and Primary Care (S.N.), UMC Utrecht; and Department of Neurology and Clinical Neurophysiology (J-T.H.v.A., L.H.V.), St. Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Stavros Nikolakopoulos
- From the Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery (H.S.G., W.L.v.d.P., H.F., N.C.N., A.J.F.E.V., M.A.v.E., L.H.v.d.B.), and Department of Biostatistics, Julius Center for Health Sciences and Primary Care (S.N.), UMC Utrecht; and Department of Neurology and Clinical Neurophysiology (J-T.H.v.A., L.H.V.), St. Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Leo H Visser
- From the Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery (H.S.G., W.L.v.d.P., H.F., N.C.N., A.J.F.E.V., M.A.v.E., L.H.v.d.B.), and Department of Biostatistics, Julius Center for Health Sciences and Primary Care (S.N.), UMC Utrecht; and Department of Neurology and Clinical Neurophysiology (J-T.H.v.A., L.H.V.), St. Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Leonard H van den Berg
- From the Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery (H.S.G., W.L.v.d.P., H.F., N.C.N., A.J.F.E.V., M.A.v.E., L.H.v.d.B.), and Department of Biostatistics, Julius Center for Health Sciences and Primary Care (S.N.), UMC Utrecht; and Department of Neurology and Clinical Neurophysiology (J-T.H.v.A., L.H.V.), St. Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
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Grimm A, Rattay TW, Winter N, Axer H. Peripheral nerve ultrasound scoring systems: benchmarking and comparative analysis. J Neurol 2016; 264:243-253. [PMID: 27878436 DOI: 10.1007/s00415-016-8305-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 10/07/2016] [Indexed: 02/06/2023]
Abstract
Ultrasound of the nerves is an additive diagnostic tool to evaluate polyneuropathy. Recently, the need for standardized scoring systems has widely been discussed; different scores are described so far. Therefore, 327 patients with polyneuropathy were analyzed by ultrasound in our laboratory. Consequently, several ultrasound scoring tools were applied, i.e., the nerve pattern classification according to Padua et al. in all patients with CIDP and variants, the Bochum ultrasound score (BUS) and the neuritis ultrasound protocol in immune-mediated neuritis, the ultrasound pattern sum score, the homogeneity score, and the nerve enlargement distribution score in all neuropathies if possible. For all scores good accuracy was found. Most patients with CIDP revealed hypoechoic enlarged nerves (Class 1), the BUS/NUP was useful to identify GBS (sensitivity >85%), MMN (100%) and CIDP (>70%), while the UPSS showed high sensitivity and positive/negative predictive values (N/PPV) in the diagnosis of GBS (>70%), CIDP (>85%) and axonal non-inflammatory neuropathies (>90%). Homogeneous nerves were found in most CMT1 patients (66.7%), while immune-mediated neuropathies mostly show regional nerve enlargement. The HS was suitable to identify CMT patients with an HS ≥5 points. All scores were easily applicable with high accuracy. The former-reported results could be similarly confirmed. However, all sores have some incompleteness concerning unselected polyneuropathy population, particularly rare and focal types. Scoring systems are useful and easily applicable. They show high accuracy in certain neuropathies, but also offer some gaps and can, therefore, only be used in addition to standard diagnostic routines such as electrophysiology.
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Affiliation(s)
- Alexander Grimm
- Center for Neurology, Tübingen University Hospital and Hertie Institute for Clinical Brain Research Eberhard-Karls University Tübingen, Tübingen, Germany.
| | - Tim W Rattay
- Center for Neurology, Tübingen University Hospital and Hertie Institute for Clinical Brain Research Eberhard-Karls University Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Natalie Winter
- Center for Neurology, Tübingen University Hospital and Hertie Institute for Clinical Brain Research Eberhard-Karls University Tübingen, Tübingen, Germany
| | - Hubertus Axer
- Hans Berger Department of Neurology, Jena University Hospital Friedrich-Schiller University Jena, Jena, Germany
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Tawfik EA. Vagus nerve ultrasound in a patient with amyotrophic lateral sclerosis. Muscle Nerve 2016; 54:978-979. [DOI: 10.1002/mus.25126] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 03/23/2016] [Accepted: 03/24/2016] [Indexed: 12/25/2022]
Affiliation(s)
- Eman A. Tawfik
- Department of Physical Medicine & Rehabilitation, Faculty of Medicine; Ain Shams University; Cairo Egypt
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Grimm A, Vittore D, Schubert V, Rasenack M, Décard BF, Heiling B, Hammer N, Axer H. Ultrasound aspects in therapy-naive CIDP compared to long-term treated CIDP. J Neurol 2016; 263:1074-82. [PMID: 27017343 DOI: 10.1007/s00415-016-8100-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 03/13/2016] [Accepted: 03/14/2016] [Indexed: 12/11/2022]
Abstract
To investigate the use of nerve ultrasound (NUS) along with the European Federation of Neurological Societies (EFNS) guidelines and clinical scores in untreated, recently diagnosed chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) vs. long-lasting treated CIDP. NUS and nerve conduction studies (NCS) of predefined nerves/cervical roots were performed in CIDP on diagnostic onset and "chronic-CIDP" (diagnosis and therapy >6 months), compared to controls. Nerve morphology was quantified using the modified ultrasound pattern sum score mUPSS, which is the sum of 3 ultrasound scores derived at 12 predefined measurement points and the homogeneity score (HS) in ulnar, median, and tibial nerve. 21 onset-CIDP, 21 "chronic-CIDP", and 21 age-matched controls were included. No differences in clinical scores or in the number of electrophysiologically affected nerves existed between the groups. Significantly enlarged cross-sectional areas of the nerves and diameters of the roots ensued already in onset-CIDP; however, with proximal predominance, whilst in chronic-CIDP, nerve enlargement was more prominent and ubiquitous. Increased UPS scores were shown in both patient groups compared to the controls. Significant differences between the patient groups were found particularly in the peripheral nerve score UPSA. Evaluation by means of HS revealed that the nerves in onset-CIDP were mostly regionally enlarged (often sparing distal segments) whereas in chronic-CIDP, nerves were more generalized enlarged. Onset- and chronic-CIDP show enlarged nerves and therefore increased mUPSS, however, nerve enlargement shows a more generalized pattern in chronic-CIDP compared to disease onset and correlates with disease duration and delayed therapy start, but not with disability.
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Rasenack M, Proebstel AK, Athanasopoulou IM, Décard BF, Grimm A. Nerve Hypertrophy in Primary Amyloidosis. Muscle Nerve 2016; 54:510-2. [PMID: 26999802 DOI: 10.1002/mus.25113] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 03/18/2016] [Accepted: 03/18/2016] [Indexed: 12/12/2022]
Affiliation(s)
- Maria Rasenack
- Department of Neurology, Basel University Hospital, Basel, Switzerland
| | | | | | - Bernhard F Décard
- Department of Neurology, Basel University Hospital, Basel, Switzerland
| | - Alexander Grimm
- Department of Neurology, Basel University Hospital, Basel, Switzerland.,Department of Neurology, Tübingen University Hospital, Tübingen, Germany
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Grimm A, Décard BF, Axer H. Ultrasonography of the peripheral nervous system in the early stage of Guillain-Barré syndrome. J Peripher Nerv Syst 2015; 19:234-41. [PMID: 25418824 DOI: 10.1111/jns.12091] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 06/22/2014] [Accepted: 07/31/2014] [Indexed: 12/18/2022]
Abstract
Ultrasonography can be used to visualize peripheral nerve abnormalities in immune-mediated neuropathies. The objective of this study was to prove the role of ultrasonography (US) in acute phase of Guillain-Barré syndrome (GBS). Systematic ultrasonic measurements of several peripheral nerves including the vagal nerve as well as the sixth cervical nerve root were performed in 18 patients with GBS at days 1-3 after symptom onset and compared to 21 healthy controls. Nerve conduction studies (NCS) of corresponding nerves were undertaken. Consequently, significant differences between the groups were found in compound muscle action potential amplitudes, F-wave latency, and persistency. Ultrasonic cross-sectional areas (CSAs) showed significant enlargement in all nerves except of the ulnar nerve (upper arm) and the sural nerve compared to healthy controls, most prominent in proximal and middle median nerve (p < 0.01). The vagal nerve also showed enlargement compared to controls (p < 0.05), which was most pronounced in patients with autonomic dysfunction compared to patients without (p < 0.05). C6 root diameter showed a significant correlation to the amount of cerebrospinal fluid (CSF)-protein (Pearson correlation, p < 0.05). US shows nerve enlargement in several peripheral nerves including vagal nerve and C6 root in acute phase of GBS and could be an additional diagnostic tool for example, in GBS of atypical onset and autonomic dysfunction.
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Affiliation(s)
- Alexander Grimm
- Department of Neurology, Basel University Hospital, Basel, Switzerland
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Grimm A, Décard BF, Schramm A, Pröbstel AK, Rasenack M, Axer H, Fuhr P. Ultrasound and electrophysiologic findings in patients with Guillain-Barré syndrome at disease onset and over a period of six months. Clin Neurophysiol 2016; 127:1657-63. [PMID: 26220732 DOI: 10.1016/j.clinph.2015.06.032] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate cross-sectional areas (CSAs) of several peripheral nerves including the vagus nerve and the diameter of spinal nerves as measured by nerve ultrasound (NUS) and nerve conduction studies (NCS) in Guillain-Barré syndrome (GBS) patients over at least six months compared to healthy controls. METHODS NUS and/or NCS of several nerves, the vagus nerve, and the 5th/6th cervical spinal nerves were performed in patients with GBS at days 2-3 after symptom onset, at days 10-14 after immunoglobulin therapy and after six months compared to healthy controls. RESULTS 27 GBS-patients and 31 controls were included. Using NUS significant enlargement was found in all measured nerves (P<0.001), except the sural nerve (P=0.086) compared to the controls at onset. The vagus (median 3.0 mm(2) vs. 2.0 mm(2), P<0.0001) and the cervical spinal nerves were significantly enlarged (median 3.5/4.0 mm vs. 2.6/3.2 mm, p<0.0001), the vagus most obviously in patients with autonomic dysregulation (AD, 4.0 mm(2)). Six months later, NCS showed persisting pathology in CMAP-amplitudes with amelioration of F-wave pathology. NUS showed restitution in the spinal nerves (median 2.6/3.2 mm) and the vagus (median 2.0 mm(2)) in all patients excluding the vagus in those with persistent AD (median 4.0 mm(2)). The peripheral nerves did not change significantly (P>0.05). CONCLUSION Ultrasonographic detection of cervical spinal nerve enlargement supports the diagnosis of GBS in the early phase. Its regression may be a good parameter for the clinical restitution over time. Vagus enlargement may be a risk marker for development of AD. SIGNIFICANCE Ultrasound is a reliable diagnostic follow-up tool in early GBS.
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Grimm A, Décard BF, Axer H, Fuhr P. The Ultrasound pattern sum score - UPSS. A new method to differentiate acute and subacute neuropathies using ultrasound of the peripheral nerves. Clin Neurophysiol 2015; 126:2216-25. [PMID: 25691156 DOI: 10.1016/j.clinph.2015.01.011] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 12/21/2014] [Accepted: 01/27/2015] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Ultrasound differentiation of neuropathies is a great challenge. We, therefore, suggest a standardized score to operationalize differentiation between several acute and subacute onset neuropathies. METHOD We retrospectively analyzed the ultrasound data of 61 patients with acute or subacute neuropathies, e.g. chronic immune-mediated neuropathies, Guillain-Barré syndrome (GBS), and axonal/vasculitic neuropathies. We compared these data to 28 healthy controls. Based on these results an ultrasound pattern sum score (UPSS) with three sub-scores (UPS-A for the sensorimotor nerves, UPS-B for the cervical roots and the vagal nerve and UPS-C for the sural nerve) was developed. Afterwards, the applicability of the score was prospectively validated in 10 patients with chronic neuropathies and in 14 patients with unknown acute and subacute PNP before performing additional tests. RESULTS UPS-A and UPSS were significantly higher in CIDP than in other neuropathies and controls (p<0.001). UPS-B was significantly more often pathologic in GBS than in CIDP and other neuropathies (p<0.001). Using receiver operation characteristics curve analysis boundary values for each score were defined. Positive predictive value (PPV) of these scores for CIDP and GBS was >85%. Vasculitic neuropathies showed an intermediate type of UPSS compared to other axonal neuropathies (p<0.001). In the prospective application the pattern score could be used with good accuracy in several types of neuropathy. CONCLUSION UPS-A and UPSS operationalize to diagnose acute and subacute-onset CIDP and its variants with high sensitivity, specificity, and PPV. An increased UPS-B with normal UPSS and other sub scores may point to the diagnosis of GBS with high PPV and enables the differentiation from CIDP. SIGNIFICANCE Using the UPSS and its sub-scores gives a new diagnostic power to the method of the peripheral nerve ultrasound.
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Affiliation(s)
- Alexander Grimm
- Department of Neurology, Basel University Hospital, Basel, Switzerland.
| | - Bernhard F Décard
- Department of Neurology, Basel University Hospital, Basel, Switzerland
| | - Hubertus Axer
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Peter Fuhr
- Department of Neurology, Basel University Hospital, Basel, Switzerland
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Grimm A, Décard BF, Bischof A, Axer H. Ultrasound of the peripheral nerves in systemic vasculitic neuropathies. J Neurol Sci 2014; 347:44-9. [PMID: 25262016 DOI: 10.1016/j.jns.2014.09.017] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 09/05/2014] [Accepted: 09/12/2014] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Ultrasound of the peripheral nerves (PNUS) can be used to visualize nerve pathologies in polyneuropathies (PNP). The aim of this study was to investigate, whether PNUS provides additional information in patients with proven systemic vasculitic neuropathies (VN). MATERIAL AND METHODS Systematic ultrasound measurements of several peripheral nerves, the vagal nerve and the 6th cervical nerve root were performed in 14 patients and 22 healthy controls. Nerve conduction studies of the corresponding nerves were undertaken. Finally, the measured results were compared to a study population of demyelinating immune-mediated and axonal neuropathies. RESULTS Patients with VN displayed significant smaller amplitudes of compound muscle action potentials (CMAP) (p<0.05) and sensory nerve action potentials (SNAP) compared to healthy controls, while conduction velocity did not differ between groups. The mean nerve cross-sectional areas (CSA) were increased in several peripheral nerves compared to the controls, most prominent in tibial and fibular nerve (p<0.01). PNUS revealed nerve enlargement in most of the clinically and electrophysiologically affected nerves (22 out of 31) in VN. Nerve enlargement was more often seen in vasculitic neuropathies than in other axonal neuropathies, but significantly rarer than in demyelinating neuropathies. CONCLUSION Focal CSA enlargement in one or more nerves in electrophysiologically axonal neuropathies can be a hint for VN and thus facilitate diagnostic and therapeutic procedures.
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Affiliation(s)
- Alexander Grimm
- Department of Neurology, Basel University Hospital, Switzerland; Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany.
| | | | - Antje Bischof
- Department of Neurology, Basel University Hospital, Switzerland; Clinical Immunology, Basel University Hospital Basel, Switzerland
| | - Hubertus Axer
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany; Center for Sepsis Control and Care (CSCC), Jena University Hospital, Germany
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