Prognostic value of nerve ultrasound and electrophysiological findings in traumatic sural neuropathy.

INTRODUCTION: We report on the prognostic role of cross sectional area (CSA) enlargement and axonal damage in traumatic sural neuropathy (TSN). METHODS: Reference values were defined in 23 healthy subjects. 13patients with TSN underwent evaluation (Thessaloniki Hypesthesia Score (THS), ultrasound, electrophysiology). All patients were followed up with THS 6 months after initial evaluation. RESULTS: During initial evaluation, the 13 patients showed a mean THS of 2.6 (SD ±â€¯0.9). 7 patients showed pathological (pUS) and 6 normal CSA (nUS). 8 patients showed axonal affection (pCS) and 5 no axonal affection (nCS). During follow up, mean THS was 3.1 (SD ±â€¯0.9) in pUS, and 1.8 (SD ±â€¯0.7) in the nUS group (p < 0.001). Mean THS was 2.8 (SD ±â€¯0.7) in pCS, and 2.1 (SD ±â€¯0.9) in nCS group (p = 0.035). DISCUSSION: CSA enlargement, but not axonal loss, seems to have a negative prognostic role in patients with TSN.

High-Resolution Nerve Ultrasound and Electrophysiological Findings in Restless Legs Syndrome.

BACKGROUND AND PURPOSE: Restless legs syndrome (RLS) is a multifactorial network disorder of a sensorimotor system extending from dopaminergic and glutamatergic cerebral structures to the spinal neurons and peripheral nerves. The role of peripheral nerve damage in the causality and severity progression for RLS patients remains unclear. METHODS: We performed a clinical and epidemiological study on a cohort of 34 RLS patients focusing on RLS risk factors and disease severity. We investigated the peripheral nerves with nerve conduction studies and with high-resolution nerve ultrasound (HRUS). RESULTS: In 18 of the 34 patients (mean age 67.4 ± 15 years old), a sensorimotor axonal neuropathy was diagnosed. These patients presented with late-onset RLS were treated with membrane stabilizing agents, whereas no neuropathy predisposing comorbidity could be identified for the majority of them. We could show an inverse correlation between the amplitudes of the tibial nerve for the patients with polyneuropathy and the RLS severity index. Neuropathy patients were characterized by an increase of the cross-sectional area (CSA) of the tibial nerve in the popliteal fossa and by increased intranerve and internerve variability values showing an asymmetry of CSA distribution. This pattern resembles previous studies on diabetic neuropathy. CONCLUSIONS: Early diagnosis, characterization, and treatment of neuropathy are increasingly relevant for RLS patients as it correlates with disease severity. HRUS revealed a pattern resembling diabetic neuropathy, which implies a similar pathophysiology with metabolic and ischemic origin of RLS-related axonal neuropathy.

Comparison of clinical, electrophysiological, sonographic and MRI features in CIDP.

INTRODUCTION: We investigated the applicability of nerve ultrasound and magnetic resonance imaging (MRI) in chronic inflammatory demyelinating polyneuropathy (CIDP). METHODS: We systematically examined several nerves with ultrasound and the lumbar roots and tibial nerve in the popliteal fossa of nine CIDP patients with MRI additionally to the nerve conduction studies. RESULTS: Patients with overall disability sum score (ODSS) 2-3 were characterised by normal fascicular structure in MRI and ultrasound. Patients with higher ODSS showed isolated enlarged fascicles and increased cross sectional area (CSA) of the peripheral nerves and of the diameter of the cauda equina and L5 root, whereas two of them showed atrophic fascicles in both imaging techniques. CONCLUSIONS: Nerve ultrasound and MRI findings show the same morphological fascicle alterations in peripheral nerves in correlation to ODSS. Nerve ultrasound as an affordable tool, easy and quick to perform, could replace MRI in daily routine for monitoring peripheral nerve morphology.

Correlation of nerve ultrasound, electrophysiological and clinical findings in chronic inflammatory demyelinating polyneuropathy.

BACKGROUND AND PURPOSE: We present the nerve ultrasound findings in chronic inflammatory demyelinating polyneuropathy (CIDP) and examine their correlation with electrophysiology and functional disability. METHODS: A total of 75 healthy controls and 48 CIDP patients underwent clinical, sonographic and electrophysiological evaluation a mean of 3.9 years(SD+/-2.7) after disease onset. RESULTS: Nerve ultrasound revealed statistically significant higher cross-sectional area (CSA) values of the median (P<.0001), ulnar (P<.0001), radial (P<.0001), tibial (P<.0001), fibular nerve(P<.0001) in most of the anatomic sites and brachial plexus (supraclavicular, P<.0001;interscalene space, P = .0118),when compared to controls. The electroneurography documented signs of permanent axonal loss in the majority of peripheral nerves. A correlation between sonographic and electrophysiological findings was found only between the motor conduction velocity and CSA of the tibial nerve at the ankle (r = -.451, P = .007). Neither nerve sonography nor electrophysiology correlated with functional disability. The CSA of the median nerve in carpal tunnel and the ulnar nerve in Guyon's canal correlated with disease duration (P = .036, P = .027 respectively). DISCUSSION: CIDP seems to show inhomogenous CSA enlargement in brachial plexus and peripheral nerves, with weak correlation to electrophysiological findings. Neither nerve sonography nor electrophysiology correlated with functional disability in CIDP patients. Multicenter, prospective studies are required to proof the applicability and diagnostic values of these findings.

Bochum ultrasound score allows distinction of chronic inflammatory from multifocal acquired demyelinating polyneuropathies.

OBJECTIVE: The aim of this observational study was to evaluate the applicability of a recently introduced ultrasound score (Bochum ultrasound score; BUS) in distinguishing the chronic inflammatory demyelinating polyneuropathy (CIDP) from the multifocal motor neuropathy (MMN) or the multifocal acquired demyelinating sensory and motor neuropathy (MADSAM). METHODS: The BUS underwent prospective evaluation of its applicability in a group of 13 patients (mean age 47.2, SD ± 13.7, 9 women), who were referred to our department between January 2012 and August 2013 with the clinical picture of a chronic symmetrical or asymmetrical sensory/sensorimotor neuropathy. RESULTS: The cut-off value of ≥ 2 points in the "Bochum ultrasound score" showed a sensitivity of 80% and specificity of 87.5% (PPV=80%, NPV=87.5%) in distinguishing CIDP from MMN or MADSAM. CONCLUSIONS: The BUS seems to allow a reliable distinction of CIDP from multifocal acquired demyelinating polyneuropathies causing predominantly motor nerve dysfunction, such as MMN or MADSAM. Our ultrasound findings indicate a stronger relationship of MADSAM to MMN, than to CIDP.

Sarcoid neuropathy: correlation of nerve ultrasound, electrophysiological and clinical findings.

INTRODUCTION: We present the nerve ultrasound findings in sarcoid neuropathy and examine their correlation with electrophysiology and functional disability. MATERIALS AND METHODS: 40 healthy controls and 13 patients with sarcoid neuropathy underwent clinical, sonographic and electrophysiological evaluation, a mean of 2.1 years (SD ± 0.7) after disease onset. RESULTS: Nerve ultrasound revealed significantly higher cross sectional area (CSA) values of the ulnar (elbow, p<0.001), fibular (fibular head, p<0.001), sural (between the lateral and the medial head of the gastrocnemius muscle, p<0.001) and tibial nerves (ankle and popliteal fossa, p<0.001), when compared to controls. The electroneurography documented significantly lower values of the 1) compound muscle action potentials (cMAPs) in the median, fibular and tibial nerves (p<0.001), and 2) sensory nerve action potential (sNAP) in the median, ulnar and sural nerves (p<0.001). A significant correlation between sonographic and electrophysiological findings in the group with sarcoid neuropathy was found only between cMAP and CSA of the ulnar nerve at the elbow (r=0.894, p<0.001). Neither nerve sonography nor electrophysiology correlated with functional disability. DISCUSSION: Sarcoid neuropathy seems to show predominantly CSA enlargement in peripheral nerves of the lower extremities, without any significant correlation to electrophysiological findings. The electroneurography documented signs of sensorimotor axonal loss in various peripheral nerves. Neither nerve sonography nor electrophysiology correlated with functional disability.

Nerve ultrasound score in distinguishing chronic from acute inflammatory demyelinating polyneuropathy.

OBJECTIVE: Aim of this study was to develop and evaluate the applicability of an ultrasound score (Bochum ultrasound score - BUS) in distinguishing chronic (CIDP) from acute inflammatory demyelinating polyneuropathy (AIDP). METHODS: Step 1: For the development of BUS 75 healthy-controls, 20 CIDP, 20 AIDP patients underwent US 4.55 ± 3.5 and 3.4 ± 2.91 years, respectively after onset. After comparing the distribution pattern and frequency of pathological US changes between the two study groups, we developed BUS, summarizing the cross sectional area (CSA) of: (1) the ulnar nerve in Guyons' canal, (2) the ulnar nerve in upper-arm, (3) the radial nerve in spiral groove, (4) the sural nerve between the gastrocnemius muscle. Step 2: The BUS underwent blinded evaluation in further 10 CIDP, 21 AIDP patients 3.8 ± 2.7 and 2.3 ± 1.5 years, respectively after onset. Step 3: The BUS underwent blinded, prospective evaluation in 8 patients with acute/subacute polyradiculoneuropathy (5 CIDP, 3 AIDP) 2.6 ± 1.8 weeks after onset. RESULTS: The BUS showed a sensitivity of 90% and specificity of 90.4% (positive predictive value, PPV=81.8%; negative predictive value, NPV=95%) in distinguishing CIDP from AIDP, when they showed no differences in disease duration (p=0.0551).In addition, the BUS distinguished subacute-CIDP from AIDP with a sensitivity of 80%, specificity of 100% (PPV=100%, NPV=75%). CONCLUSION: The BUS seems to allow a reliable distinction of CIDP from AIDP. SIGNIFICANCE: The BUS may be helpful in distinguishing subacute-CIDP from AIDP.