scholarly journals Peripheral Nerve Imaging Aids in the Diagnosis of Immune-Mediated Neuropathies—A Case Series

Diagnostics ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. 535
Author(s):  
Marc Dörner ◽  
Frank Schreiber ◽  
Heike Stephanik ◽  
Claus Tempelmann ◽  
Natalie Winter ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Treatment Options ◽  
Case Series ◽  
Multifocal Motor Neuropathy ◽  
Motor Neuropathy ◽  
Magnetic Resonance Neurography ◽  
Immune Mediated ◽  
Nerve Imaging ◽  
Diagnostic Work ◽  
Peripheral Nerve Imaging

Background: Diagnosis of immune-mediated neuropathies and their differentiation from amyotrophic lateral sclerosis (ALS) can be challenging, especially at early disease stages. Accurate diagnosis is, however, important due to the different prognosis and available treatment options. We present one patient with a left-sided dorsal flexor paresis and initial suspicion of ALS and another with multifocal sensory deficits. In both, peripheral nerve imaging was the key for diagnosis. Methods: We performed high-resolution nerve ultrasound (HRUS) and 7T or 3T magnetic resonance neurography (MRN). Results: In both patients, HRUS revealed mild to severe, segmental or inhomogeneous, nerve enlargement at multiple sites, as well as an area increase of isolated fascicles. MRN depicted T2 hyperintense nerves with additional contrast-enhancement. Discussion: Peripheral nerve imaging was compatible with the respective diagnosis of an immune-mediated neuropathy, i.e., multifocal motor neuropathy (MMN) in patient 1 and multifocal acquired demyelinating sensory and motor neuropathy (MADSAM) in patient 2. Peripheral nerve imaging, especially HRUS, should play an important role in the diagnostic work-up for immune-mediated neuropathies and their differentiation from ALS.

Hand and Wrist Neuropathies: High-resolution Ultrasonography and MR Neurography

2021 ◽  
Vol 25 (02) ◽  
pp. 366-378
Author(s):  
Avneesh Chhabra ◽  
Raghu Ratakonda ◽  
Federico Zaottini ◽  
Riccardo Picasso ◽  
Carlo Martinoli
Keyword(s):  
Magnetic Resonance ◽  
High Resolution ◽  
Peripheral Nerve ◽  
Mr Neurography ◽  
Magnetic Resonance Neurography ◽  
Nerve Imaging ◽  
High Resolution Ultrasonography ◽  
Peripheral Nerve Imaging ◽  
Technical Considerations

AbstractHigh-resolution ultrasonography (US) and magnetic resonance neurography (MRN) have followed parallel paths for peripheral nerve imaging with little comparison of the two modalities. They seem equally effective to study a variety of neuropathies affecting large and small nerves in the wrist and hand. This article outlines the technical considerations of US and MRN and discusses normal and abnormal imaging appearances of hand and wrist nerves from etiologies such as entrapment, injury, tumor, and proximal and diffuse neuropathy, with specific case illustrations.

Intravenous immunoglobulin treatment in multifocal motor neuropathy and other chronic immune-mediated neuropathies

1997 ◽  
Vol 3 (2) ◽  
pp. 93-97 ◽  
Author(s):  
G. Comi ◽  
R. Nemni ◽  
S. Amadio ◽  
G. Galardi ◽  
L. Leocani
Keyword(s):  
Plasma Exchange ◽  
Chronic Inflammatory Demyelinating Polyneuropathy ◽  
Case Series ◽  
Multifocal Motor Neuropathy ◽  
Initial Therapy ◽  
Motor Neuropathy ◽  
Short Term ◽  
Term Efficacy ◽  
Immune Mediated

This review deals with the use of intravenous IVIg immunoglobulines in the treatment of chronic immune-mediated neuropathies: multifocal motor neuropathy, chronic inflammatory demyelinating polyneuropathy, neuropathies associated with monoclonal gammopathies. A particular attention is given to case series and trials which compare IVIg to other therapies, such as steroid treatment, immunosuppressors and plasma exchange. At present, clinical and instrumental data seem to indicate the short term efficacy of IVIg in multifocal motor neuropathies, especially as early treatment; further studies are need in order to prove its long term efficacy in this disease. Concerning chronic inflammatory demyelinating polyneuropathies, short term IVIg efficacy is comparable to that of plasma exchange and in the long term most patients need repeated treatments. Most patients respond to the initial therapy and the initial nonresponders usually improve with a second treatment modality.

Focal peripheral neuropathy

2011 ◽  
Author(s):  
Michael Donaghy
Keyword(s):  
Peripheral Nerve ◽  
Immunosuppressive Treatment ◽  
Conduction Block ◽  
Multifocal Motor Neuropathy ◽  
Nerve Damage ◽  
High Dose ◽  
Motor Neuropathy ◽  
Peripheral Nerve Damage ◽  
Entrapment Neuropathies ◽  
Focal Neuropathy

Some causes of focal peripheral nerve damage are self-evident, such as involvement at sites of trauma, tissue necrosis, infiltration by tumour, or damage by radiotherapy. Focal compressive and entrapment neuropathies are particularly valuable to identify in civilian practice, since recovery may follow relief of the compression. Leprosy is a common global cause of focal neuropathy, which involves prominent loss of pain sensation with secondary acromutilation, and requires early antibiotic treatment. Mononeuritis multiplex due to vasculitis requires prompt diagnosis and immunosuppressive treatment to limit the severity and extent of peripheral nerve damage. Various other medical conditions, both inherited and acquired, can present with focal neuropathy rather than polyneuropathy, the most common of which are diabetes mellitus and hereditary liability to pressure palsies. A purely motor focal presentation should raise the question of multifocal motor neuropathy with conduction block, which usually responds well to high-dose intravenous immunoglobulin infusions.

Clinical Differential Diagnosis of Multifocal Motor Neuropathy

2012 ◽  
Vol 7 (2) ◽  
pp. 124 ◽  
Author(s):  
Jean-Marc Léger ◽  
Eugen Gavriliuc ◽  
◽  
Keyword(s):  
Differential Diagnosis ◽  
Correct Diagnosis ◽  
Rare Condition ◽  
Multifocal Motor Neuropathy ◽  
Motor Neuropathy ◽  
Diagnostic Challenge ◽  
Limb Weakness ◽  
Progressive Muscle Weakness ◽  
Immune Mediated ◽  
Clinical Differential Diagnosis

Multifocal motor neuropathy (MMN) is a rare, clinically well-defined condition within the spectrum of chronic, immune-mediated neuropathies. A typical patient history involves slowly or stepwise progressive, predominantly distal, asymmetrical limb weakness and muscle wasting, most frequently in the arm, that may have developed over a period of years. As a rare condition, MMN may present a diagnostic challenge for non-specialists and some patients may wait years for a correct diagnosis. Timely and accurate diagnosis is essential for patients with MMN. Unlike some motor neuropathies, MMN is treatable with intravenous immunoglobulin and untreated patients are likely to experience progressive muscle weakness that may result in serious functional impairment and impaired quality of life. The aim of this article is therefore to provide a guide for non-specialist neurologists to the clinical recognition and differential diagnosis of MMN.

Diffusion-direction-dependent imaging: a novel MRI approach for peripheral nerve imaging

2007 ◽  
Vol 25 (3) ◽  
pp. 406-411 ◽  
Author(s):  
Mikael Skorpil ◽  
Mathias Engström ◽  
Anders Nordell
Keyword(s):  
Peripheral Nerve ◽  
Nerve Imaging ◽  
Peripheral Nerve Imaging

scholarly journals European Federation of Neurological Societies/Peripheral Nerve Society guideline on management of multifocal motor neuropathy*

2006 ◽  
Vol 13 (8) ◽  
pp. 802-808 ◽  
Author(s):  
I. N. van Schaik ◽  
P. Bouche ◽  
I. Illa ◽  
J-M. Leger ◽  
P. Van den Bergh ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Multifocal Motor Neuropathy ◽  
European Federation ◽  
Motor Neuropathy ◽  
Society Guideline
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