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Clin Neurophysiol. 2014 Jan;125(1):154-9. doi: 10.1016/j.clinph.2013.05.025. Epub 2013 Jul 20.

Multifocal enlargement and increased vascularization of peripheral nerves detected by sonography in CIDP: a pilot study.

Author information

  • 1Department of Neurology, St. Elisabeth Hospital, Tilburg, The Netherlands; Department of Clinical Neurophysiology, St. Elisabeth Hospital, Tilburg, The Netherlands.
  • 2Department of Neurology, St. Elisabeth Hospital, Tilburg, The Netherlands; Department of Clinical Neurophysiology, St. Elisabeth Hospital, Tilburg, The Netherlands. Electronic address: l.visser@elisabeth.nl.

Abstract

OBJECTIVE:

Detection of nerve enlargement in polyneuropathies by sonography is a new research area. No systematic investigation has been done yet in chronic inflammatory demyelinating polyneuropathy (CIDP). Therefore we investigated this in CIDP.

METHODS:

Eleven patients with CIDP fulfilling the international criteria on CIDP underwent ultrasonographic examination of the median, ulnar, fibular and posterior tibial nerves and sometimes the brachial plexus bilaterally, using a standardized protocol. We assessed presence of nerve thickening and increased nerve vascularization.

RESULTS:

In 7 of the 11 patients multiple nerve enlargements were detected: ulnar nerve 7, fibular nerve 5, posterior tibial nerve 4 and median nerve in 4 patients. The number of enlarged nerves was related with the MRC sum-score (p=0.03) and the total protein in the cerebrospinal fluid (CSF) at diagnosis (p=0.02). Increased vascularization was seen in 6 of the 11 patients: 4 in one nerve and in 2 in multiple nerves. The number of nerves with increased vascularization was associated with the number of enlarged nerves (p=0.01) and total protein in the CSF (p=0.006).

CONCLUSION:

Multiple nerve enlargements occur in CIDP showing a relation with a lower MRC sum-score, increased nerve vascularization and a higher total protein of the CSF.

SIGNIFICANCE:

Our findings of nerve enlargement and increased nerve vascularization may be tools to monitor disease activity in CIDP, but further studies are needed.

Copyright © 2013 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

KEYWORDS:

CSF protein; Chronic inflammatory demyelinating polyneuropathy (CIDP); EMG; Nerve hypertrophy; Polyneuropathy; Sonography

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PMID:
23880223
[PubMed - indexed for MEDLINE]
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