Alexander Grimm1, Natalie Winter2, Tim W Rattay3, Florian Härtig4, Nele M Dammeier5, Eva Auffenberg6, Marilin Koch7, Hubertus Axer8. 1. Center for Neurology, Tübingen University Hospital and Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, Tübingen, Germany. Electronic address: alexander.grimm@med.uni-tuebingen.de. 2. Center for Neurology, Tübingen University Hospital and Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, Tübingen, Germany. Electronic address: Natalie.Winter@med.uni-tuebingen.de. 3. 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. Electronic address: Tim.Rattay@uni-tuebingen.de. 4. Center for Neurology, Tübingen University Hospital and Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, Tübingen, Germany. Electronic address: Florian.Haertig@med.uni-tuebingen.de. 5. Center for Neurology, Tübingen University Hospital and Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, Tübingen, Germany. Electronic address: Nele.Dammeier@med.uni-tuebingen.de. 6. Center for Neurology, Tübingen University Hospital and Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, Tübingen, Germany. Electronic address: Eva.Auffenberg@med.uni-tuebingen.de. 7. Center for Neurology, Tübingen University Hospital and Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, Tübingen, Germany. Electronic address: Marilin.Koch@med.uni-tuebingen.de. 8. Hans Berger Department of Neurology, Jena University Hospital, Friedrich-Schiller University Jena, Jena, Germany. Electronic address: Hubertus.Axer@med.uni-jena.de.
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.
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.
Authors: Angela Puma; N Azulay; N Grecu; C Suply; E Panicucci; C Cambieri; L Villa; C Raffaelli; S Sacconi Journal: J Neurol Date: 2019-06-07 Impact factor: 4.849