BACKGROUND: We sought to determine the usefulness of sonography in the detection of nerve involvement in patients with vasculitic neuropathy. METHODS: We enrolled 16 consecutive patients with vasculitic neuropathy (11 systemic vasculitis and 5 single organ peripheral nerve vasculitis), who met the diagnostic criteria of the Peripheral Nerve Society, and 16 disease controls with noninflammatory axonal polyneuropathy (10 cryptogenic, 4 metabolic, 2 hereditary). Patients underwent standardized nerve conduction studies and assessment of muscle strength (Medical Research Council scale), in addition to sonography of large arm and leg nerves, and brachial plexus. Nerves were evaluated bilaterally at predetermined sites for nerve size (cross-sectional area) and presence of hypervascularization. RESULTS: We found enlarged nerves at common sites of nerve compression in all vasculitic and control patients. Multifocal enlargement in arm nerves, proximal to common sites of nerve compression, was sensitive (94%) and specific (88%) for vasculitic neuropathy. Sonography showed nerve enlargement in 51% of clinically or electrodiagnostically unaffected nerves. Sonography of the brachial plexus was normal. We found hypervascularization in 3 patients with systemic vasculitis. CONCLUSIONS: Sonographic enlargement of arm nerves proximal to sites of nerve compression with sparing of the brachial plexus may indicate a pattern characteristic of patients with vasculitic neuropathy. Sonography may represent a sensitive and specific technique for the detection of inflammatory neuropathy. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that sonographic enlargement of arm nerves proximal to sites of nerve compression accurately identifies patients with vasculitic neuropathy.
BACKGROUND: We sought to determine the usefulness of sonography in the detection of nerve involvement in patients with vasculitic neuropathy. METHODS: We enrolled 16 consecutive patients with vasculitic neuropathy (11 systemic vasculitis and 5 single organ peripheral nerve vasculitis), who met the diagnostic criteria of the Peripheral Nerve Society, and 16 disease controls with noninflammatory axonal polyneuropathy (10 cryptogenic, 4 metabolic, 2 hereditary). Patients underwent standardized nerve conduction studies and assessment of muscle strength (Medical Research Council scale), in addition to sonography of large arm and leg nerves, and brachial plexus. Nerves were evaluated bilaterally at predetermined sites for nerve size (cross-sectional area) and presence of hypervascularization. RESULTS: We found enlarged nerves at common sites of nerve compression in all vasculitic and control patients. Multifocal enlargement in arm nerves, proximal to common sites of nerve compression, was sensitive (94%) and specific (88%) for vasculitic neuropathy. Sonography showed nerve enlargement in 51% of clinically or electrodiagnostically unaffected nerves. Sonography of the brachial plexus was normal. We found hypervascularization in 3 patients with systemic vasculitis. CONCLUSIONS: Sonographic enlargement of arm nerves proximal to sites of nerve compression with sparing of the brachial plexus may indicate a pattern characteristic of patients with vasculitic neuropathy. Sonography may represent a sensitive and specific technique for the detection of inflammatory neuropathy. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that sonographic enlargement of arm nerves proximal to sites of nerve compression accurately identifies patients with vasculitic neuropathy.
Authors: Michael P Collins; P James B Dyck; Gary S Gronseth; Loïc Guillevin; Robert D M Hadden; Dieter Heuss; Jean-Marc Léger; N C Notermans; John D Pollard; Gérard Said; Gen Sobue; A F J E Vrancken; John T Kissel Journal: J Peripher Nerv Syst Date: 2010-09 Impact factor: 3.494
Authors: Kelly Graham Gwathmey; Ted Michael Burns; Michael Paul Collins; P James Bonham Dyck Journal: Lancet Neurol Date: 2014-01 Impact factor: 44.182
Authors: Nora A Visser; Nicolette C Notermans; Rosalie S N Linssen; Leonard H van den Berg; Alexander F J E Vrancken Journal: Neurology Date: 2014-12-12 Impact factor: 9.910
Authors: H Stephan Goedee; Nicolette C Notermans; Leo H Visser; Jan-Thies H van Asseldonk; Hessel Franssen; Alexander F J E Vrancken; Stavros Nikolakopoulos; Leonard H van den Berg; W Ludo van der Pol Journal: Muscle Nerve Date: 2019-07-24 Impact factor: 3.217