Nerve ultrasound can distinguish chronic inflammatory demyelinating polyneuropathy from demyelinating diabetic sensorimotor polyneuropathy

History-taking and nerve conduction studies are fundamental for the diagnosis and assessment of the severity of acute (AIDP) or chronic inflammatory demyelinating polyneuropathy (CIDP). The diagnostic challenge of distinguishing these two immune-mediated subacute polyradiculoneuropathies remains high, as intravenous immunoglobulin and steroids exert short-term clinical improvement in the majority of the CIDP cases, whereas steroids have no effect on AIDP patients. Accordingly, the precise classification of subacute polyradiculoneuropathies significantly affects the early application of steroids in CIDP. This review aims to give a timely update on the application of clinical, electrophysiological and nerve ultrasound parameters in distinguishing subacute CIDP from AIDP.

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Chronic Inflammatory Demyelinating Polyneuropathy in Diabetes Patients

US Neurology ◽

10.17925/usn.2015.11.01.47 ◽

2015 ◽

Vol 11 (01) ◽

pp. 47

Author(s):

Alon Abraham ◽

Majed Alabdali ◽

Mohammad Qrimli ◽

Carolina Barnett ◽

Hans D Katzberg ◽

...

Keyword(s):

Clinical Characteristics ◽

Chronic Inflammatory Demyelinating Polyneuropathy ◽

Demyelinating Polyneuropathy ◽

Poor Control ◽

Sensorimotor Polyneuropathy ◽

Inflammatory Demyelinating Polyneuropathy ◽

Variable Combination ◽

Type 1 Dm ◽

Electrophysiologic Studies

Diabetes mellitus (DM) is pandemic, and is the leading global cause of polyneuropathy, most commonly, a distal symmetric sensorimotor polyneuropathy (DSP). By contrast, chronic inflammatory demyelinating polyneuropathy (CIDP) is rare, and characterized mainly by symmetrical proximal and distal muscles weakness. There are currently 15 sets of criteria using a variable combination of clinical, electrophysiologic, laboratory, and biopsy features to identify CIDP, but it is unclear if these criteria are the same in patients with and without DM. Slowed conduction velocity, a feature of demyelination, is observed in patients with type 1 DM with poor control, and the clinical characteristics of these patients differ from those who have CIDP and DM, suggesting a different pathophysiology. Treatment response rates in CIDP patients, with and without DM, are as high as 80 %, and it is recommended that treatment be started early to prevent secondary axonal loss. However, patients with type 1 DM with CIDP are far less likely to be treated than CIDP patients who do not have DM. In patients with type 1 DM with polyneuropathy who have prominent weakness or demyelination in electrophysiologic studies, a diagnosis of CIDP and a trial of therapy should be considered.

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Inhaled Solvent Abuse Mimicking Chronic Inflammatory Demyelinating Polyradiculoneuropathy

Child Neurology Open ◽

10.1177/2329048x20934914 ◽

2020 ◽

Vol 7 ◽

pp. 2329048X2093491

Author(s):

Salini Thulasirajah ◽

Jean Michaud ◽

Asif Doja ◽

Hugh J. McMillan

Keyword(s):

Clinical Symptoms ◽

Chronic Inflammatory Demyelinating Polyneuropathy ◽

Nerve Biopsy ◽

Demyelinating Polyneuropathy ◽

Solvent Exposure ◽

Health Counseling ◽

Sensorimotor Polyneuropathy ◽

Appropriate Treatment ◽

Diagnostic Certainty ◽

Inflammatory Demyelinating Polyneuropathy

Exposure to n-hexane or toluene-containing solvents such as glue or gasoline can produce clinical symptoms and neurophysiological findings that can mimic chronic inflammatory demyelinating polyneuropathy. The authors present a case of a boy with severe sensorimotor polyneuropathy with demyelinating features. Cerebrospinal fluid testing and magnetic resonance imaging spine did not show findings typical of chronic inflammatory demyelinating polyneuropathy. His lack of response to immunosuppressive therapy prompted a nerve biopsy which was instrumental in confirming a diagnosis of chronic organic solvent exposure, subsequently confirmed on history. This case highlights the importance of additional testing to ensure diagnostic certainty which allows appropriate treatment and/or disease management to be tailored appropriately including in this instance, the involvement of mental health counseling and avoidance of immunosuppressant medication.

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Nerve Ultrasound and Electrophysiology for Therapy Monitoring in Chronic Inflammatory Demyelinating Polyneuropathy

Journal of Neuroimaging ◽

10.1111/jon.12279 ◽

2015 ◽

Vol 25 (6) ◽

pp. 931-939 ◽

Cited By ~ 26

Author(s):

Antonios Kerasnoudis ◽

Kalliopi Pitarokoili ◽

Ralf Gold ◽

Min-Suk Yoon

Keyword(s):

Chronic Inflammatory Demyelinating Polyneuropathy ◽

Therapy Monitoring ◽

Demyelinating Polyneuropathy ◽

Nerve Ultrasound ◽

Inflammatory Demyelinating Polyneuropathy

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Nerve Ultrasound Comparison Between Transthyretin Familial Amyloid Polyneuropathy and Chronic Inflammatory Demyelinating Polyneuropathy

Frontiers in Neurology ◽

10.3389/fneur.2021.632096 ◽

2021 ◽

Vol 12 ◽

Author(s):

Kang Du ◽

Ke Xu ◽

Si Cheng ◽

He Lv ◽

Wei Zhang ◽

...

Keyword(s):

Chronic Inflammatory Demyelinating Polyneuropathy ◽

Compound Muscle Action Potential ◽

Familial Amyloid Polyneuropathy ◽

Demyelinating Polyneuropathy ◽

Lower Limbs ◽

Nerve Ultrasound ◽

Inflammatory Demyelinating Polyneuropathy ◽

Amyloid Polyneuropathy ◽

The Mean ◽

Transthyretin Familial Amyloid Polyneuropathy

Backgrounds: Transthyretin familial amyloid polyneuropathy (TTR-FAP) is frequently misdiagnosed as chronic inflammatory demyelinating polyneuropathy (CIDP) because of similar phenotypes in the two diseases. This study was intended to identify the role of nerve ultrasonography in evaluating TTR-FAP and CIDP.Methods: Eighteen patients with TTR-FAP, 13 patients with CIDP, and 14 healthy controls (HC) were enrolled in this study. Consecutive ultrasonography scanning was performed in six pairs of nerves of bilateral limbs with 30 sites. The cross-sectional areas (CSAs) and CSA variability data of different groups were calculated and compared.Results: Both TTR-FAP and CIDP showed larger CSAs at most sites of both upper and lower limbs than in HC groups. CIDP patients had larger CSAs than TTR-FAP patients at 8/15 of these sites, especially at U1-3, Sci2 sites (p < 0.01). However, the CSAs at above sites were not a credible index to differentiate TTR-FAP from CIDP with a low area under the curve (<0.8). The CSA variability of median nerves was significantly higher in CIDP than in TTR-FAP and HC groups, with high sensitivity (0.692) and specificity (0.833) to differentiate CIDP from TTR-FAP. The CSA variability of ulnar nerves was not significantly different between the three groups. For the TTR-FAP group, mean CSAs at each site were not correlated with different Coutinho stages, modified polyneuropathy disability, course of sensory motor peripheral neuropathy, Neuropathy Impairment Score, or Norfolk Quality of life-diabetic neuropathy score. The mean compound muscle action potential of ulnar nerves was negatively correlated with the mean CSAs of ulnar nerves.Interpretation: TTR-FAP patients had milder nerve enlargement with less variability in CSAs of median nerves than those with CIDP, suggesting that nerve ultrasound can be a potential useful auxiliary tool to help differentiate the two neuropathies.

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