Ultrasound scanning in the diagnosis of peripheral neuropathies

Nerve ultrasound scanning has become a valuable diagnostic tool in the routine workup of peripheral nerve disorders, effectively complementing conventional electrodiagnostic studies. The most relevant sonographic features are nerve size and structural integrity. Several peripheral neuropathies show characteristic and distinct patterns of nerve enlargement, allowing their early and accurate identification, and reducing test-burden and diagnostic delay for patients. In mononeuropathies such as carpal tunnel syndrome and ulnar neuropathy at the elbow, nerve enlargement develops only at specific sites of entrapment, while in polyneuropathy the nerve enlargement may be multifocal, regional or even diffuse. Nerve ultrasound scanning can reliably identify chronic inflammatory neuropathies, even when extensive electrodiagnostic studies fail, and it should therefore be embedded in routine diagnostic workup of peripheral neuropathies. In this paper we describe a potential diagnostic strategy to achieve this.

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ULTRASONIC STUDY IN DIAGNOSTICS OF PERIPHERAL NEUROPATHIES (CASE FROM PRACTICE)

Medical Journal ◽

10.51922/1818-426x.2021.4.144 ◽

2021 ◽

pp. 144-146

Author(s):

Hamanovich A.I. ◽

◽

Baida A.G. ◽

Koyalo L.G. ◽

Levantsevich V.V. ◽

...

Keyword(s):

Nervous System ◽

Gold Standard ◽

Peripheral Nerves ◽

Peroneal Nerve ◽

Clinical Case ◽

Clinical Symptoms ◽

Nerve Trunk ◽

Peripheral Neuropathies ◽

Ultrasound Scanning ◽

Electrophysiological Methods

Electrophysiological methods, such as electromyography and neuromyography, are traditionally recognized as the "gold standard" for detecting pathology of the peripheral nervous system. It should be noted, however, that the information obtained during the above examinations does not give an idea of the state of the surrounding tissues, does not indicate the nature and cause of damage to the nerve trunk, and does not always accurately reflect the localization of changes. At the same time, it is this information that helps to determine the tactics of conservative or surgical treatment of the patient. Ultrasound scanning is quite successfully used in the diagnosis of damage and diseases of the peripheral nerves. The article presents a clinical case of a diagnostic search for a causative disease in a patient with clinical symptoms of neuropathy of the peroneal nerve.

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Nodes, paranodes and neuropathies

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2016-315480 ◽

2017 ◽

Vol 89 (1) ◽

pp. 61-71 ◽

Cited By ~ 24

Author(s):

Janev Fehmi ◽

Steven S Scherer ◽

Hugh J Willison ◽

Simon Rinaldi

Keyword(s):

Peripheral Nerves ◽

Clinical Importance ◽

Specific Cell ◽

Peripheral Neuropathies ◽

Autoimmune Neuropathy ◽

Basic Understanding ◽

Clinical Variants ◽

Inflammatory Neuropathies ◽

The Common ◽

Treatment Responsiveness

This review summarises recent evidence supporting the involvement of the specialised nodal and perinodal domains (the paranode and juxtaparanode) of myelinated axons in the pathology of acquired, inflammatory, peripheral neuropathies.The identification of new target antigens in the inflammatory neuropathies heralds a revolution in diagnosis, and has already begun to inform increasingly targeted and individualised therapies. Rapid progress in our basic understanding of the highly specialised nodal regions of peripheral nerves serves to strengthen the links between their unique microstructural identities, functions and pathologies. In this context, the detection of autoantibodies directed against nodal and perinodal targets is likely to be of increasing clinical importance. Antiganglioside antibodies have long been used in clinical practice as diagnostic serum biomarkers, and associate with specific clinical variants but not to the common forms of either acute or chronic demyelinating autoimmune neuropathy. It is now apparent that antibodies directed against several region-specific cell adhesion molecules, including neurofascin, contactin and contactin-associated protein, can be linked to phenotypically distinct peripheral neuropathies. Importantly, the immunological characteristics of these antibodies facilitate the prediction of treatment responsiveness.

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Tarsal Tunnel Syndrome Associated with a Pulsating Artery

Journal of the American Podiatric Medical Association ◽

10.7547/1000209 ◽

2010 ◽

Vol 100 (3) ◽

pp. 209-212 ◽

Cited By ~ 12

Author(s):

Eunkuk Kim ◽

Martin K. Childers

Keyword(s):

High Resolution ◽

Ultrasound Imaging ◽

Tibial Nerve ◽

Tarsal Tunnel ◽

Posterior Tibial Nerve ◽

Tarsal Tunnel Syndrome ◽

Ultrasound Guided ◽

Nerve Ultrasound ◽

Posterior Tibial ◽

Tunnel Syndrome

We describe a patient with tarsal tunnel syndrome in whom ultrasound imaging revealed compression of the posterior tibial nerve by a pulsating artery. High-resolution ultrasound showed a round pulsating hypoechoic lesion in contact with the posterior tibial nerve. Ultrasound-guided injection of 0.5% lidocaine temporarily resolved the paresthesia. These findings suggest an arterial etiology of tarsal tunnel syndrome. (J Am Podiatr Med Assoc 100(3): 209–212, 2010)

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Ulnar Nerve Enlargement at the Medial Epicondyle Negatively Correlates With Nerve Conduction Velocity in Cubital Tunnel Syndrome

Hand ◽

10.1177/1558944718792275 ◽

2018 ◽

Vol 15 (2) ◽

pp. 165-169

Author(s):

T. David Luo ◽

Amy P. Trammell ◽

Luke P. Hedrick ◽

Ethan R. Wiesler ◽

Francis O. Walker ◽

...

Keyword(s):

Ulnar Nerve ◽

Nerve Conduction ◽

Nerve Conduction Velocity ◽

Motor Nerve ◽

Cubital Tunnel Syndrome ◽

Medial Epicondyle ◽

Cubital Tunnel ◽

Motor Nerve Conduction ◽

Nerve Enlargement ◽

Tunnel Syndrome

Background: In cubital tunnel syndrome (CuTS), chronic compression often occurs at the origin of the flexor carpi ulnaris at the medial epicondyle. Motor nerve conduction velocity (NCV) across the elbow is assessed preoperatively to corroborate the clinical impression of CuTS. The purpose of this study was to correlate preoperative NCV to the direct measurements of ulnar nerve size about the elbow at the time of surgery in patients with clinical and/or electrodiagnostic evidence of CuTS. Methods: Data from 51 consecutive patients who underwent cubital tunnel release over a 2-year period were reviewed. Intraoperative measurements of the decompressed nerve were taken at 3 locations: at 4 cm proximal to the medial epicondyle, at the medial epicondyle, and at the distal aspect of Osborne fascia at the flexor aponeurotic origin. Correlation analysis was performed comparing nerve size measurements to slowing of ulnar motor nerve conduction velocities (NCV) below the normal threshold of 49 m/s across the elbow. Results: Enlargement of the ulnar nerve at the medial epicondyle and nerve compression at the flexor aponeurotic origin was a consistent finding. The mean calculated cross-sectional area of the ulnar nerve was 0.21 cm2 above the medial epicondyle, 0.30 cm2 at the medial epicondyle, and 0.20 cm2 at the flexor aponeurotic origin ( P < .001). There was an inverse correlation between change in nerve diameter and NCV slowing ( r = −0.529, P < .001). Conclusions: For patients with significantly reduced preoperative NCV and clinical findings of advanced ulnar neuropathy, surgeons can expect nerve enlargement, all of which may affect their surgical decision-making.

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Design and Test of an Autonomous Reconfigurable Dynamic Investigation Test-Rig on Haptics (ARDITA) for Pre-Screening of the Peripheral Neuropathy Diseases

Volume 5A: 42nd Mechanisms and Robotics Conference ◽

10.1115/detc2018-86040 ◽

2018 ◽

Author(s):

Maria Laura D’Angelo ◽

Darwin Caldwell ◽

Ferdinando Cannella ◽

Paolo Liberini ◽

Alessandro Padovani ◽

...

Keyword(s):

Healthy People ◽

Tactile Sensitivity ◽

Peripheral Neuropathies ◽

Test Rig ◽

New Device ◽

Tunnel Syndrome ◽

The Subject ◽

The Relationship ◽

Dynamic Investigation ◽

Little Finger

This work presents a new device ARDITA (Autonomous Reconfigurable Dynamic Investigation Test-rig on hAptics) that is able to indent the fingertip with sinusoidal waves. Its reconfigurability permits to change these waves in amplitude, spatial and timing frequencies. The device is designed in order to be autonomous and reconfigurable, but also the portability and the size were taken into account, because the clinicians had to move it from an hospital to the other one and because each patient arms has a different size. In this work, the authors applied this feature to investigate the relationship between the tactile sensitivity of index and little finger both in healthy people and people who suffer peripheral neuropathies as the Carpal Tunnel Syndrome (CTS). The last ones were examined also with the Electromyography (EMG). 40 healthy people and 17 ill patients were tested. The results showed that ARDITA determined not only the index and little finger performance were inverted in patients respect to the subject, but also the increment of incorrect responses were perfected correlated with the increment of the degree of the illness.

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Nerve ultrasound in clinical management of carpal tunnel syndrome in mucopolysaccharidosis

Developmental Medicine & Child Neurology ◽

10.1111/dmcn.13127 ◽

2016 ◽

Vol 58 (11) ◽

pp. 1172-1179 ◽

Cited By ~ 14

Author(s):

Tobias Bäumer ◽

Nina Bühring ◽

Thomas Schelle ◽

Alexander Münchau ◽

Nicole Muschol

Keyword(s):

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Clinical Management ◽

Nerve Ultrasound ◽

Tunnel Syndrome

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The ipsilateral silent period: an early diagnostic marker of callosal disconnection in ALS

Therapeutic Advances in Chronic Disease ◽

10.1177/20406223211044072 ◽

2021 ◽

Vol 12 ◽

pp. 204062232110440

Author(s):

Annemarie Hübers ◽

Jan Kassubek ◽

Hans-Peter Müller ◽

Nicolas Broc ◽

Jens Dreyhaupt ◽

...

Keyword(s):

Structural Integrity ◽

Diagnostic Marker ◽

Diffusion Tensor ◽

Diagnostic Delay ◽

Silent Period ◽

The Body ◽

Diagnostic Tools ◽

Microstructural Alterations ◽

Early Stages ◽

Early Diagnostic

Introduction: Imaging studies showed affection of the corpus callosum (CC) in amyotrophic lateral sclerosis (ALS). Here, we sought to determine whether these structural alterations reflect on the functional level, using transcranial magnetic stimulation (TMS). Methods: In 31 ALS patients and 12 controls, we studied mirror movements (MM) and transcallosal inhibition (TI) using TMS. Structural integrity of transcallosal fibres was assessed using diffusion tensor imaging. Results: TI was pathologic in 25 patients (81%), 22 (71%) showed MM. Loss of TI was observed in very early stages (disease duration <4 months). No correlation was found between TI/MM and fractional anisotropy of transcallosal fibres. Discussion: These results substantiate the body of evidence towards a functional involvement of the CC in early ALS beyond microstructural alterations. Significance: TI may become a useful early diagnostic marker in ALS, even before descending tracts are affected. Diagnostic delay in ALS is high, often preventing patients from gaining access to therapeutic trials, and sensitive diagnostic tools are urgently needed. Our findings also provide insights into the pathophysiology of ALS, potentially supporting the so-called ‘top-down’ hypothesis, that is, corticoefferent (intracortical/corticospinal) propagation. Callosal affection in early stages might represent the ‘missing link’ to explain corticocortical disease-spreading.

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GUILLAIN-BARRE SYNDROME AS A DIFFERENTIAL DIAGNOSIS OF LOW BACK PAIN SYNDROME

Coluna/Columna ◽

10.1590/s1808-185120161503152478 ◽

2016 ◽

Vol 15 (3) ◽

pp. 244-247 ◽

Cited By ~ 1

Author(s):

JOSÉ MARÍA JIMÉNEZ AVILA ◽

ALBERTO ACEVES PÉREZ ◽

ARELHI CATALINA GONZÁLEZ CISNEROS ◽

JOSÉ LUIS GUZMÁN GUZMÁN

Keyword(s):

Spinal Cord ◽

Differential Diagnosis ◽

Urinary Incontinence ◽

Motor Neurons ◽

Postural Hypotension ◽

Pain Syndrome ◽

Diagnostic Strategy ◽

Low Back ◽

Peripheral Neuropathies ◽

Burning Pain

ABSTRACT Peripheral neuropathies are diseases of the lower motor neurons of the spinal cord and brainstem it can often mimic symptoms associated with the injuries of compressive radiculopathy. They are manifested by tingling, coldness, numbness, burning, pain, hypersensitivity, weakness, atrophy, postural hypotension, impotence, anhidrosis, and urinary incontinence. Therefore, it is important in the diagnostic strategy to keep in mind this type of pathology, especially when it comes to patients already in the 6th decade of life.

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P244 Validation of the Red Flags index for early diagnosis of Crohn’s disease: A prospective general practitioner study

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.373 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S267-S269

Author(s):

G Fiorino ◽

D Gilardi ◽

S Bonovas ◽

A Di Sabatino ◽

E Angeli ◽

...

Keyword(s):

Crohn’S Disease ◽

General Practitioner ◽

Crohn's Disease ◽

Early Diagnosis ◽

Diagnostic Accuracy ◽

Diagnostic Delay ◽

Diagnostic Strategy ◽

Red Flags ◽

Faecal Calprotectin ◽

Predictive Values

Abstract Background A diagnostic delay >12 months is frequent in Crohn’s disease (CD), and associated with lower therapeutic response rates and worse outcomes. The Red Flags index, a simple tool to help to identify early CD and reduce diagnostic delay, was recently developed. We aimed to assess its accuracy for early diagnosis of CD patients. Methods Consecutive adult patients, suffering from intestinal symptoms and having no medical history of any gastrointestinal disease, referring to the General Practitioner (GP) were screened. Patients should have at least one of the following symptoms: chronic abdominal pain, chronic diarrhoea, nocturnal diarrhoea, unexpected weight loss, or perianal lesions. The GPs administered the Red Flags questionnaire to each eligible patient. Then, all patients were referred to the nearest participating Centre to confirm or exclude the diagnosis of CD. IBD specialists were blinded to the results of the questionnaire. The first-line examination systematically included blood cell count, serum C-reactive protein, faecal calprotectin (FC) and abdominal ultrasound, according to routine practice. If required to confirm CD, second-line examinations were planned (i.e. colonoscopy and cross-sectional imaging). Sensitivity (Se), specificity (Sp), positive and negative predictive values (PPV, NPV) of the Red Flags index were estimated. Patients lost to follow-up were included in the analysis by a non-responder imputation assuming they were negative for CD. Results From 11/2016 to 11/2019, 64 GPs participated (Bergamo: 52, Pavia: 12, in charge of a population of 93,000 subjects) and 112 patients over a mean number of 53,568 subjects screened were included in the study (median age 35 years, range: 18–69, 37% males). Only 66 subjects (59%) completed the study. The prevalence of CD was 3.6% in the study population (4 of 112 subjects; 3 with B1, and 1 with B2 phenotype). The Red Flags index had Se=0.50 (95% CI: 0.07–0.93), Sp = 0.58 (0.49–0.68), PPV=0.04 (0.01–0.15), and NPV=0.97 (0.89–1.00). A combined diagnostic strategy with faecal calprotectin (in which a subject was considered ‘positive’ if having RFI ≥8 and/or FC >250) resulted in significantly improved diagnostic accuracy: Se=1.00 (0.29–1.00), Sp = 0.72 (0.55–0.85), PPV=0.21 (0.05–0.51), NPV=1.00 (0.88–1.00); however, only 42 subjects (with 3 confirmed cases of CD) were available for this analysis. Conclusion The diagnostic accuracy of the Red Flags questionnaire was moderate when applied alone to a primary care setting. However, the combined diagnostic strategy of the Red Flags index and faecal calprotectin has given promising results. Further research is warranted on how to best identify patients with early clinical onset of CD.

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