P 158 Peripheral nerve ultrasound scoring systems in polyneuropathy – benchmarking and comparative analysis. Issue 10 (October 2017)

• Record Type: Journal Article
• Authors: Grimm, A.; Winter, N.; Rattay, T.; Axer, H.
• Is Part Of: Clinical neurophysiology. Volume 128:Issue 10(2017:Oct.)
• Page Start: e404
• Page End: e405
• Publication Date: 2017-10
• Subjects: Neurophysiology -- Periodicals; Electroencephalography -- Periodicals; Electromyography -- Periodicals; Neurology -- Periodicals; 612.8
• DOI: 10.1016/j.clinph.2017.06.229
• Languages: English
• ISSNs: 1388-2457

Abstract

Abstract : Much progress has been done in the recent past concerning the additive value of nerve ultrasound in polyneuropathies. Most authors go along, that – generally spoken – the enlarged cross-sectional areas are the most evident pathology in PNP. Overall, demyelinating neuropathies display nerve enlargement, while most axonal types do not or only rarely. CSA measurements alone are not all, however, without CSA measurements all is nothing. Increased nerves are not pathognomonic at all; they appear in inherited (Charcot Marie Tooth), inflammatory (CIDP, GBS) and metabolic neuropathies (amyloidosis, metachromatic leukodystrophy), in focal (MMN, MADSAM) and asymmetric generalized (vasculitis) neuropathies. Therefore, quantification and pattern analysis of nerve enlargement might be the key to success. Scoring systems have been presented bang up-to-date, e.g. the nerve pattern classification in CIDP by Padua and colleagues, the Bochum ultrasound score for immune-mediated neuropathies, the quantification of nerve enlargement in demyelinating neuropathies by Zaidman et al., or the ultrasound pattern sum score and the homogeneity score. All of these scores have their strength in accuracy and exclusion of certain neuropathies, however all fail by incompleteness concerning others, e.g. rarer variants. Although we can assume generalized nerve enlargement in inherited neuropathies, and more regional enlargement in inflammatory neuropathies, the philosopher's stone is not yet found. Further effort must be done, even including fascicle next to CSA pathology, echogenicity and physiologic aspects (age, height, weight and ethnicity). Nevertheless - to the best of our knowledge – some simple rules can simplify daily practice. First, if any nerve enlargement is found, heredity or immune mediation should be checked with caution. Second, simple critical landmarks could help to preselect certain neuropathies (as shown in Fig. 1): the brachial plexus/the cervical roots and the vagus (particularly for CIDP and GBS), the median and ulnar nerve in the forearm (e.g. for MMN and MADSAM) and the tibial and the sural nerve in the ankle (e.g. for vasculitis). The accuracy of these marks would not be 100%, but can facilitate the following diagnostic steps.