Nerve ultrasound can distinguish chronic inflammatory demyelinating polyneuropathy from demyelinating diabetic sensorimotor polyneuropathy. (November 2018)

• Record Type: Journal Article
• Authors: Tan, Cheng-Yin; Arumugam, Thaarani; Razali, Siti Nur Omaira; Yahya, Mohd Azly; Goh, Khean-Jin; Shahrizaila, Nortina
• Is Part Of: Journal of clinical neuroscience. Volume 57(2018)
• Page Start: 198
• Page End: 201
• Publication Date: 2018-11
• Subjects: Diabetic sensorimotor polyneuropathy -- Chronic inflammatory demyelinating polyneuropathy -- Nerve ultrasound -- Demyelinating neuropathies -- Immune-mediated neuropathies; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2018.08.031
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: Demyelinating diabetic sensorimotor polyneuropathy (DDSP) can be difficult to distinguish from CIDP. Nerve ultrasound shows larger nerves in CIDP than DDSP. Nerve ultrasound is useful as an additional tool in differentiating CIDP from DDSP. Abstract: Diabetic patients with poor glycaemic control can demonstrate demyelinating distal sensorimotor polyneuropathy (D-DSP) on electrophysiology. Distinguishing D-DSP from chronic inflammatory demyelinating polyneuropathy (CIDP) can be challenging. In this study, we investigated the role of nerve ultrasound in differentiating the two neuropathies. Nerve ultrasound findings of D-DSP patients (fulfilling the electrophysiological but not clinical criteria for CIDP) were compared with non-diabetic CIDP patients (fulfilling both criteria). We studied 108 and 95 nerves from 9 D-DSP and 10 CIDP patients respectively. CIDP patients had significantly larger cross-sectional areas of the median nerve at the mid-arm (17.0 ± 12.5 vs 8.7 ± 2.6; p = 0.005), ulnar nerve at the wrist (7.3 ± 3.1 vs 4.1 ± 1.0; p = 0.001), mid forearm (8.8 ± 5.3 vs 5.5 ± 1.5; p = 0.002) and mid-arm (14.5 ± 14.1 vs 7.5 ± 1.9; p = 0.013), and radial nerve at mid forearm (4.1 ± 2.4 vs 1.2 ± 0.4; p < 0.001). In comparison to D-DSP, CIDP patients had markedly larger nerves at the proximal and non-entrapment sites of the upper limbs, suggesting that nerve ultrasound is useful in differentiating the two neuropathies.