Document Type : Original Article
Authors
1 Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
2 Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Background: Peripheral nerve ultrasound(US) has been used as a promising diagnosing technique for peripheral nerve disorders. This study aimed to compare the US findings of Guillain-Barre syndrome (GBS) with chronic inflammatory demyelinating polyneuropathy (CIDP).
Methods: This case-control study was done on 25 patients with GBS at 3 weeks after onset of disease and 25 patients with CIDP. Demographic information and US results of median nerve at 2 points, ulnar nerve at 3 points, and tibial and peroneal nerves were collected.
Results: Left median nerve diameter in patients with CIDP with the mean of 0.141 ± 0.047 was more than GBS group with the mean of 0.095 ± 0.034 (P < 0.001). Both sides of median nerve diameter in patients with CIDP were higher than patients with GBS (P < 0.05), but in the left side, it was more in patients with CIDP (P = 0.003).
Conclusion: The diameter and circumference of median, ulnar, and tibial nerves in forearm and elbow of patients with CIDP are more than patients with GBS; therefore, it may be possible to use US findings based on these differences in diagnosis and differentiation of the two diseases.
Keywords
- Yuki N, Hartung HP. Guillain-Barre syndrome. N Engl J Med 2012; 366(24): 2294-304.
- Goedee HS, Brekelmans GJ, van Asseldonk JT, Beekman R, Mess WH, Visser LH. High resolution sonography in the evaluation of the peripheral nervous system in polyneuropathy--a review of the literature. Eur J Neurol 2013; 20(10): 1342-51.
- Mori A, Nodera H, Takamatsu N, Maruyama-Saladini K, Osaki Y, Shimatani Y, et al. Sonographic evaluation of peripheral nerves in subtypes of Guillain-Barre syndrome. J Neurol Sci 2016; 364: 154-9.
- Pitarokoili K, Kronlage M, Baumer P, Schwarz D, Gold R, Bendszus M, et al. High-resolution nerve ultrasound and magnetic resonance neurography as complementary neuroimaging tools for chronic inflammatory demyelinating polyneuropathy. Ther Adv Neurol Disord 2018; 11: 1756286418759974.
- Van den Bergh PY, Rajabally YA. Chronic inflammatory demyelinating polyradiculoneuropathy. Presse Med 2013; 42(6 Pt 2): e203-e215.
- Kerasnoudis A, Pitarokoili K, Behrendt V, Gold R. Nerve ultrasound score in distinguishing chronic inflammatory demyelinating polyneuropathy from Guillain-Barre syndrome. J Neurol Sci 2013; 333: e442-e443.
- Wilder-Smith EP. Swollen nerves slimming: Sequential nerve ultrasound in acute Guillain-Barre syndrome. Clin Neurophysiol 2016; 127(2): 1013-4.
- Grimm A, Decard BF, Axer H. Ultrasonography of the peripheral nervous system in the early stage of Guillain-Barre syndrome. J Peripher Nerv Syst 2014; 19(3): 234-41.
- Koller H, Kieseier BC, Jander S, Hartung HP. Chronic inflammatory demyelinating polyneuropathy. N Engl J Med 2005; 352(13): 1343-56.
- Vallat JM, Sommer C, Magy L. Chronic inflammatory demyelinating polyradiculoneuropathy: Diagnostic and therapeutic challenges for a treatable condition. Lancet Neurol 2010; 9(4): 402-12.
- Dalakas MC. Advances in the diagnosis, pathogenesis and treatment of CIDP. Nat Rev Neurol 2011; 7(9): 507-17.
- Matsuoka N, Kohriyama T, Ochi K, Nishitani M, Sueda Y, Mimori Y, et al. Detection of cervical nerve root hypertrophy by ultrasonography in chronic inflammatory demyelinating polyradiculoneuropathy. J Neurol Sci 2004; 219(1-2): 15-21.
- Goedee HS, Brekelmans GJ, Visser LH. Multifocal enlargement and increased vascularization of peripheral nerves detected by sonography in CIDP: a pilot study. Clin Neurophysiol 2014; 125(1): 154-9.
- Zaidman CM, Al-Lozi M, Pestronk A. Peripheral nerve size in normals and patients with polyneuropathy: an ultrasound study. Muscle Nerve 2009; 40(6): 960-6.
- Scheidl E, Bohm J, Simo M, Bereznai B, Bereczki D, Aranyi Z. Different patterns of nerve enlargement in polyneuropathy subtypes as detected by ultrasonography. Ultrasound Med Biol 2014; 40(6): 1138-45.
- Grimm A, Heiling B, Schumacher U, Witte OW, Axer H. Ultrasound differentiation of axonal and demyelinating neuropathies. Muscle Nerve 2014; 50(6): 976-83.
- Kerasnoudis A, Pitarokoili K, Behrendt V, Gold R, Yoon MS. Correlation of nerve ultrasound, electrophysiological and clinical findings in chronic inflammatory demyelinating polyneuropathy. J Neuroimaging 2015; 25(2): 207-16.
- Padua L, Granata G, Sabatelli M, Inghilleri M, Lucchetta M, Luigetti M, et al. Heterogeneity of root and nerve ultrasound pattern in CIDP patients. Clin Neurophysiol 2014; 125(1): 160-5.
)