Clinical utilization and complications of sural nerve biopsy

Rappaport, William D.; Valente, John F.; Hunter, Gleen C.; Rance, Naomi E.; Lick, Scott D.; Lewis, Tanya; Neal, David

doi:10.1016/s0002-9610(05)80968-7

Cited by 96 publications

(55 citation statements)

References 9 publications

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“…Indeed, given the 20% prevalence of distal symmetric polyneuropathy among reported patients with NSVN, nerve biopsy should be considered in all patients with progressive axonal neuropathies, irrespective of symmetry. That said, among patients with an idiopathic, chronic, symmetric polyneuropathy, nerve biopsy yields a diagnosis of definite vasculitis in only 3% [109][110][111] , much lower than the 20% yield among patients with a clinical phenotype that raises suspicion of vasculitis [112][113][114] . This low yield must, therefore, be weighed against the risks of biopsy.…”

Section: Brighton Collaboration Case Definition Of Vasculitic Neuropamentioning

confidence: 99%

The nonsystemic vasculitic neuropathies

2017

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The vasculitides are a clinically diverse group of diseases with the histopathological signature of blood vessel-centred inflammation that results in vascular damage and ischaemic injury to the affected tissues 1 . Vasculitis can be caused by drugs, infections and cancers, but diagnostic workup reveals no trigger in most patients. Autoimmune mechanisms are active in all vasculitides, except those caused by direct infection of vessel walls. Most vasculitides are systemic and involve multiple organs and tissues. Those affecting small-to medium-sized vessels often manifest with a vasculitic neuropathy. For example, neuropathies occur in 60-70% of patients with polyarteritis nodosa, eosinophilic granulomatosis with polyangiitis and cryoglobulinaemic vasculitis, and 40-50% of those with microscopic polyangiitis and rheumatoid vasculitis 2 .Vasculitic neuropathy can also occur without systemic vasculitis. This single-organ vasculitis of the PNS has commonly been referred to as nonsystemic vasculitic neuropathy (NSVN), but other forms of clinically isolated PNS vasculitis are now recognized and can be considered variants of NSVN 3 . Although NSVN is classically an acute, relapsing, multifocal neuropathy, it can present as a slowly progressive neuropathy without distinct asymmetries. As such, it should be considered as a possible cause of any progressive axonal neur opathy. NSVN can be diagnosed only with a nerve biopsy, with or without a concomitant muscle or skin biopsy; as nerve biopsies are seldom performed, the condition is under-recognized. The disorder must be distinguished from many other causes of multifocal neuropathy, the definition of which is itself not standardized and requires clarification.A Peripheral Nerve Society guideline group reviewed the literature on vasculitic neuropathy and published consensus recommendations on the classification, diagnosis and immunosuppressive treatment of NSVN in 2010 (REF. 4) Abstract | Nonsystemic vasculitic neuropathy (NSVN) is an under-recognized single-organ vasculitis of peripheral nerves that can only be diagnosed with a nerve biopsy. A Peripheral Nerve Society guideline group published consensus recommendations on the classification, diagnosis and treatment of NSVN in 2010, and new diagnostic criteria for vasculitic neuropathy were developed by the Brighton Collaboration in 2015. In this Review, we provide an update on the classification, diagnosis and treatment of NSVN. NSVN subtypes include Wartenberg migratory sensory neuropathy and postsurgical inflammatory neuropathy. Variants include diabetic radiculoplexus neuropathy and -arguably -neuralgic amyotrophy. NSVN with proximal involvement is sometimes termed nondiabetic lumbosacral radiculoplexus neuropathy. Cutaneous polyarteritis nodosa and other skin-nerve vasculitides overlap with NSVN clinically. Three patterns of involvement in NSVN have been identified: multifocal neuropathy, distal symmetric polyneuropathy, and overlapping multifocal neuropathy (asymmetric polyneuropathy). These patterns lack standard defi...

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Section: Brighton Collaboration Case Definition Of Vasculitic Neuropamentioning

confidence: 99%

The nonsystemic vasculitic neuropathies

2017

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“…Most of the articles discussed the nerve biopsy findings in specific diseases, the clinical suspicion of which had prompted the biopsy. [23][24][25][26][27][28][29][30][31][32][33][34] No article provided guidance regarding when to perform a nerve biopsy in the evaluation of DSP.…”

Section: Analysis Of Evidencementioning

confidence: 99%

Practice Parameter: Evaluation of distal symmetric polyneuropathy: Role of autonomic testing, nerve biopsy, and skin biopsy (an evidence-based review) [RETIRED]

England¹,

Gronseth²,

Franklin³

et al. 2009

Neurology

287

142

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“…However, disadvantages include prolonged operative times, higher facility costs, and donor site morbidity which may include pain, scarring, neuroma formation, and sensory loss. (5,6,7,8) Autograft alternatives include allografts and artificial nerve conduits, which eliminate donor site morbidity. Several clinical studies have documented the effectiveness of nerve conduits for short gaps (9); however, the clinical value of nerve conduits to bridge larger gaps remains unclear.…”

Section: Introductionmentioning

confidence: 99%