Footdrop after peroneal nerve lesion

Abstract

Background: Chronic inflammatory demyelinating polyneuropathy (CIDP) is a heterogeneous disorder having a wide clinical range, and is characterised by multifocal demyelination that can involve the distal nerve terminals, intermediate nerve segments, and nerve roots. Objective: To investigate whether the distribution patterns of demyelination along the course of the nerve correlate with clinical profiles in patients with CIDP. Methods: Motor nerve conduction studies were carried out on 42 consecutive patients. According to the physiological criteria for demyelination, the presence of a demyelinative lesion was determined in the distal nerve segments (distal pattern) or intermediate nerve segments (intermediate pattern), or in both (diffuse pattern). The serum concentration of tumour necrosis factor (TNF)-α was measured by immunoassay. Results: Patients were classified as having a distal (n=10), intermediate (n=13), or diffuse (n=15) pattern, or were unclassified (n=4). Patients with the distal or diffuse pattern had common clinical features such as subacute onset, symmetric symptoms, and weakness involving proximal as well as distal muscles. Patients with the distal pattern had a good response to treatment and a monophasic remitting course, but the diffuse pattern was associated with a treatment dependent relapsing course, reflecting longer disease activity. The serum TNF-α concentrations increased only in the "diffuse" subgroup of patients, and this might be associated with breakdown of the blood-nerve barrier and therefore, involvement of the intermediate segments. The intermediate pattern was characterised by a chronic course, asymmetric symptoms, less severe disability, and refractoriness to treatments. Conclusions: CIDP consists of subtypes with varying predilections for lesions along the course of the nerve. The distribution patterns of conduction abnormalities may be useful in the prediction of outcome of patients with CIDP.

Multicenter study of peroneal mononeuropathy: clinical, neurophysiologic, and quality of life assessment

“…Validated patient‐perspective measures have been suggested in neurologic disorders ( Devinsky, 1995 ) , and patient‐oriented tools were included in some neurologic and musculoskeletal studies providing interesting results ( Padua et al, 1999 ) . Several studies have described different predisposing factors of peroneal mononeuropathy (PM) ( Katirji and Wilbourn, 1988 ; Dillavou et al, 1997 ; Aulisa et al, 1998 ; Aprile et al, 2000; 2003 ; Cruz‐Martinez et al, 2000 ; Bendszus et al, 2002 ; Bendszus and Koltzenburg, 2002 ; Goitz and Tomaino, 2003 ; Nishikawa et al, 2003 ; Tacconi et al, 2004 ) , but none of the previous studies was multidimensional and multicenter. None evaluated the quality of life (QoL) and disability.…”