Post-surgical inflammatory neuropathy

Staff, Nathan P.; Engelstad, JaNean; Klein, Christopher J.; Amrami, Kimberly K.; Spinner, Robert J.; Warner, Mark A.; Warner, Mary E.; Dyck, Peter J.

doi:10.1093/brain/awq252

Cited by 210 publications

(173 citation statements)

References 27 publications

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“…Postsurgical inflammatory neuropathy is a self-limited, acute, focal or multifocal axonal neuropathy that emerges within 30 days of a surgical procedure in the absence of trauma to affected nerves 48 . To qualify, the condition must develop after the immediate postoperative period or, if it develops within this period, involve nerves remote from the surgical field.…”

Section: Subtypesmentioning

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: Subtypesmentioning

confidence: 99%

The nonsystemic vasculitic neuropathies

2017

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“…These early passive transfer experiments suggest roles for B cells and IgM [67], and IgG autoantibodies [66]. Additionally, there is strong pathological and physiological evidence that focal injury to nerves sustained during surgery (which breaches the blood-nerve barrier) sometimes triggers autoimmune neuropathy [68]. Although CRPS was not referenced, surgeries are a common trigger for CRPS, and it is logical to assume that nonsurgical traumas could also trigger antinerve autoimmunity.…”

Section: Complex Regional Pain Syndromementioning

confidence: 99%

Immunotherapy Prospects for Painful Small-fiber Sensory Neuropathies and Ganglionopathies

Oaklander

2016

Neurotherapeutics

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The best-known peripheral neuropathies are those affecting the large, myelinated motor and sensory fibers. These have well-established immunological causes and therapies. Far less is known about the somatic and autonomic "small fibers"; the unmyelinated C-fibers, thinly myelinated A-deltas, and postganglionic sympathetics. The small fibers sense pain and itch, innervate internal organs and tissues, and modulate the inflammatory and immune responses. Symptoms of small-fiber neuropathy include chronic pain and itch, sensory impairment, edema, and skin color, temperature, and sweating changes. Small-fiber polyneuropathy (SFPN) also causes cardiovascular, gastrointestinal, and urological symptoms, the neurologic origin of which often remains unrecognized. Routine electrodiagnostic study does not detect SFPN, so skin biopsies immunolabeled to reveal axons are recommended for diagnostic confirmation. Preliminary evidence suggests that dysimmunity causes some cases of small-fiber neuropathy. Several autoimmune diseases, including Sjögren and celiac, are associated with painful small-fiber ganglionopathy and distal axonopathy, and some patients with "idiopathic" SFPN have evidence of organ-specific dysimmunity, including serological markers. Dysimmune SFPN first came into focus in children and teenagers as they lack other risk factors, for example diabetes or toxic exposures. In them, the rudimentary evidence suggests humoral rather than cellular mechanisms and complement consumption. Preliminary evidence supports efficacy of corticosteroids and immunoglobulins in carefully selected children and adult patients. This paper reviews the evidence of immune causality and the limited data regarding immunotherapy for small-fiberpredominant ganglionitis, regional neuropathy (complex regional pain syndrome), and distal SFPN. These demonstrate the need to develop case definitions and outcome metrics to improve diagnosis, enable prospective trials, and dissect the mechanisms of small-fiber neuropathy.

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“…Another possible cause of neuropathy is peripheral nerve inflammation following surgery. A recent study carried by Staff et al (13) suggests that neuropathies following surgeries may have an inflammatory etiology. Nerve biopsies of 21 patients showed increased epineurial perivascular lymphocytic inflammation.…”

Section: Discussionmentioning

confidence: 99%

Bariatrik Cerrahi Sonrası Gelişen Nütrisyonel Polinöropati: Alışılmış Bir Klinikle Ortaya Çıkan Nadir Bir Olgu

...

2012

Tftr

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Sum maryWith rising frequency of bariatric surgery, the common adverse effects of that procedure is more frequently encountered. Our patient unluckily developed pulmonary embolism after 3 months of bariatric surgery and that clinic picture was aggravated with proximal lower extremity weakness and numbness. Electromyography performed on admission revealed asymmetric polyradiculopathy with axonal degeneration, whereas somatosensory evoked potentials showed no tibial peripheric and cortical responses. Although we found no sign of malabsorption (except 25 OH vitamin D deficiency), the history of weight loss of 70 kg within 3 months after the surgery led us to the diagnosis of nutritional polyneuropathy. On the other hand, neuropathic pain in our patient responded well to pregabalin and, after strengthening of muscles via rehabilitation, the patient gained independent mobility again. Turk J Phys Med Re hab 2012;58:151-3. Key Words: Bariatric surgery, polyneuropathy,neuropathic pain Özet Bariatrik cerrahilerin daha sık uygulanması sonucunda bu prosedürün yan etkilerine daha çok rastlanılmaktadır. Hastamızda talihsiz bir şekilde bariatrik cerrahiden 3 ay sonra pulmoner emboli gelişmiş ve bu klinik tablo proksimal alt ektstremitede güçsüzlük ve hissizlik ile ağırlaşmıştır. Yapılan elektromyografik inceleme sonucunda aksonal dejenerasyonun hakim olduğu asimetrik polinöropati tanısı konmuş, duysal uyandırılmış potansiyallerde tibial periferik ve kortikal cevaplar alınamamıştır. İncelemeler sonucunda 25 OH Vitamin D eksikliği dışında bir vitamin ya da mineral eksikliği saptanmazken, hastanın operasyon sonrası 3 ay içerisinde 70 kg kaybetmesi bizi nütrisyonel polinöropati tanısına yönlendirmiştir. Diğer yandan hastamızın nöropatik karakterdeki ağrısı pregabaline iyi yanıt vermiş ve kas güçlendirme eğitimi sonrasında hastamız mobilitede bağımsızlığa kavuşmuştur.

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Post-surgical inflammatory neuropathy

Cited by 210 publications

References 27 publications

The nonsystemic vasculitic neuropathies

The nonsystemic vasculitic neuropathies

Immunotherapy Prospects for Painful Small-fiber Sensory Neuropathies and Ganglionopathies

Bariatrik Cerrahi Sonrası Gelişen Nütrisyonel Polinöropati: Alışılmış Bir Klinikle Ortaya Çıkan Nadir Bir Olgu

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