Spinal root and plexus hypertrophy in chronic inflammatory demyelinating polyneuropathy

Abstract

MRI was performed on the spinal roots, brachial and lumbar plexuses of 14 patients with chronic inflammatory demyelinating polyneuropathy (CIDP). Hypertrophy of cervical roots and brachial plexus was demonstrated in eight cases, six of whom also had hypertrophy of the lumbar plexus. Of 11 patients who received gadolinium, five of six cases with hypertrophy and one of five without hypertrophy demonstrated enhancement. All patients with hypertrophy had a relapsing-remitting course and a significantly longer disease duration. Gross onion-bulb formations were seen in a biopsy of nerve from the brachial plexus in one case with clinically evident nodular hypertrophy. We conclude that spinal root and plexus hypertrophy may be seen on MRI, particularly in cases of CIDP of long duration, and gadolinium enhancement may be present in active disease.

Chronic inflammatory demyelinating polyradiculoneuropathy: two cases with cervical spinal cord compression

“…Enlarged spinal roots may be identified in patients being investigated for demyelinating neuropathy as in our first case. N e rve root enhancement with gadolinium, seen in our patient, is sometimes found in inflammatory demyelinating neuropathies 5,9,11 . When CIDP evolves slowly and its pro g re s s i o n is more insidious it may be difficult to distinguish it from a hypert rophic CMT.…”

“…Thickened peripheral nerves were seen in 11% in one larg e s e r i e s 3 . Although exceedingly rare, there have been re c o rded cases of CIDP presenting with spinal cord compression due hypertrophic spinal roots [5][6][7][8][9][10][11][12][13] . We re p o rt two patients with CIDP of long evolution with cervical spinal compression due to hypertrophic roots.…”

Cranial nerve hypertrophy in pediatric chronic inflammatory demyelinating polyradiculoneuropathy

“…MRI may reveal cranial nerve hypertrophy and enhancement even without clinical deficit [1]. MR evidence of spinal root hypertrophy occurs in 60% of adult patients, typically those with long disease duration [2]. Root thickening may be seen in paediatric CIDP but, unlike that in our patient, is generally mild.…”

Neuro-ophthalmological Complications of Chronic Inflammatory Demyelinating Polyradiculoneuropathy

“…1 A magnetic resonance imaging (MRI) study of 14 cases of CIDP found cervical and brachial plexus hypertrophy in 8. 4 These cases had significantly longer disease courses (mean 15.9 years) than those cases without hypertrophy (mean 3.3 years, p = 0.05). The phenomenon is most likely due to the chronic effects of the disease; however, two of the cases with hypertrophy had short disease courses (7 and 18 months), but both patients were moderately to severely disabled, suggesting that nerve hypertrophy may be a marker of disease activity.…”