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0378 Fast evaluation of characteristics of sural nerve myelin of patients with polineuropathies. Complementary morphometric and X-ray diffraction studies
Poster Abstracts
Monday, November 7, 2005
S195
different between the hemodialysis and control group: 50.73 ± 1.32 and 51.96 ± 1.49 m/s vs 57.8 ± 2.4 and 59.9 ± 2.1 respectively, p < 0.001. In the henrodialysis group, 70% o f tire patients had itching, 75% had cranrps, 90<'/0 paresthesias, 70<'/0 restless-legs syndrome, 60% had upper limb nmsde hypo trophy, 70 % lower limb nmsde tlyp otrophy and 75% abolished ankle tendon reflex. The motor velocity of the median nerve correlated significantly with serum phosphate, calcium, PTH and alkaline phosphatase, p < 0.005, 0.01 and 0.05 respectively. The motor velocity of the ulnar nerve correlated significantly with serum phosphate and calciunr, p < 0.01 and 0.05. Motor velocity of tire peroneal nerve correlated significantly with duration ofhemodialysis in years, phosphate and alkaline phosphatase, p < 0.01, 0.005 and 0.05 respectively. Sensitive velocity of the median nerve correlated significantly with serum phosphate and alkaline phosphatase only, p < 0.005 and 0.001 respectively. Sensitive velocity of the ulnar nerve correlated significantly with the duration of hemodialysis in years, serunr phosphate and alkaline phosphatase, p<0.05 and 0.01 respectively. D M L of the median nerve correlated only with the duration of hemodialysis and serum phosphate, p < 0.005 and 0.05 respectively. D M L of the ulnar nerve correlated significantly with the duration of hemodialysis, semnl phosphate and alkaline phosphatase, p < 0.005 and 0.001 respectively. "H'" reflex correlated siglrificantly with tire duration of hemodialysis and serunr phosphate, p < 0.05. F-wave velocity correlated only with the duration o f hemodialysis, p < 0.01. Conclusion: It can be concluded that uremic polyneuropathy is widely clinically present in hemodialysis patients, and neuropathic findings confirm that. One should search for polyneuropathy when the first signs of hyperparathyroidism occur.
mediated. Typical presentation is that of slowly progressive, asymmetric involvement of motor nerves without sensory involvement. Diagnosis of M M N C B requires the denronstration of conduction block in multiple motor nerves on nerve conduction studies. We suggest that a unifocal presentation of M M N C B may warrant therapy. Method: We describe a patient presenting with significant pain and disabifity associated with a right radial nerve palsy. Conduction block was demonstrated in motor nerve conduction studies in the affected nerve only. Sensory studies were normal. The patient was treated with intravenous inmmnoglobulin due to the severe, disabling symptoms and a rapid remission was observed. Several years later the patient developed involvement of multiple nerves. Conduction block in several nerves was demonstrable on neurophysiologic testing. Remission again resulted from treatment with immunoglobulin. Results of sequential neurophysiology studies will be detailed. Rationale for treatnrent of unifocal motor neuropathy with conduction block will be discussed in tire context of current recommendations for diagnosis and treatnrent. Results: The patient requires intermittent treatment with immunoglobulin during episodic relapses. No underlying cause of neuropathy has been identified. Conclusion: M M N C B may initially present in one nerve only. Early treatment of tire condition may be beneficial in inducing remission, and possibly deferring progression to widespread involvement.
0375 Neurofibromatous Neuropathy presenting as bilateral foot drop in a case of nf-1
Objective: To present five cases of anterior tarsal tunnel's syndrome, electrophysiologic results and patients outcome after surgical treatment. Baekgiound: Anterior tarsal tumtel's syndrome first described by Marinacd in 1968 is a rarely docunrented compression neuropathy of the deep peroneal nerve under the inferior extensor retinaculum of the foot. Patients present with pain and dysaesthesia at the dorsum of the foot, paresis and atrophy o f the extensor digitorum brevis and sensory deficit in the first interdigital space. Design]Methods: During the past 4 years we diagnosed 5 patients, 3 males and 2 females (154-76 years ) complaining of pain and disaesthesiea at the wrist of their feet as compression of the deep peroneal nerve in the anterior tarsal tunnel. Clinical signs were paresis and atrophy of the extensor digitorum brevis and sensory loss over the first interdigital space. Results: Electroneurography showed prolonged distal latency (median 7,8 ms ) and diminished CMAP amplitude of the deep peroneal nerve while NCV of the peroneal nerve at the calf was normal. The tibial nerve, the sural nerve and the superficial peroneal nerve were normal. EMG of the ribialis anterior and the extensor halhids was normal, the extensor digitormn brevis showed denervation potentials. Two patients underwent surgical decompression and showed relief from pain and reimtervation in E M G of the extensor digitormn brevis. Contusion: Anterior tarsal tunnel's syndrome can be reliably diagnosed by electrophysiology in patients with pain at the dorsum of the foot. Early diagnosis can lead to surgical decompression and pain relief.
Sujith, O l, Raj ~, Girija, A ~. SMedical College, Calicut, Kerala, India
Baekgiound: Neurofibromatosis typed (NF-1) is a common autosomal dominant neurocutaneous disease. The incidence of Neuro fibromatous Neuropathy has been estimated to be 1.3 - 2.5 % in diagnosed cases of NF- 1. Perineural disruption resulting in failure to initiate and to maintain appropriate cell signaling between Schwan cells, fibroblasts and perineural cells can occur in NF-1. Method: 23-year-old male who was fulfilling clinical criteria for NF-1 presented with difficulty in walking for tire past two months. Examination revealed bilateral foot drop and absent ankle jerks. Sphincter tone and anal reflex were normal. There was distal symmetrical sensory loss for all modalities of sensation in both lower limbs. He had thickening o f all the palpable peripheral nerves. MRI spine revealed no infiltration into the sacral roots. Results: Nerve conduction study and nerve biopsy were performed. Nerve conduction showed reduction in amplitude and conduction velocity in peroneal and tibial nerves. Sensory conduction revealed absent peroneal sensory bilaterally. Sural sensory showed prolonged distal latency suggestive of denralination. Nerve biopsy showed enlarged fascicles with characteristic neurofibromatous tissue. Tire intra neural plexiform neurofibromas were compatible with neurofibromatous neuropathy. Conclusion: This patient had predominantly motor symptoms and signs in contrast to the predominantly sensory type of presentation described in literature in cases of NF-1 associated neuropathy. 0376 Unifoeal presentation of Multifocal Motor Nemopathy: rationale for early treatment
Tondinson, S.E l, Taggart, S ~, Bathgate, D a, Newman, P.K ~, Fisher, C ~.
1James Cook University Hospital, Middlesbrough, United Kingdom Baekgiound: Multifocal Motor Neuropathy with Conduction Block (MMNCB) is air acquired neuropathy wlfich is thought to be inmmne
0377 Anterior Tarsal Tunnel's Symironle, presentation of live cases Vass, A, Hitzenberger, P, Grisold, W. Department Of Neurology and
LBI For Neurooncology
0378 Fast Evaluation of Characteristics of Sural Nerve Myelin of Patients w~th Polineuropattfies. CoinpleinentaXy Morphometric and X-Ray Ditl~action Studies
Vonasek, E l, Rodriguez, p 2 Rojas, j3, Cotfia, M 4, Camargo, B4, Parthe, V ~, Bonillo, T a, Vargas, R a, Mateu, L ~. 1Molecular Structure
Laboratory, DBE, IVIC, Caracas, Venezuela; 2Microscopy Service, Sirnrn Rodriquez University, Caracas, Venezuela; 3LISA Group, Angers University, Angers, France; 4Neurology Service, Caracas University Hospital, UCV, Caracas, Venezuela
Monday, November 7, 2005
S195
different between the hemodialysis and control group: 50.73 ± 1.32 and 51.96 ± 1.49 m/s vs 57.8 ± 2.4 and 59.9 ± 2.1 respectively, p < 0.001. In the henrodialysis group, 70% o f tire patients had itching, 75% had cranrps, 90<'/0 paresthesias, 70<'/0 restless-legs syndrome, 60% had upper limb nmsde hypo trophy, 70 % lower limb nmsde tlyp otrophy and 75% abolished ankle tendon reflex. The motor velocity of the median nerve correlated significantly with serum phosphate, calcium, PTH and alkaline phosphatase, p < 0.005, 0.01 and 0.05 respectively. The motor velocity of the ulnar nerve correlated significantly with serum phosphate and calciunr, p < 0.01 and 0.05. Motor velocity of tire peroneal nerve correlated significantly with duration ofhemodialysis in years, phosphate and alkaline phosphatase, p < 0.01, 0.005 and 0.05 respectively. Sensitive velocity of the median nerve correlated significantly with serum phosphate and alkaline phosphatase only, p < 0.005 and 0.001 respectively. Sensitive velocity of the ulnar nerve correlated significantly with the duration of hemodialysis in years, serunr phosphate and alkaline phosphatase, p<0.05 and 0.01 respectively. D M L of the median nerve correlated only with the duration of hemodialysis and serum phosphate, p < 0.005 and 0.05 respectively. D M L of the ulnar nerve correlated significantly with the duration of hemodialysis, semnl phosphate and alkaline phosphatase, p < 0.005 and 0.001 respectively. "H'" reflex correlated siglrificantly with tire duration of hemodialysis and serunr phosphate, p < 0.05. F-wave velocity correlated only with the duration o f hemodialysis, p < 0.01. Conclusion: It can be concluded that uremic polyneuropathy is widely clinically present in hemodialysis patients, and neuropathic findings confirm that. One should search for polyneuropathy when the first signs of hyperparathyroidism occur.
mediated. Typical presentation is that of slowly progressive, asymmetric involvement of motor nerves without sensory involvement. Diagnosis of M M N C B requires the denronstration of conduction block in multiple motor nerves on nerve conduction studies. We suggest that a unifocal presentation of M M N C B may warrant therapy. Method: We describe a patient presenting with significant pain and disabifity associated with a right radial nerve palsy. Conduction block was demonstrated in motor nerve conduction studies in the affected nerve only. Sensory studies were normal. The patient was treated with intravenous inmmnoglobulin due to the severe, disabling symptoms and a rapid remission was observed. Several years later the patient developed involvement of multiple nerves. Conduction block in several nerves was demonstrable on neurophysiologic testing. Remission again resulted from treatment with immunoglobulin. Results of sequential neurophysiology studies will be detailed. Rationale for treatnrent of unifocal motor neuropathy with conduction block will be discussed in tire context of current recommendations for diagnosis and treatnrent. Results: The patient requires intermittent treatment with immunoglobulin during episodic relapses. No underlying cause of neuropathy has been identified. Conclusion: M M N C B may initially present in one nerve only. Early treatment of tire condition may be beneficial in inducing remission, and possibly deferring progression to widespread involvement.
0375 Neurofibromatous Neuropathy presenting as bilateral foot drop in a case of nf-1
Objective: To present five cases of anterior tarsal tunnel's syndrome, electrophysiologic results and patients outcome after surgical treatment. Baekgiound: Anterior tarsal tumtel's syndrome first described by Marinacd in 1968 is a rarely docunrented compression neuropathy of the deep peroneal nerve under the inferior extensor retinaculum of the foot. Patients present with pain and dysaesthesia at the dorsum of the foot, paresis and atrophy o f the extensor digitorum brevis and sensory deficit in the first interdigital space. Design]Methods: During the past 4 years we diagnosed 5 patients, 3 males and 2 females (154-76 years ) complaining of pain and disaesthesiea at the wrist of their feet as compression of the deep peroneal nerve in the anterior tarsal tunnel. Clinical signs were paresis and atrophy of the extensor digitorum brevis and sensory loss over the first interdigital space. Results: Electroneurography showed prolonged distal latency (median 7,8 ms ) and diminished CMAP amplitude of the deep peroneal nerve while NCV of the peroneal nerve at the calf was normal. The tibial nerve, the sural nerve and the superficial peroneal nerve were normal. EMG of the ribialis anterior and the extensor halhids was normal, the extensor digitormn brevis showed denervation potentials. Two patients underwent surgical decompression and showed relief from pain and reimtervation in E M G of the extensor digitormn brevis. Contusion: Anterior tarsal tunnel's syndrome can be reliably diagnosed by electrophysiology in patients with pain at the dorsum of the foot. Early diagnosis can lead to surgical decompression and pain relief.
Sujith, O l, Raj ~, Girija, A ~. SMedical College, Calicut, Kerala, India
Baekgiound: Neurofibromatosis typed (NF-1) is a common autosomal dominant neurocutaneous disease. The incidence of Neuro fibromatous Neuropathy has been estimated to be 1.3 - 2.5 % in diagnosed cases of NF- 1. Perineural disruption resulting in failure to initiate and to maintain appropriate cell signaling between Schwan cells, fibroblasts and perineural cells can occur in NF-1. Method: 23-year-old male who was fulfilling clinical criteria for NF-1 presented with difficulty in walking for tire past two months. Examination revealed bilateral foot drop and absent ankle jerks. Sphincter tone and anal reflex were normal. There was distal symmetrical sensory loss for all modalities of sensation in both lower limbs. He had thickening o f all the palpable peripheral nerves. MRI spine revealed no infiltration into the sacral roots. Results: Nerve conduction study and nerve biopsy were performed. Nerve conduction showed reduction in amplitude and conduction velocity in peroneal and tibial nerves. Sensory conduction revealed absent peroneal sensory bilaterally. Sural sensory showed prolonged distal latency suggestive of denralination. Nerve biopsy showed enlarged fascicles with characteristic neurofibromatous tissue. Tire intra neural plexiform neurofibromas were compatible with neurofibromatous neuropathy. Conclusion: This patient had predominantly motor symptoms and signs in contrast to the predominantly sensory type of presentation described in literature in cases of NF-1 associated neuropathy. 0376 Unifoeal presentation of Multifocal Motor Nemopathy: rationale for early treatment
Tondinson, S.E l, Taggart, S ~, Bathgate, D a, Newman, P.K ~, Fisher, C ~.
1James Cook University Hospital, Middlesbrough, United Kingdom Baekgiound: Multifocal Motor Neuropathy with Conduction Block (MMNCB) is air acquired neuropathy wlfich is thought to be inmmne
0377 Anterior Tarsal Tunnel's Symironle, presentation of live cases Vass, A, Hitzenberger, P, Grisold, W. Department Of Neurology and
LBI For Neurooncology
0378 Fast Evaluation of Characteristics of Sural Nerve Myelin of Patients w~th Polineuropattfies. CoinpleinentaXy Morphometric and X-Ray Ditl~action Studies
Vonasek, E l, Rodriguez, p 2 Rojas, j3, Cotfia, M 4, Camargo, B4, Parthe, V ~, Bonillo, T a, Vargas, R a, Mateu, L ~. 1Molecular Structure
Laboratory, DBE, IVIC, Caracas, Venezuela; 2Microscopy Service, Sirnrn Rodriquez University, Caracas, Venezuela; 3LISA Group, Angers University, Angers, France; 4Neurology Service, Caracas University Hospital, UCV, Caracas, Venezuela