High ultrasound variability in chronic immune-mediated neuropathies. Review of the literature and personal observations

Chronic immune-mediated neuropathies show high clinical variability. Diagnosis is based on clinical and neurophysiological studies, but recently ultrasound (US) of peripheral nerves has been shown to provide useful morphological information. US has already been shown to crucially influence diagnosis and clinical care in entrapment neuropathies, in traumatic nerve lesions and in tumors. The role of US in the evaluation of polyneuropathies is still not clearly defined, but increasing attention has recently been focused on the immune-mediated neuropathies and specific US measures (namely the intra- and inter-nerve cross-sectional area variability) have been developed. The aim of the current paper is to make a review of the available nerve US studies and provide data from personal observations in the most common chronic immune-mediated neuropathies.     

Nerve ultrasound in hereditary transthyretin amyloidosis: red flags and possible progression biomarkers

Journal of Neurology - Diagnostic delay of hereditary transthyretin amyloidosis (ATTRv, v for variant) prevents timely treatment and, therefore, concurs to the mortality of the disease. The aim of...     

Gait in adolescent cerebral palsy: the effect of partial unweighting

OBJECTIVE: To determine the efficacy of partial unweighting in improving gait in a patient with cerebral palsy. PATIENT: One medically stable 17-year-old female, classified as having spasticity. METHODS AND MATERIALS: Heart rate, blood pressure, and perceived exertion were recorded across increments in treadmill gait speed as a function of nonsupported and partial unweighting conditions (30% of body mass supported). Nonsupported and partial unweighting conditions were administered 1 week apart. RESULTS: The partial unweighting condition resulted in significantly lower physiologic (heart rate and blood pressure) indices and perceived exertion across all increments in gait speed. Additionally, the subject was able to ambulate at a faster rate of speed under the partial unweighting relative to nonsupported conditions. CONCLUSIONS: These results suggest partial unweighting improves gait efficiency across increments in gait speed, but only to a certain point. For the subject in this report, gait efficiency declined as speed increased beyond some critical threshold (about 2.72km/h), suggesting a limit to partial unweighting during gait training as a function of endurance and training.     

Ulnar neuropathy at wrist: entrapment at a very “congested” site

Ulnar tunnel syndrome indicates ulnar neuropathy at different sites within the wrist. Several classifications of ulnar tunnel syndrome are present in literature, based upon typical nerve anatomy. However, anatomical variations are not uncommon and can complicate assessment. The etiology is also complex, due to the numerous potential causes of entrapment. Clinical examination, neurophysiological testing, and imaging are all used to support the diagnosis. At present, many therapeutic approaches are available, ranging from observation to surgical management. Although ulnar neuropathy at the wrist has undergone extensive prior study, unresolved questions on diagnosis and treatment remain. In the current paper, we review relevant literature and present the current knowledge on ulnar tunnel syndrome.     

Tarsal tunnel syndrome: still more opinions than evidence. Status of the art

Tarsal tunnel syndrome is an entrapment neuropathy of the posterior tibial nerve or its terminal branches within its fibro-osseous tunnel beneath the flexor retinaculum on the medial side of the ankle. The condition is frequently underdiagnosed leading to controversies regarding its epidemiology and to an intense debate in the literature. With the advent of nerve imaging techniques, the diagnostic confirmation and the etiological identification have become more accurate. However, management of this entrapment neuropathy remains challenging because of many intervention strategies but limited robust evidence. Uncertainties still exist about the best conservative treatment, timing of surgical intervention, and best surgical approach. In the attempt to clarify these aspects and to provide the reader some understanding of the status of the art, we have reviewed the published literature on this controversial condition.