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Optimizing Investigations for Evaluation of Enlargements of the Roots, Plexuses and Nerves: A Study of 133 Patients
Annals of Indian Academy of Neurology ( IF 1.9 ) Pub Date : 2020-09-01 , DOI: 10.4103/aian.aian_504_19 Satish Khadilkar 1 , Narayan Dilip Deshmukh 2 , Neha H Shah 3 , Sunila Jaggi 3 , Khushnuma A Mansukhani 4 , Bhagyadhan Patel 5 , Sonali Shah 3 , Sarika Patil 6 , Vanaja Shetty 7
Background and Aims: A wide variety of neurological diseases result in clinical and/or radiological enlargement of nerves, roots and plexuses. With the advancement in techniques and use of magnetic resonance neurography (MRN), aided by electrophysiology, proximal segments of the lower motor neuron (LMN) can be well studied. The relative merits of investigative modalities have not been well defined and comprehensive information on this subject is sparse. Methods: This retrospective study included data from January 2010 to June 2018. Patients having clinical and/or radiological enlargements of lower motor neuron were included. Clinical and laboratory work up, electrophysiology, MRN and biopsy studies were documented and analyzed. Results: 133 patients fulfilled the inclusion criteria. The diagnostic categories were of leprosy (32%), immune neuropathies (27.8%), nerve infiltrations (8.2%), inherited neuropathies (9%), diabetic radiculopathies (9%) and others (12.7%). MRN was essential to diagnosis in 24.8% and supportive in 31.5% patients. Electrophysiology was essential in diagnosis in 70.6%, biopsy in 45.8% and genetic studies in 6.4% patients. Conclusion: The manuscript presents a large cohort of diseases causing enlargement of LMN with clinical and investigative aspects of 7 patients of the most unusual condition of chronic immune sensorimotor polyradiculopathy (CISMP) and details of 7 other patients with chronic mononeuropathies at non-entrapment sites. A table of comparative utility and an algorithm depicting the optimization of investigations has been presented.
中文翻译：
优化评估根部、神经丛和神经扩大的调查：一项针对 133 名患者的研究
背景和目的：多种神经系统疾病会导致神经、神经根和神经丛的临床和/或放射学扩大。随着技术的进步和磁共振神经造影 (MRN) 的使用，在电生理学的帮助下，可以很好地研究下运动神经元 (LMN) 的近端节段。调查方式的相对优点尚未得到很好的定义，关于这一主题的综合信息很少。方法：这项回顾性研究包括 2010 年 1 月至 2018 年 6 月的数据。包括临床和/或放射学下运动神经元增大的患者。记录和分析临床和实验室检查、电生理学、MRN 和活检研究。结果：133 名患者符合纳入标准。诊断类别为麻风病 (32%)、免疫性神经病 (27.8%)、神经浸润 (8.2%)、遗传性神经病 (9%)、糖尿病神经根病 (9%) 和其他 (12.7%)。MRN 对 24.8% 的患者的诊断至关重要，对 31.5% 的患者有支持作用。70.6% 的患者需要电生理学诊断，45.8% 的患者需要活检，6.4% 的患者需要基因检查。结论：这份手稿介绍了一大群导致 LMN 扩大的疾病，其中包括 7 名最不寻常的慢性免疫感觉运动多发性神经根病 (CISMP) 患者的临床和调查方面，以及其他 7 名非截留部位慢性单神经病患者的详细信息。已经提出了一个比较效用表和一个描述调查优化的算法。
更新日期：2020-09-01
Annals of Indian Academy of Neurology ( IF 1.9 ) Pub Date : 2020-09-01 , DOI: 10.4103/aian.aian_504_19 Satish Khadilkar 1 , Narayan Dilip Deshmukh 2 , Neha H Shah 3 , Sunila Jaggi 3 , Khushnuma A Mansukhani 4 , Bhagyadhan Patel 5 , Sonali Shah 3 , Sarika Patil 6 , Vanaja Shetty 7
Affiliation
Background and Aims: A wide variety of neurological diseases result in clinical and/or radiological enlargement of nerves, roots and plexuses. With the advancement in techniques and use of magnetic resonance neurography (MRN), aided by electrophysiology, proximal segments of the lower motor neuron (LMN) can be well studied. The relative merits of investigative modalities have not been well defined and comprehensive information on this subject is sparse. Methods: This retrospective study included data from January 2010 to June 2018. Patients having clinical and/or radiological enlargements of lower motor neuron were included. Clinical and laboratory work up, electrophysiology, MRN and biopsy studies were documented and analyzed. Results: 133 patients fulfilled the inclusion criteria. The diagnostic categories were of leprosy (32%), immune neuropathies (27.8%), nerve infiltrations (8.2%), inherited neuropathies (9%), diabetic radiculopathies (9%) and others (12.7%). MRN was essential to diagnosis in 24.8% and supportive in 31.5% patients. Electrophysiology was essential in diagnosis in 70.6%, biopsy in 45.8% and genetic studies in 6.4% patients. Conclusion: The manuscript presents a large cohort of diseases causing enlargement of LMN with clinical and investigative aspects of 7 patients of the most unusual condition of chronic immune sensorimotor polyradiculopathy (CISMP) and details of 7 other patients with chronic mononeuropathies at non-entrapment sites. A table of comparative utility and an algorithm depicting the optimization of investigations has been presented.
中文翻译：
优化评估根部、神经丛和神经扩大的调查：一项针对 133 名患者的研究
背景和目的：多种神经系统疾病会导致神经、神经根和神经丛的临床和/或放射学扩大。随着技术的进步和磁共振神经造影 (MRN) 的使用，在电生理学的帮助下，可以很好地研究下运动神经元 (LMN) 的近端节段。调查方式的相对优点尚未得到很好的定义，关于这一主题的综合信息很少。方法：这项回顾性研究包括 2010 年 1 月至 2018 年 6 月的数据。包括临床和/或放射学下运动神经元增大的患者。记录和分析临床和实验室检查、电生理学、MRN 和活检研究。结果：133 名患者符合纳入标准。诊断类别为麻风病 (32%)、免疫性神经病 (27.8%)、神经浸润 (8.2%)、遗传性神经病 (9%)、糖尿病神经根病 (9%) 和其他 (12.7%)。MRN 对 24.8% 的患者的诊断至关重要，对 31.5% 的患者有支持作用。70.6% 的患者需要电生理学诊断，45.8% 的患者需要活检，6.4% 的患者需要基因检查。结论：这份手稿介绍了一大群导致 LMN 扩大的疾病，其中包括 7 名最不寻常的慢性免疫感觉运动多发性神经根病 (CISMP) 患者的临床和调查方面，以及其他 7 名非截留部位慢性单神经病患者的详细信息。已经提出了一个比较效用表和一个描述调查优化的算法。
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