Abstract
Background: Ultrasound is a valuable and accessible technique for the diagnosis of neuropathy including multifocal motor neuropathy (MMN). Case report: A 65 years old male presented with a four months history of progressive weakness in right hand and cervicobrachialgia. The examination revealed a severe global distal paresis in the upper right limb,most in forearm flexors, ulnar areflexia and predominant denervation signs in the electrophysiology. Both examination and motor nerve conductions were normal in the rest limbs, as well as the sensitive study. Magnetic resonance imaging showed a back center C7 disc herniation. The patient was diagnosed of C7 radiculopathy and he underwent cervical disc surgery. One month later, he developed progressive weakness in the right forearm and the contralateral hand, showing signs of moderate subacute denervation with a remarkable proximal demyelination of the median, ulnar and radial nerves. By HRNS (high resolution ultrasonogaphy) (Sonosite, 6-13Mhz), suggestive signs of intense inflammation were demonstrated in non-compressible segments of nerves, thickened with a poorly defined edge and hyperechoic epineural and clear structural alteration. After a 5-day course of intravenous immunoglobulin, the patient had a good result with adequate recovery of motor deficits. Discussion: MMN is a slow progressive dysimmune multineuritis with a established criteria. although the electrophysiological findings are the gold standart for the diagnosis, ultrasonographic diagnosis of peripheral nerves is a reliable, fast and secure tecnique to support it. We report a case of atypical presentation with rapid and agressive evolution. The initial denervation signs were probably due to intense and sudden demyelinization which altered the electrical findings. Our case highlights that high resolution sonography of the nerve is a useful tool in the evaluation of neuropathies as MMN and it should be included in the clinical practice.
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