Ultrasound Nerve Research Articles

Optic nerve ultrasonography in the evaluation of the relationship between arachnoid cyst and headache.

This study is aimed to show the difference between optic nerve sheath diameter (ONSD) values in migraine patients with and without arachnoid cysts from migraine patients and control groups, and to evaluate the relationship with the arachnoid cyst size on magnetic resonance imaging (MRI) and their clinical severity. This cross-sectional study included pediatric patients who were previously diagnosed with migraine and the control group. The patients consist of 3 groups. The first group was 24 patients with arachnoid cysts on brain magnetic resonance imaging (MRI) who met the diagnostic criteria for migraine (group 1); the second group was 20 patients with only headache without arachnoid cysts or other findings on brain magnetic resonance imaging (MRI) (group 2); the third group was completely healthy 20 control group. Demographic data of the patients, the onset of headache time, clinical severity, electroencephalography (EEG) findings, optic nerve sheath diameter (ONSD) measurements by ultrasonography, and the volume of arachnoid cyst on brain MRI were determined and compared. The optic nerve sheath diameter (ONSD) value was the highest in group 1 and the lowest in the control group (p: 0.001). The clinical severity was statistically different between the groups (p: 0.038). Accordingly, the majority of the clinical severity of group 1 was determined in grades 3 and 4. A weak positive correlation was found between the arachnoid cyst size on MRI and the ONSD measurement (r = 0.410, p = 0.047). The ONSD value statistically significantly increased with clinical severity in group 1 (p: 0.003). The reliability of the optic nerve sheath diameter (ONSD) measurements in determining the increase of the intracranial pressure was shown in previous studies. This is the first study in the literature presenting that the intracranial pressure effects of arachnoid cysts can be demonstrated by ONSD. We have considered that arachnoid cysts detected in headaches can create a compression effect and cause the pain to intensify.

Comparison and Evaluation of Efficacy of Soft Splint, Transcutaneous Electric Nerve Stimulation and Ultrasound in Temporomandibular Disorders

Comparison and Evaluation of Efficacy of Soft Splint, Transcutaneous Electric Nerve Stimulation and Ultrasound in Temporomandibular Disorders

Erratum: Methylprednisolone pulse therapy for leprosy neuritis: A retrospective study with sensory testing and peripheral nerve ultrasonography correlation.

Erratum: Methylprednisolone pulse therapy for leprosy neuritis: A retrospective study with sensory testing and peripheral nerve ultrasonography correlation.

Ultrasound of Median Nerve in the Diagnosis of Carpal Tunnel Syndrome-Correlation with Electrophysiological Studies.

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy caused by impairment of the median nerve due to compression as it passes through the carpal tunnel.The current gold standard in diagnosing CTS and nerve damage is by electrophysiological nerve conduction study (NCS). However, 10 to 25% of NCS results are falsely negative. Moreover, NCS remains an expensive and time-consuming procedure for patients. Ultrasonography serves as a real-time, well-tolerated, portable, and noninvasive tool for assessing the carpal tunnel.This study aims to assess the role of high-frequency ultrasound of the median nerve at the wrist in evaluating CTS and correlate with NCS to determine whether sonography can be used as an alternative to NCS in diagnosing and grading CTS.

Nerve Echogenicity: Changes in High-Resolution Nerve Ultrasound in Carpal Tunnel Syndrome after Surgery.

The aim of our prospective study was to detect changes in nerve echogenicity of the median nerve before and after successful surgery in patients with carpal tunnel syndrome (CTS) using high-resolution ultrasound. Fifteen patients with a definite diagnosis of CTS who underwent surgery were scanned by one examiner with high-resolution ultrasound, and images were analyzed by two blinded raters using ImageJ to assess the echogenicity of the median nerve (fraction of black) with a semiautomated thresholding technique before and 3 mo after surgery compared with 15 controls. In CTS patients, nerve echogenicity before surgery was significantly lower compared with that of controls (fraction of black: mean 63.9 vs. 44.6, p < 0.0001). Three months after surgery nerve echogenicity significantly increased (fraction of black was lower, mean 55.5; p < 0.0001) as a possible sign of reduction of intraneural edema, but did not reach the values of healthy controls. Semi-automated evaluation of the echogenicity of the median nerve may be used as a marker of successful carpal tunnel release. Further studies are warranted to detect how nerve echogenicity changes after unsuccessful carpal tunnel release.

Nerve Ultrasound Distinguishes Non-Inflammatory Axonal Polyneuropathy From Inflammatory Polyneuropathy With Secondary Axonal Damage.

IntroductionChronic inflammatory demyelinating polyneuropathy (CIDP) may have a similar clinical and electrophysiological presentation to non-inflammatory axonal polyneuropathies (NIAPs) when secondary axonal damage occurs. We aimed to investigate if nerve ultrasound can help to differentiate CIDP with additional secondary axonal damage from NIAP.MethodsIn a retrospective analysis, the cross-sectional area (CSA) of the peripheral nerves measured by ultrasound at six suitable nerve sites was compared in 95 patients with CIDP and 82 patients with NIAP. We developed the adjusted Bochum ultrasound score (aBUS) ranging from 0 to 6 resulting from the number of sites with enlarged CSA (median, ulnar, radial, and sural nerve).ResultsThe mean CSA of patients with CIDP was enlarged at all six nerve sites compared with the mean CSA of patients with NIAP. A total of 21 patients with CIDP did not meet 2010 electrophysiological diagnostic criteria (European Academy of Neurology/Peripheral Nerve Society Guideline, EFNS/PNS criteria) for CIDP at examination timepoint but only in further follow-up, while 25 patients with NIAP fulfilled electrophysiological EFNS/PNS criteria for CIDP as “possible” or “probable” CIDP. To increase diagnostic power, we included aBUS measured by ultrasound in patients classified as “possible” or “probable” resulting in an improved specificity of 94% and a sensitivity of 59%, compared to a specificity of the EFNS/PNS criteria alone of 60% and sensitivity of 78%.ConclusionUsing nerve ultrasound and the aBUS as a complementary method to distinguish CIDP from NIAP in case of secondary axonal damage can facilitate the diagnosis of CIDP.

Differentiation of Critical Illness Myopathy and Critical Illness Neuropathy Using Nerve Ultrasonography.

Intensive care unit-acquired weakness occurs frequently in intensive care unit patients, including critical illness myopathy (CIM) and critical illness polyneuropathy (CIPN). The authors present a prospective study to assess the ultrasound pattern sum score to differentiate between confirmed CIM, sensory neuropathy, and CIPN cases. Cross-sectional areas of 12 predefined nerve segments in 16 patients were sonographically examined. Single-nerve cross-sectional areas and ultrasound pattern sum score values were compared; results are given as P-values and receiver operating characteristic area under the curve (AUC). In neuropathy, significant single-nerve cross-sectional area enlargement was observed in the median (P = 0.04), ulnar (P = 0.04), and fibular nerves (P = 0.0003). The ultrasound pattern sum score could reliably differentiate between pure CIM and neuropathy (P = 0.0002, AUC 0.92), CIM and sensory neuropathy (P = 0.001, AUC 0.88), and CIM and CIPN (P = 0.007, AUC 0.92), but not between sensory neuropathy and CIPN (P = 0.599, AUC 0.48). Nerve ultrasonography reliably identifies neuropathy in intensive care unit-acquired weakness, yet cannot differentiate between sensory neuropathy and CIPN. A standardized ultrasound algorithm can serve as a fast bedside test for the presence of neuropathy in intensive care unit-acquired weakness.

Peripheral Nerve Ultrasound: from Clinic to Operating Room

Peripheral Nerve Ultrasound: from Clinic to Operating Room

Ultrasound Measurements of the Median Nerve at the Distal Wrist Crease Correlate With Electrodiagnostic Studies.

Background: Carpal tunnel syndrome (CTS) is the most common nerve entrapment neuropathy and is commonly evaluated using electrodiagnostic studies (EDSs). Ultrasound (US) has emerged as a potentially easier and more comfortable alternative to EDSs. The purpose of this study is to evaluate whether measurements of the cross-sectional area (CSA) of the median nerve via US correlate with the severity rating of CTS based on EDSs. Methods: A retrospective review of patients aged 18 years or older who underwent US and EDSs of the median nerve for CTS was performed. Sensory nerve action potential, distal motor latency, and compound muscle action potential were measured, and severity was graded on American Association of Neuromuscular and Electrodiagnostic Medicine guidelines. Cross-sectional area of the median nerve was measured via US at the wrist crease. Results: There was a significant association between increasing CSA and increasing EDS severity (P < .0001). The mean CSA for normal, mild, moderate, and severe CTS was 7.48 ± 2.00, 10.36 ± 2.53, 12.01 ± 3.64, and 14.34 ± 4.77 mm2, respectively. The area under the curve demonstrated the ability of median nerve CSA to discriminate between normal and abnormal EDSs with an optimal cutoff CSA of ≥10 mm2, as well as, the ability to discriminate between mild CTS and moderate to severe CTS at a cutoff CSA of greater than or equal to 12 mm2. Conclusions: The results of this study show that US measurements of the median nerve at the distal wrist crease discriminate between normal and abnormal EDSs, and between mild CTS and moderate to severe CTS.

Prognostic and monitoring biomarkers in chronic inflammatory demyelinating polyneuropathy

Chronic inflammatory demyelinating polyneuropathy (CIDP) is a clinical entity with significant phenotypic variability both in its onset and in its course. Therefore, it is important to have objective biomarkers with which to monitor its evolution. In this review we present clinical, neurophysiological, neuroimaging, blood and cerebrospinal fluid (CSF) biomarkers for the monitoring and prognosis of CIDP. Different clinical tools have been developed and validated to monitor CIDP by assessing strength and disability. However, the best parameter for monitoring gait remains to be determined. Monitoring by neurophysiological examination is also widespread and the amplitude of the compound muscle action potential is the most commonly used. More recently, the Motor Unit Number Index sum score has been developed, which is an accurate and reproducible technique. The role of nerve ultrasonography is under development and a correlation between clinical evolution and ultrasound findings has been described. Multiple biomarkers have been described in blood and CSF, including antinodal/paranodal antibodies, neurofilament light chain, serum immunoglobulin G levels and CSF sphingomyelin levels. Genetic variants and cytokines associated with prognosis and response to treatment have also been described. One of the most important challenges in the management of CIDP is the monitoring of clinical changes after treatment initiation. The combination of biomarkers that allow an accurate understanding of the disease is crucial for the optimal management of CIDP.

Comparison of Optic Nerve Sheath Diameters Measured by Optic Ultrasonography Before and After Lumbar Puncture in Idiopathic Intracranial Hypertension Patients.

Idiopathic intracranial hypertension (IIH) symptoms include headache, blurred vision, and papilledema which may lead to permanent vision loss unless diagnosed and treated. Definitive diagnosis of IIH usually requires the measurement of intracranial pressure (ICP) via lumbar puncture (LP) which is an invasive and unwanted technique for patients. In our study, optic nerve sheath diameters (ONSD) were measured before and after lumbar puncture in IIH patients and the relationship of these measurements with ICP changes was evaluated as well as the effect of decreasing cerebrospinal fluid (CSF) pressure after a lumbar puncture on ONSD. Thus, we want to investigate whether optic nerve ultrasonography (USG) is a useful tool instead of the invasive LP for the diagnosis of IIH. A total of 25 patients who applied to the neurology clinics of Ankara Numune Training and Research Hospital between May 2014 and December 2015 and were diagnosed with IIH were included in the study. The control group consisted of 22 individuals who applied with complaints other than headaches, visual impairment or tinnitus. Optic nerve sheath diameters were measured from both eyes before and after the LP. After pre-LP measurements were taken, opening and closing CSF pressure was measured. In the control group, ONSD was measured with optic USG. Mean age of the IIH group and the control group was determined as 34.8±11.5 and 45.8±13.3 years, respectively. In the patient group, mean CSF opening pressure was 33.9±8.0 cm H2O and mean closing pressure was 18.1±4.7 cm H2O. Mean ONSD measured pre-LP was 7.1±1.0 mm in the right eye and 6.9±0.7 mm in the left eye, while mean post-LP ONSD was 6.7±0.9 mm in the right eye and 6.4±0.8 mm in the left eye. There was a statistically significant difference between ONSD values before and after the LP (p=0.006 for the right eye, p<0.001 for the left eye). In the control group, mean ONSD was 5.4±0.7 mm in the right eye and 5.5±0.6 mm in the left eye, and a statistically significant difference was found between ONSD values before and after the LP (p<0.001 for the right eye and left eye). A significant positive correlation was determined between left ONSD measurements before the LP and CSF opening pressure (r=0.501, p=0.011). In the present study, it was found that ONSD measurement by optic USG significantly displays increased ICP, and decreasing pressure via LP is rapidly reflecting ONSD measurement. Based on these findings, it is suggested that ONSD measurements by optic USG, a non-invasive method, can be used in the diagnosis and follow-up of IIH patients.

Vagus nerve ultrasound in transthyretin familial amyloid polyneuropathy: A pilot study.

Background and PurposeAutonomic dysfunction is common in transthyretin familial amyloid polyneuropathy (TTR‐FAP). Because ultrasonography is a powerful tool to study peripheral neuropathy, vagus nerve (VN) ultrasonography was used in our study to investigate the possible changes of the dimension of VN in TTR‐FAP.MethodsEighteen patients with TTR‐FAP and 17 age‐ and gender‐matched individuals without any neuropathies were enrolled in a pilot study. The cross‐sectional areas (CSAs) were measured bilaterally on transverse scans of vagus, median, and ulnar nerves. Clinical data were collected to explore the correlations with CSAs of VN.ResultsThe median CSAs of VN in TTR‐FAP were 3.5 (2.0‐6.0) mm2 on the right side and 2.5 (1.0‐6.0) mm2 on the left side, compared with 2.0 (1.0‐3.0) mm2 and 1.0 (1.0‐2.0) mm2 for healthy controls (HCs). There was a significant difference between the two groups on both sides (p < .001). The mean VN CSAs were correlated positively with the course of disease (r = .7203, p = .0016)（not including the patient with the longest disease course), the Composite Autonomic Symptom Score 31 (r = .5252, p = .0252), the left ventricular posterior wall thickness (r = .5426, p = .0200), and the interventricular septum thickness (r = .5103, p = .0305). The cutoff values of right and left VN CSAs to identify TTR‐FAP from HCs were 2.5 and 1.5 mm2 and the areas under the curve were .9395 and .8856, with a high sensitivity (.889 and .889) and specificity (.941 and .765), respectively.ConclusionVN enlargement is prevalent among TTR‐FAP patients. VN ultrasonography may be an important clinical tool for assessing the severity of autonomic dysfunction in TTR‐FAP.

Median nerve ultrasonography examination correlates with electrodiagnostic studies for the diagnosis of moderate to severe carpal tunnel syndrome.

The aim of the study was to investigate the associations of cross-sectional area (CSA) of the median nerve measured by ultrasonography, the median to ulnar nerve ratio (MUR), the median to ulnar nerve difference (MUD) and the ratio of CSA of the median nerve to height squared (MHS) in relation to electrodiagnostic classification of moderate and severe carpal tunnel syndrome (CTS) and thus to identify patients suitable for surgical treatment. A prospective study was conducted in patients aged ≥ 18 years who underwent both median and ulnar nerve ultrasonography and electrodiagnostic studies (EDS). 124 wrists of 62 patients were examined. The patients' characteristics were acquired through a questionnaire. CTS was diagnosed using EDS and classified according to the guidelines of the Czech Republic Association of Electrodiagnostic Medicine. The CSA of the median nerve and of the ulnar nerve were measured at the carpal tunnel inlet. Median nerve CSA at the tunnel inlet ≥ 12 mm2 correlates with electrodiagnostic classification of moderate to severe carpal tunnel syndrome. At this cut-off value, the sensitivity of ultrasonography is 82.4%, its specificity is 87.7%, the positive predictive value is 82.4%, the negative predictive value is 87.7%. MUD, MUR and MHS perform worse than the median nerve CSA, as shown by their lower area under the receiver operating characteristic curve. Ultrasound could help us indicate surgical treatment for CTS, especially in patients with clinical findings. Our results suggest a cut-off value of CSA at the tunnel inlet of ≥ 12mm2.

Correlation Nerve Conduction Studies with Findings of the Ultrasound of the Median Nerve in Patients with Carpal Tunnel Syndrome

Background: Ultrasonography is a diagnostic resource that serves as a complement in the evaluation of patients with carpal tunnel syndrome. The correlation of ultrasonography findings with nerve conduction studies can serve to classify new phenotypes and to evaluate therapeutic responses. Objectives: To determine the diagnostic sensitivity of ultrasound, the correlation between the diameter of the nerve (CSA) against the motor and sensitive latencies, and the capacity to differentiate the mild, moderate and severe degrees of the electrophysiological classification of carpal tunnel syndrome. Methods: A cross-sectional study with prospective data collection was carried out. An ultrasonography system with a 15 MHz transducer was used. Nerve conduction studies of the median nerve were performed with conventional techniques. Data from the most symptomatic hand were used. Determination of the correlations of nerve diameter with motor and sensitive latencies of the median nerve was performed in four age groups: &lt;40(n=11), 40-54 (n=47), 55-70 (n=42) y &gt;70(n=27). Results : A total of 127 patients were evaluated (average age = 58.2 years: minimum = 26; maximum = 85; SD = 13.4); 109 (85.8%) were female patients. According to the electrophysiological classification, 40 (31.5%) were mild ; 60 (47.2%) were moderate ; and 27 (21.3%) were severe . Significant differences in the area of the median nerve were found between the electrophysiological types (mild, moderate and severe; p = 0.000). The diagnostic sensitivity of ultrasonography differed for each age group. In general, the diagnostic sensitivity was high in patients with severe cases and low for mild cases. The capacity for ultrasonography to classify the degrees of electrophysiological severity was different for each age group. For patients above 70 years and in the age group of 40 to 54 years, the CSA did not differentiate the electrophysiologically moderate cases from the severe ones. Conclusions: There is a well-defined and significant correlation between nerve conduction studies and median nerve diameter in patients with Carpal Tunnel Syndrome. However, it shows that the exclusive use of the ultrasonographic measurement of the cross-sectional area through the inlet of the carpal tunnel would not be enough to confirm or rule out an entrapment of the median nerve through the carpal tunnel, nor to predict in every case their electrophysiological severity.

Acute carpal tunnel syndrome: Clinical, electromyographic, and ultrasound features in 25 patients

BackgroundThe acute presentation of carpal tunnel syndrome (CTS) is rare. When symptoms start acutely with no obvious causes, ultrasound (US) imaging may provide clues to the etiology. ObjectiveThis study describes the clinical, electromyographic, and US findings in 25 patients presenting with acute CTS (ACTS). MethodsIn this analysis, of the patients referred for electrodiagnostic confirmation of CTS over the past decade, 25 had an acute onset of symptoms. All patients underwent EMG/NCV and US of the median nerve at the carpal tunnel and forearm. ResultsOf the 25 cases with ACTS, 5 (20%) had bilateral involvement leading to the total hands studied to 30. In 14 (56%) patients, an inciting event was identified as a possible cause of ACTS. In 11 (44%) patients without an antecedent event, 7 (64%) had a persistent median artery (PMA) detected by US. Electrodiagnostic studies showed prolonged distal motor latency with normal motor conduction velocity proximal to the carpal tunnel in 24 (80%) of 30 hands, 6 (20%) hands showed absent compound muscle action potentials over the abductor pollicis brevis (APB), and 22 (73%) hands had absent sensory potentials. Denervation changes were seen in the APB in 13 (43%) hands, and motor unit potentials were absent in 6 (20%) hands. Sixteen (64%) patients underwent a carpal tunnel release for severe symptoms. ConclusionCTS may present acutely without a clinically identifiable cause. US complements electrodiagnostic studies and is particularly useful when electrodiagnostic tests are non-diagnostic (due to absent compound muscle and sensory action potentials). US may also provide clues to the underlying cause.

High Resolution Ultrasound of the Tibial Nerve in Diabetic Peripheral Neuropathy

Abstract Background The main role of this study was to highlight the value of musculoskeletal ultrasound in the diagnosis of nerve affection in patients with diabetic peripheral neuropathy. This was evident by the significant correlation between cross sectional area and all study parameters with sensitivity and specificity of 90% and 100% respectively. Objectives Our study aims to highlight the value of newer ultrasound imaging techniques in identifying morphological changes of the tibial nerve in the patients with diabetic peripheral neuropathy. Patients and Methods During a period of ten months duration started in November 2019, 40 subjects were enrolled in this study. 20 diabetic patients with clinical manifestations of DPN had undergone nerve conduction study of both lower limbs then compared to 20 healthy control subjects as regard the ultrasound examination of TN bilaterally. The study was conducted according to the stipulations of the ASU ethical and scientific committee. The privacy of participants and confidentiality of data were guaranteed during the various phases of the study. Results We found that the cross sectional area (CSA) in patients with diabetic peripheral neuropathy (DPN) is significantly larger than the healthy controls. A positive significant correlation was found between CSA and duration of diabetes, HbA1c% and tibial nerve (TN) latency while a negative significant correlation was found with TN amplitude and conduction velocity. Conclusion Despite giving significantly larger values in cases than controls, MTNF was found to non-significantly correlated with all studied parameters. In view of the above data, CSA can be adopted as a reliable screening and diagnostic tool for DPN but further work-up is needed to assess its role in the follow up of the disease process. On the other hand, MTNF can be used for description of the morphological changes in a diabetic nerve.

POCUS OBTAINED OPTIC NERVE SHEATH DIAMETER IN PATIENTS PRESENTING WITH INTRACEREBRAL HEMORRHAGE

TOPIC: Critical Care TYPE: Original Investigations PURPOSE: Intracerebral hemorrhage (ICH) results in spontaneous bleeding into the brain. This accounts for 10-15% of all strokes in the United States and has poor outcomes due to death or disability. An ICH can result in increased intracranial pressure due to blood occupying extra space. Optic nerve ultrasonography has emerged as a quick noninvasive procedure to detect increased intracranial pressure. A question that has not been answered is whether there is a specific correlation between the size of hematoma in the brain and the optic nerve sheath diameter (ONSD). The optic nerve is wrapped by a sheath derived from the meninges. Cerebrospinal fluid (CSF) can transfer freely between the intracranial and intraorbital spaces. METHODS: 23 patients were recruited into this study. Each of these patient’s received the diagnosis of ICH and admitted to the neuro intensive care unit (NICU). Ultrasound of the optic nerve was performed using a Sonosite machine and the high frequency probe. The exam was performed upon admission to the NICU. Both eyes were scanned in two planes, longitudinal and transverse. Once the ONSD measurements were recorded, the volume of the ICH was noted on initial head CT. RESULTS: The average ICH score was 1.35 and the average APACHE IV score was 27.35. In addition, the average GCS on admission was 13. The most common cause of ICH was hypertension. The most common location for the ICH was lobar hemorrhage. 8 out of 23 patients had midline shift on their initial head CT. 4 out of 23 patients underwent some sort of surgical intervention. The smallest average combined ONSD was 4.43cm. The longest average combined ONSD was 8.03cm. The minimum hemorrhage volume was 0.20cm3. The maximum was 60.0cm3. A moderate, positive correlation was detected between average optic nerve size and hemorrhage volume (correlation=0.5262; p-value=0.0099). A weak positive correlation was detected between APACHE IV and average ONSD (correlation=0.2052; p-value=0.3476). A weak-moderate positive correlation was detected between ICH score and average ONSD. (correlation=0.3622; p-value=0.0895). Those who experienced a midline shift had significantly higher averaged ONSD compared to those who did not. CONCLUSIONS: This study determined there was a moderate positive correlation between the ONSD and volume of hematoma. From a pathophysiological standpoint, conditions like ICH lead to cerebral parenchyma swelling which is transmitted to the optic nerves through the meninges. Additionally, our study revealed a significant difference in average ONSD and midline shift observed on CT scan. In settings where no invasive monitoring is available, ONSD enlargement may be a useful technique for monitoring midline shift. CLINICAL IMPLICATIONS: There are already established prognostic indicators for ICH including an ICH volume of 60cm3or greater on initial CT along with a GCS of 9 or less which predict a 30 day mortality of 19%. ONSD has a role in prognostication. Growth of the hematoma in the first 24 hours is an independent predictor of mortality and poor outcome. Serial exams of a patients ONSD can be applied to indirectly monitor any expanding hematoma. Given the positive correlation between ONSD and hematoma volume, I would be interested in ONSD and the degree of disability scores such as the modified rankin scale. DISCLOSURES: No relevant relationships by Braden Anderson, source=Web Response No relevant relationships by Shekhar Ghamande, source=Web Response No relevant relationships by Sarita Kambhampati, source=Web Response No relevant relationships by Matthew Lohse, source=Web Response No relevant relationships by Alireza Nathani, source=Web Response

Functional reconstruction in traumatic paralysis

Traumatic nerve injuries are associated with ahigh morbidity and long rehabilitation times. The extent of anerve lesion and the related regeneration potential can often only be estimated during the course, whereby the time window for successful surgical interventions is limited. The incidence and distribution of traumatic nerve lesions are reported. Algorithms for treatment decisions are presented. Statistics from the German TraumaRegister DGU® as well as international registers were evaluated. The results of basic research and expert recommendations for diagnostics and treatment are discussed. A strategic approach to conservative and surgical treatment of traumatic nerve injuries depending on the extent of injury and resulting regeneration potential is recommended. In conjunction with the clinical course, electrophysiology and imaging diagnostics, e.g. nerve sonography, can help to differentiate between neurapraxia, axonotmesis and neurotmesis.

Normative Values for the Sonographic Measurement of the Pediatric Median and Ulnar Nerves

Ultrasound investigation of peripheral nerves, long used in the adult population, has been shown to be of value in diagnosing a variety of peripheral nerve abnormalities. More recently, nerve sonography has also been shown to be of use in pediatrics. However, normative values for nerve size in children have been lacking. As such, the goal of this research was to establish normative data for cross sectional area (CSA) measurements of the median and ulnar nerves in children. The median and ulnar nerves of 48 children ranging in age from 2 years to 17 years were imaged by ultrasound. CSA measurements were made at 2 separate sites for each nerve and measured independently by 6 pediatric radiologists. Reliability of ultrasound measurements between the radiologists was assessed by calculating intraclass correlation coefficients. Linear mixed-effects modeling was performed to develop prediction models for nerve cross sectional area for each nerve segment; 95% prediction values were generated from these models to approximate normal ranges. Agreement in nerve cross-sectional area measurements among the 6 radiologists for all nerve segments was good (ICC 0.82, 95% CI 0.78 to 0.85). CSA for both the median and ulnar nerves is larger in older children. However, statistical models to predict CSA using height perform better rather than those using a child's age. The range of normal nerve segment CSA using these prediction models based on child height are reported. Median and ulnar nerve CSA can be reliably measured with ultrasound. Normal reference values for ulnar and median nerve CSA correlate with patient age but may be more optimally determined based on a child's height.

Peripheral nerve sonography, a novel technique for improving the diagnosis of Hansen’s neuropathy

Peripheral nerve sonography, a novel technique for improving the diagnosis of Hansen’s neuropathy