Document Detail

Progressive idiopathic axonal neuropathy--a comparative clinical and histopathological study with vasculitic neuropathy.
MedLine Citation:
PMID:  15015005     Owner:  NLM     Status:  MEDLINE    
Patients with a progressive disabling idiopathic axonal neuropathy could have a potentially treatable immune mediated neuropathy. To evaluate whether progressive idiopathic axonal neuropathy could be a pathologically difficult to prove vasculitic neuropathy pathologically difficult to prove or if it could be a separate clinical entity (i. e. with the axon as the primary immunological target), we performed a comparative clinical and histopathological study in 10 patients with progressive idiopathic axonal neuropathy, 10 patients with vasculitic neuropathy, and 12 patients with chronic idiopathic axonal polyneuropathy (CIAP). The clinical features and disease course in patients with progressive idiopathic axonal neuropathy and patients with vasculitic neuropathy were similar. Six patients with progressive idiopathic axonal neuropathy had been treated with prednisone and/or intravenous immunoglobulin. Disability decreased in all these six patients, but also in two of the four non-treated patients. Upon reviewing the sural nerve biopsy specimens, vasculitis was found in one patient with progressive idiopathic axonal neuropathy. Vasculitis-associated signs of ischemic injury or inflammation (most notably: large variation in fascicular axonal degeneration, perivascular inflammation, inflammation of the blood vessel wall without lumen obstruction) were found in four patients with progressive idiopathic axonal neuropathy, in all patients with vasculitic neuropathy, but were absent in patients with CIAP. The findings show that there is a small chance of finding sural nerve vasculitis upon scrutinising biopsy examination in progressive idiopathic axonal neuropathy. The presence of vasculitis-associated signs in progressive idiopathic axonal neuropathy suggests that some of these patients could have vasculitic neuropathy, even if vasculitic lesions cannot be demonstrated. However, if inflammatory changes cannot be demonstrated this does not preclude an immune-mediated origin.
Alexander F J E Vrancken; Nicolette C Notermans; Gerard H Jansen; John H J Wokke; Gérard Said
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Journal of neurology     Volume:  251     ISSN:  0340-5354     ISO Abbreviation:  J. Neurol.     Publication Date:  2004 Mar 
Date Detail:
Created Date:  2004-03-11     Completed Date:  2004-05-19     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0423161     Medline TA:  J Neurol     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  269-78     Citation Subset:  IM    
Service de Neurologie et Laboratoire Louis Ranvier, Centre Hospitalier Universitaire de Bicêtre, Université Paris Sud XI, Le Kremlin-Bicêtre, France.
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MeSH Terms
Analysis of Variance
Disease Progression
Middle Aged
Peripheral Nervous System Diseases / drug therapy,  pathology*
Prednisone / therapeutic use
Statistics, Nonparametric
Sural Nerve / pathology
Vasculitis / drug therapy,  pathology*
Reg. No./Substance:

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