1998 AFIP Course
نویسنده
چکیده
The decision to biopsy peripheral nerve should begin with a discussion between the requesting clinician and neuropathologist regarding the differential diagnosis since specialized procedures or an unusual sampling scheme may be required. Nerve biopsy has been shown to contribute to the diagnosis of primary and secondary neoplastic, ischemic (especially vasculitidies, particularly those confined to nerve), hereditary (Charcot-Marie-Tooth, HNPP, giant axonal neuropathy), dysimmune (GBS, CIDP, paraprotein), infectious (leprosy, Herpes zoster, HIV, Lyme borreliosis), metabolic (amyloidosis), toxic (glue-sniffer’s neuropathy, amiodarone) and other (sarcoid) processes. However, chronic idiopathic axonal polyneuropathy is a common entity in older patients and a significant public health problem in which a definitive diagnostic entity may not be identified. Analysis of nerve conduction studies on 3,969 patients determined by neurologists to have a normal neurologic examination showed some 24% of individuals aged 70–79 years had absent sural sensory responses (and less than 1% younger than 50, Rivner et al, 2001), the former typically showing axonal degeneration. Nerve biopsy is typically more helpful in patients with distal, acute, demyelinating, asymmetric, and multifocal types of neuropathy than in those with chronic, symmetric axonal types which often have metabolic, toxic or inherited etiologies. Based on the identification of likely or defined hereditary neuropathy in a family, genetic tests may replace nerve biopsy in the evaluation of family members.
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