Annals of Indian Academy of Neurology
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Optimizing investigations for evaluation of enlargements of the roots, plexuses and nerves: A study of 133 patients


1 Dean, Bombay Hospital and Institute of Medical Sciences, Mumbai, Maharashtra, India
2 Department of Neurology, Bombay Hospital and Institute of Medical Sciences, Mumbai, Maharashtra, India
3 Department of Radiology, Bombay Hospital and Institute of Medical Sciences, Mumbai, Maharashtra, India
4 Department of Electrophysiology, Bombay Hospital and Institute of Medical Sciences, Mumbai, Maharashtra, India
5 Consulting Neurophysician, Brain and Nerve clinic, Ahmedabad, Gujarat, India
6 Department of Neurology, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
7 Department of Pathology, Foundation for Medical Research lab, Mumbai, Maharashtra, India

Correspondence Address:
Satish Khadilkar,
Dean's Office, 1st Floor, MRC Building, Bombay Hospital Institute of Medical Sciences, 12, New Marine Lines, Mumbai - 400 020, Maharashtra
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/aian.AIAN_504_19

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.


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    -  Khadilkar S
    -  Deshmukh ND
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