title: Normalization of sonographical multifocal nerve enlargements in a MADSAM patient following a good clinical response to intravenous immunoglobulin.
abstract: Focal nerve enlargements at sites of conduction blocks can be visualized sonographically in patients with multifocal acquired demyelinating sensory and motor neuropathy (MADSAM). However, little is known about association between nerve morphological changes and treatment responses. Here we present a 73-year-old female MADSAM patient whose sonographical multifocal nerve enlargements normalized following a good treatment response. She was admitted to our department with progressive asymmetrical muscle weakness and sensory disturbances for 6 months. Ultrasonography revealed multifocal nerve enlargements at sites of electrophysiological demyelination. Intravenous immunoglobulin improved her symptoms and electrophysiological abnormalities. Six months later, ultrasonography revealed normalization of multifocal nerve enlargements. Contrary to our observations, one previous report described a MADSAM patient with persistent nerve enlargements at the sites of resolved conduction blocks. In this earlier patient, however, the time from onset to remission was approximately 30 months. Morphological changes of nerve enlargements in MADSAM may vary with treatment response.
authors.affiliation: Department of Neurology, Tenri Hospital, Tenri, Japan. Electronic address: tanaka19830311kanta@gmail.com.
authors.forename: Kanta
authors.initials: K
authors.lastname: Tanaka
authors.affiliation: Department of Clinical Pathology, Tenri Hospital, Tenri, Japan.
authors.forename: Natsuko
authors.initials: N
authors.lastname: Ota
authors.affiliation: Department of Clinical Pathology, Tenri Hospital, Tenri, Japan.
authors.forename: Yuzuru
authors.initials: Y
authors.lastname: Harada
authors.affiliation: Department of Neurology, Tenri Hospital, Tenri, Japan.
authors.forename: Ikko
authors.initials: I
authors.lastname: Wada
authors.affiliation: Department of Neurology, Tenri Hospital, Tenri, Japan.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Suenaga
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007155:Immunologic Factors / Q000627:therapeutic use*; D008475:Median Nerve / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011115:Polyneuropathies / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome; D014459:Ulnar Nerve / Q000000981:diagnostic imaging* / Q000503:physiopathology; D014463:Ultrasonography
chemical_list: D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors
keywords: Conduction block; Demyelinating polyneuropathies; MADSAM neuropathy; Multifocal nerve enlargements; Nerve echogenicity; Peripheral nerve ultrasound