Prospective study on usefulness of sural-nerve biopsy

Nipun Saproo; Roma Singh

doi:10.18203/2320-6012.ijrms20213939

Authors

Nipun Saproo Department of Neurology, Government Medical College and Super-Specialty Hospital Jammu, Jammu and Kashmir, India
Roma Singh Consultant Pathologist, Jammu, Jammu and Kashmir, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20213939

Keywords:

Nerve biopsy, Peripheral neuropathy, Sural nerve

Abstract

Background: Peripheral neuropathies are a heterogeneous group of disorders, but common among patients attending neurology clinics. A systematic approach, like sural nerve biopsy, is the need of the hour, for a cost effective diagnosis. Studies have shown that nerve biopsy improves treatment in up-to 60% patients. Present study was conducted to evaluate the clinical profile and usefulness of sural nerve biopsy in peripheral neuropathy.

Methods: A prospective study was conducted in the Department of Neurology in collaboration with Department of Pathology, Medanta: The Medicity, Gurugram, for a period of six months from January 2019- June 2019. Out of total 82 randomly selected patients, 43 patients were selected for nerve biopsy.

Results: Mean age in the biopsy group was 45.61±19.24 years. Duration of illness was less than 1 year in 60.5% patients. In 39.5% of cases, nerve biopsies established the diagnosis and in total 77% of cases it was worthwhile. Hansen’s disease was diagnosed in 44%, CIDP in 12%, Vasculitis in 14%, and diabetes in 7% patients. Biopsy proved more diagnostic when tingling and numbness was there. Diminished DTRs was also statistically significant symptom in biopsy favoring group. Nerve biopsy in multiple mononeuropathy (65.1%) proved more beneficial than in polyneuropathy (32.6%). Similarly, motor-sensory was a predominant presentation in 28 (65.1%) patients with nerve biopsy being more valuable.

Conclusions: Nerve biopsy, having a good diagnostic yield, can be a useful aid in cases with multiple mono-neuropathy. It can be the key to prevent long term neurological complications in patients.

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References

Patidar SP, Joshi D, Mishra VN, Chaurasia RN Ansari AZ. Diagnostic yield of sural nerve biopsy: study from a tertiary care referral centre in India. J Neurol Neurosci. 2016;6:1.

Gabriel CM, Howard R, Kinsella N, Lucas S, McColl I, Saldanha G, et al. Prospective study of the usefulness of sural nerve biopsy. J Neurol Neurosurg Psychiatr. 2000;69:442-6.

Argov Z, Steiner I, Soffer D. The yield of sural nerve biopsy in the evaluation of peripheral neuropathies. Acta Neurol Scand. 1989;79:243-5.

Hellmann DB, Laing TJ, Petri M, Whiting-O'Keefe Q, Parry GJ. Mononeuritis multiplex: the yield of evaluations for occult rheumatic diseases. Medicine (Baltimore). 1988;67:145-53.

Said G, Lacroix-Ciaudo C, Fujimura H, Blas C, Faux N. The peripheral neuropathy of necrotizing arteritis: a clinicopathological study. Ann Neurol. 1988;23:461-5.

Midroni G, Bilbao JM. Examination of the peripheral nerve biopsy. In: Midroni G, Bilbao JM, eds. Biopsy diagnosis in peripheral neuropathy. Newark, Butterworths; 1995;241-262.

Argov Z, Soffer D, Steiner I. The yield of sural nerve biopsy in the evaluation of peripheral neuropathies. Acta Neurol Scand. 1989;79:243-5.

Said G. Indications and usefulness of nerve biopsy. Arch Neurol. 2002;59(10):1532-5.

Neundörfer B, Grahmann F, Engelhardt A, Harte U. Postoperative effects and value of sural nerve biopsies: a retrospective study. Eur Neurol. 1990;30:350-2.

Oh SJ. Diagnostic usefulness and limitations of the sural nerve biopsy. Yonsei Med J. 1990;31:1-26.

Hughes RA, Adams CW, Hall S. The contribution of nerve biopsy to the management of peripheral nerve disease. J Neurol Neurosurg Psychiatr. 1990;53:714.

Talwar S, Jha PK, Tiwari VD. Neuritic leprosy: epidemiology and therapeutic responsiveness. Lepr Rev. 1992;63:263-8.

Mahajan PM, Jogaikar DG, Mehta JM. A study of pure neuritic leprosy: clinical experience. Indian J Lepr. 1996;68:137-41.

Uplekar MW, Antia NH. Clinical and histopathological observations on pure neuritic leprosy. Indian J Lepr. 1986;58:513-21.

Chia L, Fernandez A, Lacroix C, Adams D, Planté V, Said G. Contribution of nerve biopsy findings to the diagnosis of disabling neuropathy in the elderly. A retrospective review of 100 consecutive patients. Brain.1996;119:1091-98.

Barach JK. Peripheral neuropathy (PN) in elderly population (65 years and above). Neurology. 1989;39:208.

Huang CY. Peripheral neuropathy in the elderly: a clinical and electrophysiologic study. J Am Geriatr Soc. 1981;29:49-54.