19: NM US of Polyneuropathy, MND, and Myopathy

Question 1

What can be seen with chronic demyelinating polyneuropathies?

Answer 1

Onion bulbs;
thickened peripheral nerves and hypertrophic neuropathy

Question 2

What is seen on US with CMT1A?

Answer 2

Symmetrically diffusely enlarged nerves

Question 3

What to look for with chronic acquired demyelinating polyneuropathies?

Answer 3

Classically look for enlarged segments of the nerve;
can evaluate the median nerves in the forearms and bilateral trunks of the brachial plexus

Question 4

How to differentiate CIDP from AIDP on U/S?

Answer 4

Classically the amount of enlargement in nerves is not as marked in AIDP relative to CIDP

Question 5

What is seen with folks who have diabetic polyneuropathy on U/S with regards to nerve change?

Answer 5

Nerve CSA’s still fall WNL at non-entrapment sites

Question 6

What is seen with nerves in acromegaly? Leprosy?

Answer 6

Diffuse enlargement of nerve CSA, particularly with median and ulnar nerves;
ulnar nerve CSA enlarged with focal thickening, increased vascularity and increased epineurial thickness

Question 7

How can U/S be helpful to potentially evaluate someone with ALS?

Answer 7

Evaluate for fasciculations in the deep and superficial muscles, as well as the tongue

Question 8

As muscle fibers shrink, this results in a hyper/hypoechoic appearance of muscle

Answer 8

Hyper (more connective tissue than muscle)

Question 9

With muscular dystrophy vs. immune myopathies, what can be seen on U/S?

Answer 9

Diffuse homogeneously increased echogenicity with attenuation of the ultrasound beam (less bone shadow), whereas in the latter there is no attenuation of the U/S beam.

Question 10

What appearance does denervation atrophy have on U/S?

Answer 10

Moth-eaten appearance

Question 11

Qualitative Muscle Scoring Scale name?

Answer 11

Heckmatt