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Velocity of intraneural blood flow is increased in inflammatory neuropathies: sonographic observation
  1. Ma Alma E Carandang1,
  2. Naoko Takamatsu1,
  3. Hiroyuki Nodera1,
  4. Atsuko Mori1,
  5. Naoya Mimura2,
  6. Nobuhisa Okada2,
  7. Hisanori Kinoshita2,
  8. Akira Kuzuya2,
  9. Makoto Urushitani2,
  10. Ryosuke Takahashi2,
  11. Yuishin Izumi1,
  12. Ryuji Kaji1
  1. 1Department of Neurology, Tokushima University, Tokushima, Japan
  2. 2Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
  1. Correspondence to Dr Hiroyuki Nodera, Department of Neurology, 3-18-15 Kuramotocho, Tokushima City 770-8503, Japan; hnodera{at}tokushima-u.ac.jp

https://doi.org/10.1136/jnnp-2016-314547

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    Introduction

    Vasa nervorum is a collective term for a complex microcirculation that provides nutrients to peripheral nerves. Vasa nervorum is known to be disturbed in diabetic neuropathy, mononeuritis multiplex, vasculitic neuropathy and few cases of facial nerve paralysis.1 Sonography has been used to detect focally increased intraneural blood flow in carpal tunnel syndrome.2 In neurolymphomatosis, enlarged nerves showed qualitatively increased blood flow within the area of thickening.3 Similar findings of increased blood flow signals were observed in leprosy.4 As inflammatory vasodilation increases intraneural blood flow in an acute postdenervation period,5 we hypothesised that intraneural blood flow in inflammatory neuropathies becomes abnormal, by employing a quantitative method.

    Methods

    We conducted a prospective study from June 2015 to December 2015. Institutional Review Board approved this study. The participants signed a written consent.

    The first group was the control group, which includes healthy non-smoking participants without clinical signs by neurological examination or symptoms of a neurological disease, no known comorbidities such as hypertension, dyslipidaemia and diabetes mellitus and without a history of traumatic injuries. The second group was the inflammatory neuropathy group, which includes participants diagnosed with chronic inflammatory demyelinating polyneuropathy (CIDP), Guillain-Barré syndrome (GBS) and multifocal motor neuropathy (MMN). The third was grouped as other peripheral nerve diseases as disease control, which includes participants diagnosed with amyotrophic lateral sclerosis (ALS) and Charcot-Marie-Tooth Disease type 1A …

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    Footnotes

    • MAEC and NT contributed equally to this work.

    • Acknowledgements The authors thank Dr Takashi Kanda (Yamaguchi University) and Hitoshi Nukada (University of Otago) for valuable comments.

    • Contributors MAEC analysed the data and wrote the draft. NT performed sonography. HN planned the project, interpreted the data and edited the manuscript. AM, NM, NO, HK and AK evaluated the patients and performed electrophysiological tests. MU, RT, YI and RK edited the manuscript.

    • Funding This work was supported (in part) by Grants-in-Aid from the Research on Measures for Intractable Diseases and a Health and Labour Sciences Research Grant on Rare and Intractable Diseases (Evidence-based Early Diagnosis and Treatment Strategies for Neuroimmunological Diseases) from the Ministry of Health, Labour and Welfare of Japan.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval Tokushima University and Kyoto University Hospitals.

    • Provenance and peer review Not commissioned; externally peer reviewed.