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1.
J Neuroinflammation ; 18(1): 150, 2021 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-34225736

RESUMO

BACKGROUND: Our recent studies have identified that the red nucleus (RN) dual-directionally modulates the development and maintenance of mononeuropathic pain through secreting proinflammatory and anti-inflammatory cytokines. Here, we further explored the action of red nucleus IL-33 in the early development of mononeuropathic pain. METHODS: In this study, male rats with spared nerve injury (SNI) were used as mononeuropathic pain model. Immunohistochemistry, Western blotting, and behavioral testing were used to assess the expressions, cellular distributions, and actions of red nucleus IL-33 and its related downstream signaling molecules. RESULTS: IL-33 and its receptor ST2 were constitutively expressed in the RN in naive rats. After SNI, both IL-33 and ST2 were upregulated significantly at 3 days and peaked at 1 week post-injury, especially in RN neurons, oligodendrocytes, and microglia. Blockade of red nucleus IL-33 with anti-IL-33 neutralizing antibody attenuated SNI-induced mononeuropathic pain, while intrarubral administration of exogenous IL-33 evoked mechanical hypersensitivity in naive rats. Red nucleus IL-33 generated an algesic effect in the early development of SNI-induced mononeuropathic pain through activating NF-κB, ERK, p38 MAPK, and JAK2/STAT3, suppression of NF-κB, ERK, p38 MAPK, and JAK2/STAT3 with corresponding inhibitors markedly attenuated SNI-induced mononeuropathic pain or IL-33-evoked mechanical hypersensitivity in naive rats. Red nucleus IL-33 contributed to SNI-induced mononeuropathic pain by stimulating TNF-α expression, which could be abolished by administration of inhibitors against ERK, p38 MAPK, and JAK2/STAT3, but not NF-κB. CONCLUSIONS: These results suggest that red nucleus IL-33 facilitates the early development of mononeuropathic pain through activating NF-κB, ERK, p38 MAPK, and JAK2/STAT3. IL-33 mediates algesic effect partly by inducing TNF-α through activating ERK, p38 MAPK and JAK2/STAT3.


Assuntos
Interleucina-33/biossíntese , Janus Quinase 2/biossíntese , Mononeuropatias/metabolismo , Neuralgia/metabolismo , Núcleo Rubro/metabolismo , Fator de Transcrição STAT3/biossíntese , Animais , Sistema de Sinalização das MAP Quinases/fisiologia , Masculino , Mononeuropatias/patologia , Neuralgia/patologia , Ratos , Ratos Sprague-Dawley , Núcleo Rubro/patologia , Fator de Necrose Tumoral alfa/biossíntese , Proteínas Quinases p38 Ativadas por Mitógeno/biossíntese
3.
Muscle Nerve ; 63(1): 104-108, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33094511

RESUMO

BACKGROUND: Multiple mononeuropathy is a rare presentation of primary (AL) amyloidosis and nerve biopsy is usually needed for diagnosis. Conventional imaging is useful to identify proximal nerve involvement but may be inadequate. We report a patient with multiple mononeuropathy whose presentation was suggestive of AL amyloid neuropathy and in whom repeated tissue biopsies were negative for amyloid (including two sensory nerves and one muscle). METHODS: The patient underwent magnetic resonance imaging (MRI) and whole body 18 F-florbetapir positron emission tomography (PET)/MRI. RESULTS: Whole body 18 F-florbetapir PET/MRI revealed abnormal low-level florbetapir uptake in the right proximal tibial and peroneal nerves, which provided a target for a sciatic bifurcation fascicular nerve biopsy that was diagnostic of AL amyloidosis. CONCLUSIONS: 18 F-florbetapir PET/MRI imaging is a promising diagnostic tool for patients with suspected peripheral nerve amyloidosis (including multiple mononeuropathy) in whom conventional imaging and nerve and muscle biopsies miss the pathology.


Assuntos
Neuropatias Amiloides/patologia , Amiloidose/patologia , Compostos de Anilina/farmacologia , Etilenoglicóis/farmacologia , Mononeuropatias/patologia , Neuropatias Amiloides/diagnóstico , Amiloidose/diagnóstico , Biópsia/métodos , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Mononeuropatias/diagnóstico , Procedimentos Neurocirúrgicos , Tomografia por Emissão de Pósitrons/métodos
5.
Rinsho Shinkeigaku ; 59(9): 604-606, 2019 Sep 25.
Artigo em Japonês | MEDLINE | ID: mdl-31474645

RESUMO

A 68-year-old woman with a medical history of interstitial pneumonia associated with systemic sclerosis (SSc) presented with numbness of the lower limbs and left drop foot. She was diagnosed with multiple mononeuropathy based on the laterality of her symptoms, muscle weakness, thermal hypoalgesia, and nerve conduction study findings. Left sural nerve biopsy showed vasculitis, and steroid therapy was effective. This case highlights the importance of histopathological assessment to select an appropriate treatment strategy.


Assuntos
Biópsia , Glucocorticoides/administração & dosagem , Mononeuropatias/etiologia , Mononeuropatias/patologia , Prednisolona/administração & dosagem , Escleroderma Sistêmico/complicações , Nervo Sural/patologia , Vasculite/complicações , Idoso , Feminino , Humanos , Mononeuropatias/diagnóstico , Mononeuropatias/tratamento farmacológico , Condução Nervosa , Resultado do Tratamento
7.
J Neurol ; 264(6): 1218-1226, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28536920

RESUMO

Multiple mononeuropathy (MM) occurs rarely during systemic lupus erythematosus (SLE) but may lead to major disability. The aim of this study was to investigate the clinic-pathological presentations of MM during SLE, as well as long-term outcomes. We conducted a multicentric retrospective study that included patients receiving a diagnosis of MM during SLE. Ten patients were included (8 women and 2 men, median age at MM diagnosis: 40.4 years). SLE was diagnosed before MM in 9/10 patients (median time 8.2 years). When MM occurred, the SLEDAI score was ≥6 for 6/9 patients. Presenting symptoms consisted of sensory deficits (n = 10), neuropathic pain (n = 9), and/or motor deficits (n = 9), sometimes symmetrical, affecting the lower limbs (10/10) and occasionally the upper limbs (5/10). All patients presented with uni- or bilateral damage of the common fibular nerve, with less frequent involvement of the tibial nerve. Serum cryoglobulinemia was positive in 5/9 patients. Electrophysiological studies confirmed the non-symmetrical involvement of multiple nerve trunks in all patients. Neuromuscular biopsy (performed in five patients) showed histological signs of vasculitis in two patients and perivascular lymphocytic inflammatory infiltrates in two others. All patients were treated with glucocorticosteroids combined with cyclophosphamide (n = 6), rituximab (n = 3), or mycophénolate-mofétil (n = 1). The median follow-up was 5 years. Two patients relapsed during follow-up. All patients had motor and/or sensory sequelae upon follow-up. MM associated with SLE is frequently caused by a vasculitis mechanism. Patients improve with steroids and immunosuppressive drugs. Long-term outcomes include frequent clinical sequelae and possible relapses.


Assuntos
Lúpus Eritematoso Sistêmico/complicações , Mononeuropatias/complicações , Adolescente , Corticosteroides/uso terapêutico , Adulto , Proteína C-Reativa/metabolismo , Eletromiografia , Feminino , Seguimentos , Humanos , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Lúpus Eritematoso Sistêmico/patologia , Masculino , Pessoa de Meia-Idade , Mononeuropatias/tratamento farmacológico , Mononeuropatias/patologia , Condução Nervosa/fisiologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Adulto Jovem
8.
Rinsho Shinkeigaku ; 57(6): 307-310, 2017 06 28.
Artigo em Japonês | MEDLINE | ID: mdl-28552872

RESUMO

A 55-year-old man was admitted with paralysis of the left lower leg. He had purpura in the left lower extremity for three years, left calf pain for two years, and dysesthesia in the left plantar region and first toe for one year. A physical examination revealed livedo reticularis on the left leg and mononeuritis multiplex was diagnosed in the bilateral tibial and left peroneal nerve area. Anti-neutrophil cytoplasmic antibody was negative. A nerve conduction study showed decreased amplitude of compound muscle-action potential in the bilateral tibial and the left peroneal nerve, sensory nerve action potential in the bilateral sural nerve. A skin biopsy revealed inflammatory cells on blood vessel walls and cutaneous arteritis was diagnosed. Cyclophosphamide pulse therapy with steroid and anti-coagulation improved the neurological symptoms. A skin biopsy should be considered when patients present with mononeuritis multiplex in the lower extremities and cutaneous findings such as livedo reticularis in the symptomatic area.


Assuntos
Arterite/complicações , Biópsia , Mononeuropatias/diagnóstico , Mononeuropatias/etiologia , Pele/irrigação sanguínea , Pele/patologia , Anticoagulantes/administração & dosagem , Arterite/tratamento farmacológico , Arterite/patologia , Ciclofosfamida/administração & dosagem , Diagnóstico Diferencial , Humanos , Masculino , Metilprednisolona/administração & dosagem , Pessoa de Meia-Idade , Mononeuropatias/tratamento farmacológico , Mononeuropatias/patologia , Prednisolona/administração & dosagem , Pulsoterapia , Resultado do Tratamento
9.
AJR Am J Roentgenol ; 208(1): W1-W10, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27824488

RESUMO

OBJECTIVE: The purpose of this article is to review advanced MRI techniques and describe the MRI findings of pure sensory mononeuropathy with relevant clinical and anatomic correlation. CONCLUSION: Peripheral sensory mononeuropathy can be challenging to evaluate with MRI because of the small caliber of pure sensory nerves and the lack of changes in secondary muscular denervation. Advances in MRI afford the necessary signal-intensity contrast and resolution for adequate evaluation of many of these small peripheral nerves.


Assuntos
Aumento da Imagem/métodos , Imageamento por Ressonância Magnética/métodos , Mononeuropatias/diagnóstico por imagem , Nervos Periféricos/diagnóstico por imagem , Distúrbios Somatossensoriais/diagnóstico por imagem , Humanos , Mononeuropatias/patologia , Nervos Periféricos/patologia , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Distúrbios Somatossensoriais/patologia
10.
J Neuroimmunol ; 297: 81-91, 2016 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-27397080

RESUMO

Contradictory results have been reported regarding the role of inflammatory mediators in the central nervous system in mediating neuropathic pain and inflammatory hyperalgesia following peripheral nerve injury or localized inflammation. The present study aims to correlate between the mRNA expression and protein secretion of proinflammatory cytokines and nerve growth factor (NGF), in the dorsal root ganglia (DRGs), spinal cord, brainstem and thalamus, and pain-related behavior in animal models of peripheral mononeuropathy and localized inflammation. Different groups of rats (n=8, each) were subjected to either lesion of the nerves of their hindpaws to induce mononeuropathy or intraplantar injection of endotoxin (ET) and were sacrificed at various time intervals. TNF-α, IL-1ß and NGF mRNA expression and protein levels in the various centers involved in processing nociceptive information were determined, by RT-PCR and ELISA. Control groups were either subjected to sham surgery or to saline injection. Mononeuropathy and ET injection produced significant and sustained increases in the mRNA expression and protein levels of TNF-α, IL-1ß and NGF in the ipsilateral and contralateral DRGs, spinal cord, and brainstem. No significant and consistent changes in the mRNA expression of cytokines were noticed in the thalamus, while a downregulation of the NGF-mRNA level was observed. The temporal and spatial patterns of the observed changes in mRNA expression of cytokines and NGF are not closely in phase with the observed allodynia and hyperalgesia in the different models, suggesting that the role of these mediators may not be reduced exclusively to the production and maintenance of pain.


Assuntos
Encéfalo/metabolismo , Citocinas/metabolismo , Regulação da Expressão Gênica/fisiologia , Inflamação/patologia , Mononeuropatias/patologia , Animais , Encéfalo/patologia , Modelos Animais de Doenças , Endotoxinas/toxicidade , Hiperalgesia/etiologia , Inflamação/induzido quimicamente , Mediadores da Inflamação/metabolismo , Lipopolissacarídeos/toxicidade , Mononeuropatias/complicações , Fator de Crescimento Neural/metabolismo , Medição da Dor , RNA Mensageiro/metabolismo , Ratos , Ratos Sprague-Dawley , Fatores de Tempo
11.
Rinsho Shinkeigaku ; 55(12): 897-903, 2015.
Artigo em Japonês | MEDLINE | ID: mdl-26511022

RESUMO

The patient was a 78-year-old man. Three years before admission, he developed transient peripheral neuropathy and purpura, and at admission, he presented with livedo reticularis of both his lower extremities and with mononeuritis multiplex. Vasculitis was not observed, and antiphospholipid antibodies were detected. The nerve and skin biopsies revealed no inflammation; axonal degeneration accompanied by thrombi was found in his arterioles and venules. Based on these findings, he was diagnosed with ischemic peripheral neuropathy due to primary antiphospholipid syndrome. Administration of anticoagulant therapy resulted in an improvement in symptoms; however, two months later, a relapse occurred, and the patient contracted an infection while undergoing immunosuppressive therapy. The infection became fulminant, and the patient succumbed to multiple organ failure. The autopsy revealed a systemic arterial and venous embolism; however, no vasculitis was observed. Antiphospholipid syndrome, which is responsive to antithrombotic treatment, should be considered as a differential diagnosis of mononeuritis multiplex.


Assuntos
Síndrome Antifosfolipídica/complicações , Síndrome Antifosfolipídica/patologia , Mononeuropatias/etiologia , Mononeuropatias/patologia , Trombose/etiologia , Idoso , Síndrome Antifosfolipídica/diagnóstico , Síndrome Antifosfolipídica/tratamento farmacológico , Arteríolas/patologia , Autorradiografia , Axônios/patologia , Diagnóstico Diferencial , Evolução Fatal , Fibrinolíticos/uso terapêutico , Humanos , Imunossupressores/uso terapêutico , Masculino , Mononeuropatias/diagnóstico , Mononeuropatias/tratamento farmacológico , Insuficiência de Múltiplos Órgãos/etiologia , Degeneração Neural , Vasculite , Vênulas/patologia
14.
Muscle Nerve ; 49(3): 443-5, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24531991

RESUMO

INTRODUCTION: Isolated sural mononeuropathy is rare and frequently constitutes a diagnostic challenge. METHODS: This investigation was a retrospective study of sural neuropathy at a single electrodiagnostic center. RESULTS: Our study included 36 patients with sural neuropathy, the largest sample so far reported. Non-surgical, non-traumatic etiologies account for 50% of the cases, including 7 patients with inflammatory or vasculitic conditions. Routine sural conduction study was positive in 34 of 36 patients, whereas a distal recording method was used to verify the diagnosis of sural mononeuropathy in 2 patients. Most (58%) patients did not require specific treatment, but persistent sensory symptoms were seen in a minority of cases. Sural nerve biopsy in 1 patient helped diagnostic and treatment planning. CONCLUSIONS: Sural mononeuropathy has distinct etiologic, clinical, and electrophysiological features. Recognition can be beneficial in treating patients with sensory symptoms involving the distal lower extremity.


Assuntos
Mononeuropatias/patologia , Nervo Sural/patologia , Nervo Sural/fisiopatologia , Adulto , Idoso , Estimulação Elétrica , Eletrodiagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Condução Nervosa/fisiologia
15.
Hum Pathol ; 45(2): 427-30, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24289971

RESUMO

We describe a 54-year-old man with mononeuritis multiplex and reactive lymphoid hyperplasia with increased immunoglobulin G4 (IgG4)-positive cells. Asymmetrical numbness and weakness had advanced stepwise for 6 years. Serum immunoglobulin G, IgG4, and immunoglobulin E levels were elevated, whereas M protein was not detected. Chest and abdominal computed tomography showed generalized lymphadenopathy. Inguinal lymph node biopsy revealed expansion of the interfollicular area with infiltration of IgG4-positive cells, of which the absolute number was greater than 100 per high-power field, and the percentage of IgG4+/immunoglobulin G+ plasma cells was 33%. Sural nerve biopsy disclosed axonal neuropathy with tumefactive lymphoid infiltrate in epineurium, but IgG4-positve plasma cells and fibrosis were not detected. Symptoms and laboratory data were improved with oral glucocorticoid therapy at a dose of 0.6 mg/kg per day. Although the causal mechanisms of neuropathy should be determined in future studies, peripheral nerve involvement may occur in patients with reactive lymphoid hyperplasia with increased IgG4-positive cells.


Assuntos
Imunoglobulina G/sangue , Mononeuropatias/patologia , Pseudolinfoma/patologia , Biópsia , Humanos , Doenças Linfáticas/patologia , Masculino , Pessoa de Meia-Idade , Plasmócitos/metabolismo
16.
BMJ Case Rep ; 20132013 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-24000206

RESUMO

B-cell prolymphocytic leukaemia (BPLL) is a haematological malignancy defined as lymphocytosis and splenomegaly with >55% circulating cells being clonal prolymphocytes of B-cell origin. The evolution of this disease is more aggressive than chronic lymphocytic leukaemia. We reported a case of a 62-year-old man with BPLL who, on treatment, attained cytological, immunophenotypic and complete cytogenetic remission. He subsequently developed an asymmetric sensorimotor neurological disorder, suggestive of lymphomatous infiltration (neurolymphocytosis). Repetition of the MRI and the electromyography was essential for diagnosis. Progressive mononeuritis multiplex in B-cell leukaemias/lymphomas is rare and may be the only presenting symptom of relapsed or progressive disease. Repeat imaging studies based on judicious evaluation of the clinical scenario for exclusion of other causes of neurological symptoms is necessary. This can be challenging in patients with long-standing malignancies who have received multiple courses of chemotherapy and/or radiotherapy.


Assuntos
Leucemia Prolinfocítica Tipo Células B , Mononeuropatias , Eletromiografia , Humanos , Leucemia Prolinfocítica Tipo Células B/complicações , Leucemia Prolinfocítica Tipo Células B/diagnóstico , Leucemia Prolinfocítica Tipo Células B/patologia , Masculino , Pessoa de Meia-Idade , Mononeuropatias/diagnóstico , Mononeuropatias/etiologia , Mononeuropatias/patologia , Neoplasias do Sistema Nervoso/complicações , Neoplasias do Sistema Nervoso/diagnóstico
17.
Skeletal Radiol ; 42(6): 853-8, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23455707

RESUMO

The authors report an unusual case of radial mononeuropathy caused by epithelioid sarcoma and describe the anatomical 3-Tesla MR neurography and the functional diffusion tensor imaging findings of the case, which were subsequently confirmed on surgical excision and histopathology.


Assuntos
Técnicas de Diagnóstico Neurológico , Imagem de Difusão por Ressonância Magnética/métodos , Nervo Radial/patologia , Neuropatia Radial/etiologia , Neuropatia Radial/patologia , Sarcoma/complicações , Sarcoma/patologia , Diagnóstico Diferencial , Humanos , Masculino , Mononeuropatias/etiologia , Mononeuropatias/patologia , Adulto Jovem
18.
Pract Neurol ; 13(1): 39-41, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23315459

RESUMO

A middle-aged man of South Asian decent presented with a 4-month history of bilateral sensory disturbance affecting the median nerve distribution and dorsum of both feet. Neurological examination was otherwise normal. A patchy absence of sensory responses was noted on nerve conduction studies and electromyogram (NCS/EMG). Over the next 3 months sensory symptoms progressed to involve median, radial, ulnar, sural and peroneal nerves bilaterally. Repeat NCS/EMG confirmed a mononeuritis multiplex predominantly involving the sensory fascicles. Areas of hypopigmentation, a right-lower motor facial weakness and ophthalmic branch trigeminal nerve involvement were noted on examination. Punch skin biopsy as well as sural nerve biopsy demonstrated chronic granulomatous inflammation without evidence of Mycobacterium. A slit skin smear test demonstrated Mycobacterium leprae consistent with a diagnosis of primary neuritic leprosy. In the appropriate clinical context, leprosy should be included in the differential diagnosis of mononeuritis multiplex.


Assuntos
Mononeuropatias , Eletromiografia , Humanos , Masculino , Nervo Mediano/patologia , Nervo Mediano/fisiopatologia , Pessoa de Meia-Idade , Mononeuropatias/tratamento farmacológico , Mononeuropatias/patologia , Condução Nervosa/fisiologia , Exame Neurológico
19.
Clin Radiol ; 68(3): 317-22, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-22959851

RESUMO

Different conditions that may lead to enlarged nerves or nerve roots include hereditary motor and sensory neuropathy (HMSN), neurofibromatosis (NF) type 1, chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), and intraneural perineurioma. Differential diagnosis of hypertrophic mono- and polyradiculopathies remains challenging but is important because of different treatments and prognosis. Magnetic resonance imaging (MRI) can identify the hypertrophic nerve segments and guide a fascicular biopsy. A fascicular biopsy will often be necessary for precise diagnosis.


Assuntos
Imageamento por Ressonância Magnética/métodos , Mononeuropatias/diagnóstico , Polineuropatias/diagnóstico , Biópsia , Meios de Contraste , Diagnóstico Diferencial , Humanos , Mononeuropatias/patologia , Polineuropatias/patologia
20.
Acta Reumatol Port ; 38(4): 286-9, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24435033

RESUMO

We describe a patient with severe multiple mononeuropathy associated with hypereosinophilia, asthma and pulmonary non cavitating micronodules. Sural nerve biopsy revealed marked perineural thickening and microfasciculation with inflammatory infiltrates in the perinerium and in the epinerium. The patient markedly improved with steroid therapy. Our final diagnosis was Churg-Strauss related multiple mononeuropathy. Thus, we report a case of Churg-Strauss related multiple mononeuropathy with uncommon pathological findings on sural nerve and we underline the importance of clinical evaluation for this diagnosis.


Assuntos
Síndrome de Churg-Strauss/complicações , Síndrome de Churg-Strauss/patologia , Mononeuropatias/complicações , Mononeuropatias/patologia , Nervo Sural/patologia , Biópsia , Feminino , Humanos , Pessoa de Meia-Idade
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