Brain, Vol. 119, No. 4, 1091-1098, 1996
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research-article |
Contribution of never biopsy findings to the diagnosis of disabling neuropathy in the elderly
A retrospective review of 100 consecutive patients
1Service de Neurologie and Laboratoire Louis Ranvier France 2Laboratoire de Neuropathologie, Centre hospitalo Universitaire de Bicêtre, Assistance Publique, Hôpitaux de Paris France
Correspondence to:
Correspondence to: Dr G. Said, Service de Neurologie, CHU de Bicêtre, 94275 Le Kremlin Bicê France
Peripheral neuropathy is an important factor disability in the elderly. Inorder to learn more on the usefulness of intensive evaluation of patients over 65 years of age with subacute or chronic disabling peripheral neuropathy, we reviewed the clinical and nerve biopsy findings of the last 100 patients of this age group who suffered from a peripheral neuropathy severe enough to justify performance of a nerve biopsy for a diagnostic or prognostic purpose. Normal nerve biopsy findings led to the diagnosis of lower motor neuron disease inthree patients and pointed to lesions of the spinal roots in six other patients. Necrotizing arteritis was demonstrated in the biopsy specimens of 23 patients, and non-necrotizing vasculitis in five. In five additional patients the diagnosis of vasculitic neuropathy was kept in spite of non-contributive biopsy findings. In two diabetic patients who had a multifocal meuropathy the biopsy also revealed the presence of vasculitis. Thus 35% of the patients included in this series had one form or another of vasculitic neuropathy. Fourteen patients ahd a chronic inflammatory demyelinating polyneuropathy. In 11 patients the neuropathy was associated with monoclonal gammopathy, which was benign in nine and associated with malignant plasma cell dyscrasia in two. Among the six patients with diabetes mellitus, two patients who presented witha multifocal neuropathy were found to have vasculitis in the nerve specimen; in the others the biopsy was performed because of uncommonly serve diabetic neuropathy. Six patients suffered from a long-lasting disability secondary to a drug-induced neuropathy. The remaining 15% had neuropathies of different origin, including amyloidosis, lepromatous leprosy, carcinomatous neuropathy and alcoholic neuropathy, Six patients had a mild, non-progressive or slowly progressive axonopathy of unknown origin, ageing of the peripheral nervous system may have played a role in its development. Our findings show that vasculitis is an important and treatable cause of disabling neuropathy in the elderly and that the proportion of patients with severe neuropathy of unknown origin is small.
peripheral neuropathy; elderly; vasculitis; nerve biopsy
Received November 27, 1995. Revised March 18, 1996. Accepted April 10, 1996.
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