Highlights
- •Demyelinating diabetic sensorimotor polyneuropathy (DDSP) can be difficult to distinguish from CIDP.
- •Nerve ultrasound shows larger nerves in CIDP than DDSP.
- •Nerve ultrasound is useful as an additional tool in differentiating CIDP from DDSP.
Abstract
Diabetic patients with poor glycaemic control can demonstrate demyelinating distal
sensorimotor polyneuropathy (D-DSP) on electrophysiology. Distinguishing D-DSP from
chronic inflammatory demyelinating polyneuropathy (CIDP) can be challenging. In this
study, we investigated the role of nerve ultrasound in differentiating the two neuropathies.
Nerve ultrasound findings of D-DSP patients (fulfilling the electrophysiological but
not clinical criteria for CIDP) were compared with non-diabetic CIDP patients (fulfilling
both criteria). We studied 108 and 95 nerves from 9 D-DSP and 10 CIDP patients respectively.
CIDP patients had significantly larger cross-sectional areas of the median nerve at
the mid-arm (17.0 ± 12.5 vs 8.7 ± 2.6; p = 0.005), ulnar nerve at the wrist (7.3 ± 3.1
vs 4.1 ± 1.0; p = 0.001), mid forearm (8.8 ± 5.3 vs 5.5 ± 1.5; p = 0.002) and mid-arm
(14.5 ± 14.1 vs 7.5 ± 1.9; p = 0.013), and radial nerve at mid forearm (4.1 ± 2.4
vs 1.2 ± 0.4; p < 0.001). In comparison to D-DSP, CIDP patients had markedly larger
nerves at the proximal and non-entrapment sites of the upper limbs, suggesting that
nerve ultrasound is useful in differentiating the two neuropathies.
Keywords
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Article info
Publication history
Published online: August 22, 2018
Accepted:
August 13,
2018
Received:
May 2,
2018
Identification
Copyright
© 2018 Elsevier Ltd. All rights reserved.
