Ultrasonography of MADSAM neuropathy: Focal nerve enlargements at sites of existing and resolved conduction blocks Erika Scheidl, Josef Böhm, Magdolna.

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Ultrasonography of MADSAM neuropathy: Focal nerve enlargements at sites of existing and resolved conduction blocks Erika Scheidl, Josef Böhm, Magdolna Simó, Csilla Rózsa, Benjamin Bereznai, Tibor Kovács, Zsuzsanna Arányi Neuromuscular Disorders Volume 22, Issue 7, Pages 627-631 (July 2012) DOI: 10.1016/j.nmd.2012.03.005 Copyright © 2012 Elsevier B.V. Terms and Conditions

Fig. 1 (A) Left ulnar nerve. The first nerve conduction study (June 2009) shows a conduction block on the forearm (scale/div: 5mV – 3ms). The second nerve conduction study (May 2011) shows resolution of the conduction block (scale/div: 5mV – 5ms). Ultrasound (May 2011) shows focal enlargement of the nerve on the forearm (arrow), corresponding to the site of the previous conduction block: the longitudinal nerve diameter increases from 1.8mm to 2.6mm, and CSA is 11.2mm2, compared to the CSA of 5.9mm2 at the proximal third of the forearm. (B) Left peroneal nerve. The first nerve conduction study (June 2009) shows a conduction block at the fibular head or above (scale/div: 2mV – 5ms). The second nerve conduction study (May 2011) shows resolution of the conduction block. Ultrasound (May 2011) shows focal enlargement of the nerve in the distal part of the popliteal fossa, corresponding to the site of the previous conduction block: the CSA of the nerve is 13.9mm2 (11.6mm2 at the fibular head), and the nerve is hypoechoic. The same focal enlargement (arrow) is also shown on a longitudinal scan. (C) Left radial nerve. Focal, spindle-like swelling (arrow) of the nerve in the spiral groove shown in transverse and longitudinal scans. On transverse scan, the CSA is significantly enlarged: 9mm2 (3.5mm2 at the same level on the right side) and the echotexture of the nerve is pathological. Neuromuscular Disorders 2012 22, 627-631DOI: (10.1016/j.nmd.2012.03.005) Copyright © 2012 Elsevier B.V. Terms and Conditions

Fig. 2 (A) Left ulnar nerve. The nerve conduction study shows a conduction block on the upper arm. Ultrasound shows focal enlargement of the nerve corresponding to the site of the conduction block. CSA on transverse scan 1cm above the medial epicondyle is 8mm2, 13cm proximal to the medial epicondyle is 14.7mm2, and nerve diameter on longitudinal scan increases from 3.5mm to 4.3mm in this segment The echotexture of the nerve is pathological. (B) Left peroneal nerve. The nerve conduction study is normal but ultrasound shows focal enlargement of the nerve in the proximal part of the popliteal fossa: the CSA on transverse scan is 14mm2 (11mm2 at the fibular head), the longitudinal nerve diameter increases from 2.5mm to 3.8mm. Neuromuscular Disorders 2012 22, 627-631DOI: (10.1016/j.nmd.2012.03.005) Copyright © 2012 Elsevier B.V. Terms and Conditions