Nerve rootlet and fascicular biopsy in patients with hypertrophic inflammatory neuropathy

The differential diagnosis of hypertrophic mononeuropathy includes multiple diagnoses with significantly differing treatments and prognosis. The value of pathologic confirmation of the disease entity is critical in defining optimal patient care.

This report is an analysis of 2 unusual cases of progressive neuropathy with radiographic evidence of peripheral nerve enlargement. The clinical presentation of the patients and diagnostic value of the nerve biopsy are discussed. The aim of this report is to alert and emphasize the importance of a peripheral nerve biopsy in patients with hypertrophic mononeuropathies and carefully selected patients with hypertrophic polyradiculopathies. Both patients were treated with immunomodulatory agents with modest improvement in their symptoms.

Pathologic confirmation of chronic inflammatory demyelinating polyradiculopathy in these patients led to the correct diagnosis and appropriate treatment. Surgical excisional biopsy of a lumbar nerve rootlet and fascicular biopsy of the sciatic nerve were necessary to secure proper diagnosis in these cases. Neither patient had any complications or sequelae from the procedures.