Low diagnostic yield of sural nerve biopsy in patients with peripheral neuropathy and primary amyloidosis

Patients with primary amyloidosis may develop peripheral neuropathy as an early feature. Sural nerve biopsy is reported to be a sensitive method for diagnosing amyloidosis in such patients. We identified nine patients, ultimately diagnosed as having amyloidosis, who were referred for peripheral neuropathy of undetermined etiology. In six, a sural nerve biopsy demonstrated no amyloid. Subsequent examination of other tissue or of the contralateral sural nerve eventually resulted in the correct diagnosis. We conclude that sural nerve biopsy may be less sensitive than previously believed for the diagnosis of amyloidosis in patients with peripheral neuropathy secondary to amyloid. When the clinical suspicion of amyloidosis is high, a nondiagnostic sural nerve biopsy should not discourage the performance of further investigative studies.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/30401/1/0000021.pd

Paratrigeminal Syndrome and Optic Neuropathy

Right-sided retro-orbital and peri-orbital pain; Decreasing vision ODA 67-year old male with episodic right sided retro-orbital and peri-orbital pain and decreasing vision OD.VA: 20/20 OU declining 20/80 OD; RAPD ODCTNecrotic fibrous mass (Aspergillus fumigatus) displacing extracavernous portion of internal right carotid arteryCorticosteroids; SurgeryAttache