Authors: Josefin Hultman, Marco Rosati, Tone Kristensen Grøn...

BACKGROUND

Granulomatous myositis is a rare condition in both humans and dogs. In humans it is most frequently related to sarcoidosis, where a concurrent granulomatous neuritis has been reported occasionally. Simultaneous granulomatous myositis and neuritis have been diagnosed previously in dogs (unpublished observations), but have not been studied further. Additional investigations are therefore warranted to characterize this disorder. Here we present a detailed description of concurrent idiopathic granulomatous myositis and granulomatous neuritis in a dog with suspected immune-mediated aetiology.

CASE PRESENTATION

The dog presented with dysphonia and paresis in the pelvic limbs and tail. In addition to muscle biopsies being taken for histopathology, magnetic resonance imaging, computed tomography and electrodiagnostics were performed. Muscle biopsies displayed granuloma formation with giant cells and epithelioid macrophages in muscle fibres and nerve branches. Microorganisms were not detected. Long-term treatment with glucocorticoids was clinically successful. Two years after the clinical signs started, the dog presented with signs of sepsis and died. Histopathologically, no granulomatous inflammation could be demonstrated in either muscles or nerves at that time.

CONCLUSIONS

This case illustrates a granulomatous interstitial polymyositis and intramuscular neuritis that improved clinically and resolved histologically with glucocorticoid treatment. Idiopathic granulomatous myositis and neuritis should be considered as a differential diagnosis in dogs with clinical signs of neuromuscular disorders.

Topics: Animals; Diagnosis, Differential; Dog Diseases; Dogs; Fatal Outcome; Granuloma; Neuritis; Polymyositis

PubMed: 33781325
DOI: 10.1186/s13028-021-00579-x

Authors: Louise Mara Giesel, Yara Hahr Marques Hökerberg, Izabela Jardim Rodrigues Pitta...

BACKGROUND

Diagnosing neuritis in leprosy patients with neuropathic pain or chronic neuropathy remains challenging since no specific laboratory or neurophysiological marker is available.

METHODS

In a cross-sectional study developed at a leprosy outpatient clinic in Rio de Janeiro, RJ, Brazil, 54 individuals complaining of neural pain (single or multiple sites) were classified into two groups ("neuropathic pain" or "neuritis") by a neurological specialist in leprosy based on anamnesis together with clinical and electrophysiological examinations. A neurologist, blind to the pain diagnoses, interviewed and examined the participants using a standardized form that included clinical predictors, pain features, and neurological symptoms. The association between the clinical predictors and pain classifications was evaluated via the Pearson Chi-Square or Fisher's exact test (p < 0.05).

RESULTS

Six clinical algorithms were generated to evaluate sensitivity and specificity, with 95% confidence intervals, for clinical predictors statistically associated with neuritis. The most conclusive clinical algorithm was: pain onset at any time during the previous 90 days, or in association with the initiation of neurological symptoms during the prior 30-day period, necessarily associated with the worsening of pain upon movement and nerve palpation, with 94% of specificity and 35% of sensitivity.

CONCLUSION

This algorithm could help physicians confirm neuritis in leprosy patients with neural pain, particularly in primary health care units with no access to neurologists or electrophysiological tests.

Topics: Brazil; Clinical Decision Rules; Cross-Sectional Studies; Humans; Leprosy; Neuralgia; Neuritis

PubMed: 34425777
DOI: 10.1186/s12879-021-06545-2

Authors: A S Jaiswal, K Sikka, A S Bhalla...

OBJECTIVE

To elucidate the aetiopathogenesis of facial neuritis in coronavirus disease 2019 associated mucormycosis.

METHODS

A retrospective review was conducted of coronavirus disease 2019 associated mucormycosis patients who presented with peripheral facial nerve palsy from January 2021 to July 2021. The clinico-radiological details of four patients were assessed to examine the potential mechanism of facial nerve involvement.

RESULTS

Serial radiological evaluation with contrast-enhanced computed tomography and contrast-enhanced magnetic resonance imaging revealed infratemporal fossa involvement in all cases, with the inflammation extending along fascial planes to reach the stylomastoid foramen. Ascending neuritis with an enhancement of the facial nerve was demonstrated in all cases.

CONCLUSION

The likely explanation for facial palsy in patients with coronavirus disease 2019 associated mucormycosis, backed by radiology, is the disease abutting the facial nerve at the stylomastoid foramen and causing ascending neuritis of the facial nerve.

Topics: COVID-19; Facial Nerve; Facial Nerve Diseases; Facial Paralysis; Humans; Magnetic Resonance Imaging; Mucormycosis; Neuritis; Radiology

PubMed: 35094716
DOI: 10.1017/S0022215121003510

Authors: Beth Pearce

BACKGROUND

Neuritis of the infrapatellar branch of the saphenous nerve can result from iatrogenic injury, entrapment, bursitis, or patellar dislocation. Currently, there is an unmet clinical need for treating refractory neuritis nonsurgically.

CASE PRESENTATION

Three patients presented with persistent anterior knee pain caused by neuritis of the infrapatellar branch of the saphenous nerve that had got excellent but only temporary relief from steroid and local anesthetic nerve block. The neuropathic pain diagnostic Douleur Neuropathique 4 questionnaire and painDETECT questionnaire confirmed presence of neuropathic pain. After injection with 25 mg amniotic and umbilical cord particulate, the patient's pain decreased from 7.3 before injection to 0.3 at 6 weeks postinjection. In addition, neuropathic symptoms significantly improved at 2 weeks and were not present by 6 weeks. By 63 weeks, two of the patients reported continued complete pain relief, while one patient underwent total knee replacement due to an allergy of a previously implanted unicondylar implant.

CONCLUSIONS

This case series suggests that amniotic and umbilical cord particulate may be a viable alternative to reduce pain in patients with neuropathic pain.

Topics: Arthroplasty, Replacement, Knee; Humans; Knee; Knee Joint; Neuralgia; Neuritis

PubMed: 34261538
DOI: 10.1186/s13256-021-02912-4

Authors: Jaspal R Singh, Vincent F Miccio, Devas J Modi...

BACKGROUND

Pain arising from the lumbar facet joints is a common cause of axial back pain in adults. Radiofrequency neurotomy (RFN) of the medial branches of the spinal dorsal rami has been used as a treatment option. The most common side effect is transient, localized, burning, neuritic-type pain, termed post-neurotomy neuritis (PNN). Corticosteroids have been administered through the radiofrequency cannula after neurotomy to prevent PNN, but no study has examined the effects of this on PNN.

OBJECTIVES

We investigated the incidence of PNN in patients who received corticosteroids after RFN and in those patients who did not receive corticosteroids.

STUDY DESIGN

Retrospective evaluation.

SETTING

Single-site interventional pain management practice in an urban tertiary academic medical center.

METHODS

One hundred and sixty-four patients were included in this study and were categorized into non-steroid (n = 87) and steroid (n = 77) groups. Patient's age, gender, body mass index (BMI), laterality of procedure, use of neuropathic pain medications, baseline pain, and duration of pain were all recorded. PNN was determined if the patient self-reported transient burning or neuropathic pain at the site prior to or at the 6-week routine follow-up encounter.

RESULTS

There was no significant difference in demographic characteristics between the 2 groups in age, gender, baseline pain, and duration of pain. The proportion of patients in the steroid treated group with PNN was 5 out of 77 (6.4%) and the non-steroid group was 6 out of 87 (6.9%). There was no statistically significant difference between the groups. There was no statistically significant difference in the incidence in neuritis between individuals taking neuropathic agents and individuals not taking neuropathic agents.

LIMITATIONS

This study has several limitations including small sample size, patients' self-reported neuropathic symptoms, and inability to draw strong conclusions due to the retrospective study design. A single interventionalist performed all the procedures in this retrospective study and variations in technique amongst others are inevitable.

CONCLUSION

Administration of steroids after RFN does not reduce the incidence of post-neurotomy neuritis. Concurrently administering neuropathic medications does not protect against neuritis.

KEY WORDS

Radiofrequency neurotomy, radiofrequency ablation, neuritis, corticosteroid, lumbar facet pain, post neurotomy neuritis.

Topics: Adrenal Cortex Hormones; Adult; Aged; Denervation; Female; Humans; Incidence; Low Back Pain; Lumbosacral Region; Male; Middle Aged; Neuritis; Retrospective Studies; Spinal Nerves; Zygapophyseal Joint

PubMed: 30700070
DOI: No ID Found

Authors: Brody Fitzpatrick, Kellen Hilton, Michael Suer...

BACKGROUND

Since its adoption as a treatment for neuropathic pain in the 1960s, radiofrequency ablation (RFA) has continued to gain popularity for the management of various pain etiologies. Although RFA is considered to be a safe procedure, post-neurotomy neuritis (PNN), a neuropathic-type pain, is one of the most common side effects. Due to the increasing recognition of PNN, some providers have attempted to mitigate the risk of PNN by injecting local corticosteroids at the site of RFA following the procedure. Recent studies have generally concluded that corticosteroids do not protect against the development of PNN, however, they have been limited by their retrospective study designs and the low incidence of PNN.

OBJECTIVES

We aimed to add to the growing literature regarding the role of post-RFA corticosteroid administration in preventing the development of PNN.

STUDY DESIGN

We conducted a prospective study evaluating the incidence of PNN as well as the efficacy of post-RFA corticosteroid administration in preventing the development of PNN.

SETTING

All RFAs were performed by the same board-certified, pain medicine fellowship-trained, attending physician at the University of Wisconsin who performed the initial patient evaluation at the pain medicine clinic.

METHODS

Thirty-nine patients (47 RFAs) were included in the study. All patients were between the ages of 30 and 81; 23 (59.0%) patients were women comprising 28 (59.6%) of the RFAs performed. RFA was performed for a variety of conditions, including facet joint pain, osteoarthritic knee pain, and occipital nerve pain. The 19 patients (25 RFAs) completed prior to February 2020 received post-RFA corticosteroids; the remaining 21 patients (22 RFAs) completed after this date did not receive corticosteroids. The Numeric Rating Scale (NRS-11) and Douleur Neuropathique 4 Questions (DN4) questionnaire scores were collected before and after completion of an RFA. After their procedure, patients were either called or seen in clinic for re-evaluation of their symptoms, at which time NRS-11 and DN4 scores were collected again.

RESULTS

There were no statistically significant differences between groups when comparing post-RFA DN4 scores. Additionally, the incidence of PNN in our study population was 0% for both treatment groups. The NRS-11 scores were similar between groups prior to completing an RFA. When comparing the post-RFA pain scores, the average NRS-11 scores in the steroid group decreased from 5.8 to 3.4, while the average NRS-11 scores in the nonsteroid group decreased from 5.4 to 3.8. However, the average NRS-11 reductions were similar between groups.

LIMITATIONS

The primary limitation of this study is small sample size, which likely limited our ability to diagnose PNN. Additionally, we utilized the 7-item DN4 and required a DN4 score of  ? 4 to diagnose PNN, and therefore, it is likely that our protocol significantly reduced our sensitivity for diagnosing PNN.

CONCLUSIONS

Overall, our study is in agreement with prior studies that RFA is effective for the treatment of facet and osteoarthritic knee pain and that the incidence of PNN is likely small.

Topics: Adrenal Cortex Hormones; Adult; Aged; Aged, 80 and over; Female; Humans; Incidence; Middle Aged; Neuralgia; Neuritis; Prospective Studies; Retrospective Studies

PubMed: 35051159
DOI: No ID Found

Authors: Rosann M Govea, Mary F Barbe, Geoffrey M Bove...

We have previously shown that nerve inflammation (neuritis) and transient vinblastine application lead to axonal mechanical sensitivity in nociceptors innervating deep structures. We also have shown that these treatments reduce axonal transport and have proposed that this leads to functional accumulation of mechanically sensitive channels in the affected part of the axons. Though informing the etiology of mechanically induced pain, axonal mechanical sensitivity does not address the common report of ongoing radiating pain during neuritis, which could be secondary to the provocation of axonal chemical sensitivity. We proposed that neuritis and vinblastine application would induce sensitivities to noxious chemicals and that the number of chemo-sensitive channels would be increased at the affected site. In adult female rats, nerves were either untreated or treated with complete Freund's adjuvant (to induce neuritis) or vinblastine. After 3-7 days, dorsal root teased fiber recordings were taken from group IV neurons with axons within the sciatic nerve. Sciatic nerves were injected intraneurally with a combination of noxious inflammatory chemicals. Whereas no normal sciatic axons responded to this stimulus, 80% and 38% of axons responded in the neuritis and vinblastine groups, respectively. In separate experiments, sciatic nerves were partially ligated and treated with complete Freund's adjuvant or vinblastine (with controls), and after 3-5 days were immunolabeled for the histamine H receptor. The results support that both neuritis and vinblastine treatment reduce transport of the histamine H receptor. The finding that nociceptor axons can develop ectopic chemical sensitivity is consistent with ongoing radiating pain due to nerve inflammation. Many patients suffer ongoing pain with no local pathology or apparent nerve injury. We show that nerve inflammation and transient application of vinblastine induce sensitivity of group IV nociceptor axons to a mixture of endogenous inflammatory chemicals. We also show that the same conditions reduce the axonal transport of the histamine H receptor. The results provide a mechanism for ongoing nociception from focal nerve inflammation or pressure without overt nerve damage.

Topics: Animals; Axons; Female; Neuritis; Nociception; Nociceptors; Rats; Rats, Sprague-Dawley; Receptors, Histamine H3; Sciatic Nerve; Vinblastine

PubMed: 28701542
DOI: 10.1152/jn.00395.2017

Authors: Xinle Li, Huan Zheng, Zhihong Zhou...

Objective

To investigate the clinical effect of Mudan granule on peripheral neuritis caused by chronic renal insufficiency (CRI).

Methods

Sixty patients with peripheral neuritis caused by CRI treated in our hospital were included from February 2018 to April 2021 in this study. The patients were arbitrarily assigned into control group and study group. The former accepted routine treatment, while the latter accepted Mudan granule treatment. The clinical efficacy, traditional Chinese medicine (TCM) clinical symptom score, nerve conduction velocity, hemorheology index, renal function index, and inflammatory factor index were compared.

Results

We firstly compared the clinical efficacy: the study group was clinically cured in 22 cases, obviously effective in 5 cases, effective in 3 cases, and ineffective in 1 case, with a total effective rate of 96.67%. The control group was clinically cured in 9 cases, obviously effective in 8 cases, effective in 7 cases, and ineffective in 6 cases, with a total effective rate of 80.00%. The total effective rate of the study group was higher compared to the control group ( < 0.05). Secondly, we compared the TCM clinical symptom scores; before treatment, there exhibited no significant difference ( > 0.05); after treatment, the TCM clinical symptom scores decreased. The clinical symptom score of TCM in the study group was lower compared to the control group ( < 0.05). Compared with the control group, the nerve conduction velocity of left MCV, right MCV, left SCV, and right SCV in the study group were remarkably higher. In terms of the hemorheological indexes, the high-shear whole blood viscosity, low-shear whole blood viscosity, and plasma viscosity in the study group were lower compared with the control group ( < 0.05). Before treatment, there existed no significant difference in renal function indexes, but after treatment, the renal function indexes decreased, and the levels of serum creatinine (SCr), blood urea nitrogen (BUN), and uric acid (UA) in the study group were lower compared to the control group ( < 0.05). Finally, we compared the indexes of inflammatory factors; there existed no significant difference before treatment, but after treatment, the indexes of inflammatory factors decreased in both groups, and the levels of IL-6 and CRP in the study group were lower compared to the control group ( < 0.05).

Conclusion

For peripheral neuritis caused by CRI, Mudan granule can remarkably promote the clinical symptoms of TCM and reduce the syndrome score of TCM; moreover, it can remarkably increase the nerve conduction velocity of median nerve and common peroneal nerve and reduce blood viscosity, which is worth popularizing and developing in clinic.

Topics: Drugs, Chinese Herbal; Humans; Medicine, Chinese Traditional; Neuritis; Renal Insufficiency, Chronic; Syndrome

PubMed: 35401777
DOI: 10.1155/2022/1052744

Authors: Ieva Satkeviciute, George Goodwin, Geoffrey M Bove...

Local nerve inflammation (neuritis) leads to ongoing activity and axonal mechanical sensitivity (AMS) along intact nociceptor axons and disrupts axonal transport. This phenomenon forms the most feasible cause of radiating pain, such as sciatica. We have previously shown that axonal transport disruption without inflammation or degeneration also leads to AMS but does not cause ongoing activity at the time point when AMS occurs, despite causing cutaneous hypersensitivity. However, there have been no systematic studies of ongoing activity during neuritis or noninflammatory axonal transport disruption. In this study, we present the time course of ongoing activity from primary sensory neurons following neuritis and vinblastine-induced axonal transport disruption. Whereas 24% of C/slow Aδ-fiber neurons had ongoing activity during neuritis, few (<10%) A- and C-fiber neurons showed ongoing activity 1-15 days following vinblastine treatment. In contrast, AMS increased transiently at the vinblastine treatment site, peaking on days 4-5 (28% of C/slow Aδ-fiber neurons) and resolved by day 15. Conduction velocities were slowed in all groups. In summary, the disruption of axonal transport without inflammation does not lead to ongoing activity in sensory neurons, including nociceptors, but does cause a rapid and transient development of AMS. Because it is proposed that AMS underlies mechanically induced radiating pain, and a transient disruption of axonal transport (as previously reported) leads to transient AMS, it follows that processes that disrupt axonal transport, such as neuritis, must persist to maintain AMS and the associated symptoms. NEW & NOTEWORTHY Many patients with radiating pain lack signs of nerve injury on clinical examination but may have neuritis, which disrupts axonal transport. We have shown that axonal transport disruption does not induce ongoing activity in primary sensory neurons but does cause transient axonal mechanical sensitivity. The present data complete a profile of key axonal sensitivities following axonal transport disruption. Collectively, this profile supports that an active peripheral process is necessary for maintained axonal sensitivities.

Topics: Animals; Axonal Transport; Disease Models, Animal; Hyperalgesia; Male; Nerve Fibers, Myelinated; Nerve Fibers, Unmyelinated; Neuralgia; Neuritis; Nociceptors; Rats; Rats, Sprague-Dawley; Sciatic Nerve; Sensory Receptor Cells; Time Factors; Tubulin Modulators; Vinblastine

PubMed: 29465329
DOI: 10.1152/jn.00882.2017

Authors: Nahid Rahman, Chiho Kezuka, Nobuyuki Higashiguchi...

This study represents cases with spontaneous neuritis of peripheral nerves in electric eels. Two electric eels were presented with abnormal swimming behavior and loss of appetite. Electric eels had extensive histopathologic lesions in the splenic and cardiac nerves. The lesions were characterized by swelling of neuronal cells, central chromatolysis and marked inflammatory cell infiltration consisting mainly of lymphocytes around the affected nerves. To the best of our knowledge, this is the first case report of spontaneous neuritis of peripheral nerves in electric eels.

Topics: Animals; Electrophorus; Female; Fish Diseases; Neuritis; Swimming

PubMed: 30842355
DOI: 10.1292/jvms.18-0751