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Objective: Conventionally, MRI aids in differentiating acute unilateral peripheral vestibulopathy/vestibular neuritis (AUPV/VN) from mimickers. Meanwhile, the diagnostic utility of MRIs dedicated to the inner ear remains to be elucidated for diagnosing AUPV/VN. Methods: We prospectively recruited 53 patients with AUPV/VN (mean age ± SD = 60 ± 15 years, 29 men). Initial MRIs were performed with a standard protocol, and an additional axial 3D‐fluid‐attenuated inversion recovery (3D‐FLAIR) sequence was obtained 4 h after intravenous injection of gadoterate meglumine. Abnormal enhancement was defined as a signal intensity that exceeded the mean + 2SD value on the healthy side. The findings of neurotologic evaluation and MRIs were compared. Results: Overall, the inter‐rater agreement for gadolinium enhancement was 0.886 (Cohen's kappa coefficient). Enhancement was observed in 26 patients (49%), most frequently in the vestibule (n = 20), followed by the anterior (n = 12), horizontal (HC, n = 8), posterior canal (n = 5), and superior (n = 3) and inferior (n = 1) vestibular nerves. In multivariable logistic regression analysis, the enhancement was associated with decreased HC gain in video head‐impulse tests (p = 0.036), increased interaural difference in ocular vestibular‐evoked myogenic potentials (p = 0.001), and a longer onset‐to‐MRI time span (p = 0.024). The sensitivity and specificity were 92.3% and 81.5%, respectively, with an area under the curve of 0.90 for predicting gadolinium enhancement. Interpretation: Robust gadolinium enhancement was observed on 4‐hour‐delayed 3D‐FLAIR images in nearly half of the patients with AUPV/VN, with a good correlation with the results of neurotologic evaluation. The positivity may be determined by the extent of vestibular deficit, timing of imaging acquisition, and possibly by the underlying etiology causing AUPV/VN. MRIs may aid in delineating the involved structures in AUPV/VN. [ABSTRACT FROM AUTHOR]

Three‐dimensional (3‐D) analysis of human epidermal melanocytes is required for deeper understanding of melanocytic disorders. The purpose of this study was to standardize 3‐D imaging and quantification for the evaluation of epidermal melanocytes. The epidermal specimen was obtained using the suction blister method from a patient with melanocytic nevus on the forearm skin. Cutaneous ACT‐PRESTO, the tissue‐clearing and labeling technique, was subsequently performed. With the 3‐D image analysis program, morphological reconstruction and quantification of selected perilesional and melanocytic nevus areas were possible. The region of melanocytic nevus showed higher numbers of total melanocytic dendrites and similar numbers of cell bodies compared with perilesional area. In addition, the mean area and volume of cell bodies increased in the melanocytic nevus area compared with the results in the perilesional area. The 3‐D evaluation method of human epidermal melanocytes can be applied to investigate novel pathologies related to hyper‐ or hypo‐pigmentary disorders. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the utility of facial nerve ultrasonography in the functional and structural assessment of early-stage Bell's palsy and the prognostic value of facial nerve ultrasonography in Bell's palsy.Study Design: Prospective longitudinal study.Setting: Single center, a university-affiliated neurology clinic.Subjects and Methods: Patients with unilateral Bell's palsy who had visited our clinic within 3 days of symptom onset were enrolled in this study. Demographic information and House-Brackmann grade were collected. Electrophysiologic studies and facial nerve ultrasonography were then performed. The facial nerves on each side were scanned longitudinally with a 5- to 12-MHz probe. The diameter of the facial nerves with and without the sheath was measured at the proximal and distal portions. Follow-up examinations, including House-Brackmann grade analysis, electrophysiologic studies, and facial nerve ultrasonography, were performed after 2 months.Results: Fifty-four patients with unilateral Bell's palsy were enrolled, and 22 underwent the follow-up examinations. The diameters of the facial nerves were larger on the affected side than on the unaffected side at the proximal and distal portions (P < .01). On the affected side, the enlarged facial nerve at the proximal portion had decreased in size after 2 months (P < .05). The initial ultrasonography findings were positively correlated with the initial severity of Bell's palsy, but they did not predict prognosis.Conclusion: Ultrasonography could be a useful tool for evaluating the facial nerve in Bell's palsy. Nevertheless, further studies are needed to demonstrate its prognostic value. [ABSTRACT FROM AUTHOR]

Three‐dimensional microscopy provides more extended depth of penetration compared with conventional light microscopy and is known to be useful in clinical evaluation of thick biological specimens. Skin nerve biopsy together with the quantification of intraepidermal nerve fibers in multiple thick sections has been widely adopted for evaluating peripheral neuropathies. The aim of the present study was to evaluate the effectivity of three‐dimensional microscopy in reducing the required time and inter‐rater discrepancies, especially in the case of personnel not familiar with the quantification methods. A total of six cryo‐sectioned specimens were analyzed for the study and the skin samples were collected from one patient with postherpetic neuralgia who voluntarily participated in the study. Two investigators, a physician and non‐physician assessed the intraepidermal nerve fiber densities and required analysis time using three different methods including direct visualization of tissue slides, and analysis with two‐ and three‐dimensional images. Three‐dimensional microscopy could produce images that enabled reliable evaluation of intraepidermal nerve fibers; the accuracy of analysis was statistically comparable between the physician and non‐physician (p > .05). Three‐dimensional microscopy also enabled the non‐physician to proceed meaningfully faster evaluation compared with the direct visualization method (p = .03). Three‐dimensional microscopy could be one of the useful methods to improve accuracy and convenience of the analysis of intraepidermal nerve fibers especially appropriate for unaccustomed physician or non‐physician. Research Highlights: Three‐dimensional microscopy is capable of producing images with more extended depth of penetration compared with conventional light microscopy and has been known to be suitable for clinical evaluation of thick biological specimens. Cutaneous nerve biopsy and the quantification of nerve fibers in thick sections has been widely adopted for evaluating peripheral neuropathies. Three‐dimensional microscopy could be especially appropriate for unaccustomed physician or non‐physician to improve accuracy and convenience of the analysis of intraepidermal nerve fibers. Three dimensional images of cutaneous nerve fibers produced by 3D microscopy (50‐μm‐thick section, ×400). The image presents detailed course of intraepidermal nerve fibers which contribute to clear evaluation of investigators [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction: Cross-sectional area (CSA) reference values of lower extremity nerves using ultrasonography have only been reported in a few studies and have been limited to white populations. Methods: For this study, 94 healthy Korean volunteers were recruited for measurement of the CSA at 7 sites of lower extremity nerves. The side-to-side difference in CSA was calculated for each nerve, and reference ranges were derived. External validity evaluation for the reference values was performed with 10 newly recruited volunteers at a different institution. Results: Nerve CSA was correlated significantly with body mass index, weight, and height; however, the absolute value of the side-to-side difference had no significant correlation with demographic factors. The external validity was adequate for all sites, ranging from 80% to 100%. Conclusions: The lower extremity nerve CSA values obtained in this study may provide normal reference values for the Asian population. Muscle Nerve 50: 564-570, 2014 [ABSTRACT FROM AUTHOR]

Introduction The aims of this study were to identify factors affecting the measurement of nerve cross-sectional area (CSA) and to establish normal reference values for nerve ultrasonography of the upper extremity. Methods Ninety-seven age-matched, healthy individuals were enrolled. Ultrasonographic tests were performed by tracing nerves from the axilla to the distal arm. CSA was measured at the following locations: median nerve (carpal tunnel inlet, forearm, antecubital fossa, midhumerus); ulnar nerve (wrist, 2 cm proximal to the wrist, forearm, cubital tunnel outlet and inlet, midhumerus); radial nerve (spiral groove, antecubital fossa); and musculocutaneous nerve (proximal humerus). Results The CSA reference values differed between the measured points along the path of each nerve. Nerve CSA correlated significantly with weight, body mass index, height, and gender; however, the CSA ratio (distal/proximal) did not correlate with demographic factors. Conclusions The normal reference values may be helpful in diagnosis of pathologies involving these nerves. Muscle Nerve 47: 864-871, 2013 [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to determine normal reference values for cross-sectional area (CSA) and the correlation between demographic factors and CSA in the cervical roots and brachial plexus trunks using ultrasonography. Methods: Ninety-five age-matched healthy individuals were studied. Ultrasonographic tests were performed via nerve tracing from the cervical root to the brachial plexus trunk. The CSA of each nerve was measured in the C5-8 ventral roots and brachial plexus (trunk level). Results: Normal values of each cervical root were: C5, 5.66 ± 1.02 mm2; C6, 8.98 ± 1.65 mm2; C7, 10.43 ± 1.86 mm2; and C8, 10.76 ± 2.02 mm2. Values for the brachial plexus were: upper trunk, 16.70 ± 2.88 mm2; middle trunk, 14.01 ± 2.70 mm2; and lower trunk, 13.75 ± 2.57 mm2. The side-to-side discrepancy was 11.91 ± 11.11%. Body mass index (BMI) and height correlated frequently with nerve CSA. Conclusions: These reference values may be helpful in investigating pathologies involving the cervical area. Muscle Nerve 46: 711-716, 2012 [ABSTRACT FROM AUTHOR]

Polyneuropathy may result in pain, numbness, and weakness, which may in turn affect driving ability. Medications used to treat neuropathic pain may alter cognition, which may further affect driving. Although such impairments have engendered questions about the driving safety in this group of patients, the rate of motor vehicle accidents (MVAs) in patients with neuropathy has not been studied rigorously. We surveyed patients with neuropathy from three medical centers for reported accident rate, and we analyzed variables related to increased risk for accidents compared to National Highway Traffic Safety Administration data. Surveys from 260 subjects demonstrated that 40.6% were involved in traffic accidents (0.11 accidents/year). Their accident rate was 10.8 MVAs per million vehicle miles traveled (MVA/MVMT), compared to 3.71 MVA/MVMT in 55-59-year-old drivers and 3.72 in 60-64-year-olds (National Highway Traffic Safety Administration data). In all, 72.4% cited their neuropathy and 55.2% cited their medications as playing a role in their accidents, and 51.6% changed their driving habits after developing neuropathy. Independently, elevated levels of pain, motor weakness, and ambulation difficulty met statistical significance for increased MVA frequency. We conclude that accident frequency and discomfort with driving are higher in neuropathy patients compared to age-matched national statistics. However, most patients seem to change habits according to their ability to drive; as such, driving issues should be addressed with caution and on a case-by-case basis. Muscle Nerve, 2009 [ABSTRACT FROM AUTHOR]

The prevalence of a history of shoulder complaints is higher in patients with Parkinson's disease (PD) than in healthy individuals. The aims of this study were to evaluate shoulder disease in PD patients with ultrasonography (US) and to identify the relationship between the US findings of shoulder disease and the motor signs in patients with PD. Thirty-three PD patients completed a shoulder disability questionnaire, a musculoskeletal examination, and US of the shoulder. Twenty-two patients had abnormal US findings. Tendon tearing was the most common abnormal US finding (22/22), and the supraspinatus tendon was the most common site involved (15/22). Patients with tendon tearing had a significantly longer duration of disease than patients without tendon tearing ( P = 0.027). Patients with adhesive capsulitis had a significantly higher rigidity score than patients without adhesive capsulitis ( P = 0.035). Disease duration and rigidity were the contributing factors for the development of tendon tearing and adhesive capsulitis, respectively. © 2008 Movement Disorder Society [ABSTRACT FROM AUTHOR]

Postcraniectomy orthostatic headache is a rare, but disabling, condition which can often interfere with patient rehabilitation. Previously, postsurgical CSF leaks have generally been managed with surgical repair. We present the case of a 32-year-old man with postcraniectomy orthostatic headache which was successively managed with repeated lumbar epidural blood patches. [ABSTRACT FROM AUTHOR]

The cubital tunnel is the most common site of ulnar nerve entrapment. Previous ultrasound studies have demonstrated enlargement of the ulnar nerve in cubital tunnel syndrome but did not report on the cubital tunnel itself. Twenty-two individuals with cubital tunnel syndrome were evaluated with nerve conduction studies and ultrasound. The ultrasound measurement that most strongly correlated with conduction velocity was the ratio of ulnar nerve to cubital tunnel cross-sectional area with the elbow flexed. Measurement of this ratio may improve the diagnostic accuracy of ultrasound in cubital tunnel syndrome, although further investigation is needed. [ABSTRACT FROM AUTHOR]

We describe a patient with ophthalmoplegic migraine and internal ophthalmoplegia with alternating unilateral involvement and bilateral involvement in whom brain MRI scan showed alternating gadolinium enhancement on the cisternal portion of the oculomotor nerve. [ABSTRACT FROM AUTHOR]