Pediatric Radiology

, Volume 42, Issue 8, pp 952–958 | Cite as

Localized hypertrophic neuropathy of the sciatic nerve in children: MRI findings

  • Adrien Roux
  • Catherine Tréguier
  • Bertrand Bruneau
  • Franck Marin
  • Laurent Riffaud
  • Philippe Violas
  • Anne Michel
  • Yves Gandon
  • Jean-Yves Gauvrit
Original Article



Localized hypertrophic neuropathy (LHN) of the sciatic nerve in children is a rare condition characterized by a painless neurological deficit in the sciatic nerve territory.


To demonstrate the role of MRI using a specific protocol and describe the primary findings in LHN.

Materials and methods

Imaging in four children (age 2 years to 12 years) is presented. All children presented with lower limb asymmetry. Three had a steppage gait. LHN was confirmed by electrophysiological studies and by MRI of the whole sciatic nerve with a dedicated protocol covering the lumbar spine and the lower limb.


There were four direct MRI findings: (1) linear and focal hypertrophy with progressive enlargement of a peripheral nerve or plexus diameter, (2) abnormal hyperintensity of the nerve on T2-weighted images, (3) preserved fascicular configuration, and (4) variable enhancement after intravenous gadolinium administration. In addition there were atrophy and fatty infiltration of innervated muscles. MRI was helpful for determining the extent of lesions and in excluding peripheral nerve compression or tumour.


MRI of the whole sciatic nerve is the method of choice for diagnosing LHN of the sciatic nerve.


Localized hypertrophic neuropathy Intraneural perineurioma Sciatic nerve Child 


  1. 1.
    Imaginariojda G, Coelho B, Tome F et al (1964) Monosymptomatic interstitial hypertrophic neuritis. J Neurol Sci 64:340–347PubMedCrossRefGoogle Scholar
  2. 2.
    Emory TS, Scheithauer BW, Hirose T et al (1995) Intraneural perineurioma. A clonal neoplasm associated with abnormalities of chromosome 22. Am J Clin Pathol 103:696–704PubMedGoogle Scholar
  3. 3.
    Bilbao JM, Khoury NJ, Hudson AR et al (1984) Perineurioma (localized hypertrophic neuropathy). Arch Pathol Lab Med 108:557–560PubMedGoogle Scholar
  4. 4.
    Johnson PC, Kline DG (1989) Localized hypertrophic neuropathy: possible focal perineurial barrier defect. Acta Neuropathol 77:514–518PubMedCrossRefGoogle Scholar
  5. 5.
    Stanton C, Perentes E, Phillips L et al (1988) The immunohistochemical demonstration of early perineurial change in the development of localized hypertrophic neuropathy. Hum Pathol 19:1455–1457PubMedCrossRefGoogle Scholar
  6. 6.
    Cazals-Hatem D, Kania R, Deroin P et al (2000) La neuropathie hypertrophique localisee: diagnostic differentiel du perineurome intra-neural. Ann Pathol 20:93–94PubMedGoogle Scholar
  7. 7.
    Hornick JL, Fletcher CD (2005) Soft tissue perineurioma: clinicopathologic analysis of 81 cases including those with atypical histologic features. Am J Surg Pathol 29:845–858PubMedCrossRefGoogle Scholar
  8. 8.
    Mitsumoto H, Wilbourn AJ, Goren H (1980) Perineurioma as the cause of localized hypertrophic neuropathy. Muscle Nerve 3:403–412PubMedCrossRefGoogle Scholar
  9. 9.
    Gruen JP, Mitchell W, Kline DG (1998) Resection and graft repair for localized hypertrophic neuropathy. Neurosurgery 43:78–83PubMedCrossRefGoogle Scholar
  10. 10.
    Mauermann ML, Amrami KK, Kuntz NL et al (2009) Longitudinal study of intraneural perineurioma – a benign, focal hypertrophic neuropathy of youth. Brain 132:2265–2276PubMedCrossRefGoogle Scholar
  11. 11.
    Takao M, Fukuuchi Y, Koto A et al (1999) Localized hypertrophic mononeuropathy involving the femoral nerve. Neurology 52:389–392PubMedCrossRefGoogle Scholar
  12. 12.
    Chou SM (1992) Immunohistochemical and ultrastructural classification of peripheral neuropathies with onion-bulbs. Clin Neuropathol 11:109–114PubMedGoogle Scholar
  13. 13.
    Simmons Z, Mahadeen ZI, Kothari MJ et al (1999) Localized hypertrophic neuropathy: magnetic resonance imaging findings and long-term follow-up. Muscle Nerve 22:28–36PubMedCrossRefGoogle Scholar
  14. 14.
    Saguintaah M, Veyrac C, Baud C et al (2002) Neuropathie hypertrophique localisee (NHL) du plexus brachial: diagnostic et bilan preoperatoire par l’IRM. J Radiol 83:745–747PubMedGoogle Scholar
  15. 15.
    Kania RE, Cazals-Hatem D, Bouccara D et al (2001) Hypertrophic neuropathy of the facial nerve. Ann Otol Rhinol Laryngol 110:257–262PubMedGoogle Scholar
  16. 16.
    Merlini L, Viallon M, De Coulon G et al (2008) MRI neurography and diffusion tensor imaging of a sciatic perineurioma in a child. Pediatr Radiol 38:1009–1012PubMedCrossRefGoogle Scholar
  17. 17.
    Lee HY, Manasseh RG, Edis RH et al (2009) Intraneural perineurioma. J Clin Neurosci 16:1633–1636PubMedCrossRefGoogle Scholar
  18. 18.
    Sciacco M, Scarpini E, Baron PL et al (1992) Sural nerve immunoreactivity for nerve growth factor receptor in a case of localized hypertrophic neuropathy. Acta Neuropathol 83:547–553PubMedCrossRefGoogle Scholar
  19. 19.
    Suarez GA, Giannini C, Smith BE et al (1994) Localized hypertrophic neuropathy. Mayo Clin Proc 69:747–748PubMedGoogle Scholar
  20. 20.
    Phillips LH 2nd, Persing JA, Vandenberg SR (1991) Electrophysiological findings in localized hypertrophic mononeuropathy. Muscle Nerve 14:335–341PubMedCrossRefGoogle Scholar
  21. 21.
    Chhabra A, Subhawong TK, Bizzell C et al (2011) 3 T MR neurography using three-dimensional diffusion-weighted PSIF: technical issues and advantages. Skeletal Radiol 40:1355–1360PubMedCrossRefGoogle Scholar
  22. 22.
    Yassini PR, Sauter K, Schochet SS et al (1993) Localized hypertrophic mononeuropathy involving spinal roots and associated with sacral meningocele. Case report. J Neurosurg 79:774–778PubMedCrossRefGoogle Scholar
  23. 23.
    Smith AB, Gupta N, Strober J et al (2008) Magnetic resonance neurography in children with birth-related brachial plexus injury. Pediatr Radiol 38:159–163PubMedCrossRefGoogle Scholar
  24. 24.
    Ma M, Guillerman RP (2010) Paradoxic hypertrophy of the sciatic nerve. Pediatr Radiol 40(Suppl 1):S177PubMedCrossRefGoogle Scholar
  25. 25.
    Gruen P, Kline DG (2007) Hypertrophic mononeuropathy. Neurosurg Focus 22:E23PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Adrien Roux
    • 1
  • Catherine Tréguier
    • 1
  • Bertrand Bruneau
    • 1
  • Franck Marin
    • 1
  • Laurent Riffaud
    • 2
  • Philippe Violas
    • 3
  • Anne Michel
    • 4
  • Yves Gandon
    • 1
  • Jean-Yves Gauvrit
    • 1
  1. 1.Department of Radiology, Hopital SudUniversity HospitalRennes cedex 2France
  2. 2.Department of Pediatric Neurosurgery, Hopital SudUniversity HospitalRennesFrance
  3. 3.Department of Pediatric Surgery, Hopital SudUniversity HospitalRennesFrance
  4. 4.Department of Neurological Functional Explorations, Hopital SudUniversity HospitalRennesFrance

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