Abstract
Background
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.
Objective
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.
Results
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.
Conclusion
MRI of the whole sciatic nerve is the method of choice for diagnosing LHN of the sciatic nerve.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Imaginariojda G, Coelho B, Tome F et al (1964) Monosymptomatic interstitial hypertrophic neuritis. J Neurol Sci 64:340–347
Emory TS, Scheithauer BW, Hirose T et al (1995) Intraneural perineurioma. A clonal neoplasm associated with abnormalities of chromosome 22. Am J Clin Pathol 103:696–704
Bilbao JM, Khoury NJ, Hudson AR et al (1984) Perineurioma (localized hypertrophic neuropathy). Arch Pathol Lab Med 108:557–560
Johnson PC, Kline DG (1989) Localized hypertrophic neuropathy: possible focal perineurial barrier defect. Acta Neuropathol 77:514–518
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 19:1455–1457
Cazals-Hatem D, Kania R, Deroin P et al (2000) La neuropathie hypertrophique localisee: diagnostic differentiel du perineurome intra-neural. Ann Pathol 20:93–94
Hornick JL, Fletcher CD (2005) Soft tissue perineurioma: clinicopathologic analysis of 81 cases including those with atypical histologic features. Am J Surg Pathol 29:845–858
Mitsumoto H, Wilbourn AJ, Goren H (1980) Perineurioma as the cause of localized hypertrophic neuropathy. Muscle Nerve 3:403–412
Gruen JP, Mitchell W, Kline DG (1998) Resection and graft repair for localized hypertrophic neuropathy. Neurosurgery 43:78–83
Mauermann ML, Amrami KK, Kuntz NL et al (2009) Longitudinal study of intraneural perineurioma – a benign, focal hypertrophic neuropathy of youth. Brain 132:2265–2276
Takao M, Fukuuchi Y, Koto A et al (1999) Localized hypertrophic mononeuropathy involving the femoral nerve. Neurology 52:389–392
Chou SM (1992) Immunohistochemical and ultrastructural classification of peripheral neuropathies with onion-bulbs. Clin Neuropathol 11:109–114
Simmons Z, Mahadeen ZI, Kothari MJ et al (1999) Localized hypertrophic neuropathy: magnetic resonance imaging findings and long-term follow-up. Muscle Nerve 22:28–36
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 83:745–747
Kania RE, Cazals-Hatem D, Bouccara D et al (2001) Hypertrophic neuropathy of the facial nerve. Ann Otol Rhinol Laryngol 110:257–262
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 38:1009–1012
Lee HY, Manasseh RG, Edis RH et al (2009) Intraneural perineurioma. J Clin Neurosci 16:1633–1636
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 83:547–553
Suarez GA, Giannini C, Smith BE et al (1994) Localized hypertrophic neuropathy. Mayo Clin Proc 69:747–748
Phillips LH 2nd, Persing JA, Vandenberg SR (1991) Electrophysiological findings in localized hypertrophic mononeuropathy. Muscle Nerve 14:335–341
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 40:1355–1360
Yassini PR, Sauter K, Schochet SS et al (1993) Localized hypertrophic mononeuropathy involving spinal roots and associated with sacral meningocele. Case report. J Neurosurg 79:774–778
Smith AB, Gupta N, Strober J et al (2008) Magnetic resonance neurography in children with birth-related brachial plexus injury. Pediatr Radiol 38:159–163
Ma M, Guillerman RP (2010) Paradoxic hypertrophy of the sciatic nerve. Pediatr Radiol 40(Suppl 1):S177
Gruen P, Kline DG (2007) Hypertrophic mononeuropathy. Neurosurg Focus 22:E23
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Roux, A., Tréguier, C., Bruneau, B. et al. Localized hypertrophic neuropathy of the sciatic nerve in children: MRI findings. Pediatr Radiol 42, 952–958 (2012). https://doi.org/10.1007/s00247-012-2418-y
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00247-012-2418-y