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INTRODUCTION Ultrasound is emerging as a useful tool for the evaluation of immune-mediated neuropathies because it can provide high-resolution anatomic information to complement electrodiagnostic data. Nerve enlargements are commonly found in chronic inflammatory demyelinating polyneuropathy (CIDP), and their presence likely useful in diagnosis, particularly if multifocal. METHODS In this study, the authors undertook a retrospective chart review to identify ultrasound findings in patients with CIDP previously studied in a single busy neurodiagnostic laboratory. RESULTS Of the 50 cases identified from 2000 to 2017, individuals with a confirmed diagnosis of CIDP (21 cases) were more likely to have multiple sites of enlargement, as well as more pronounced nerve enlargement, than patients who were subsequently found to have an alternate cause of neuropathy (22 cases). The presence of any moderately enlarged nerve segment predicted definite CIDP with sensitivity of 81% and specificity 77%. CONCLUSION This study demonstrates that ultrasound can be of diagnostic utility in patients with suspected CIDP, even when conducted in a nonstandardized real-world setting.

PURPOSE Electrodiagnostic testing is often critical for the diagnosis of neuromuscular disease, but it can be challenging in the pediatric population because of poor tolerance. This study evaluates an ultrasound-first approach as a means of reducing the number of electrodiagnostic tests (nerves stimulated and muscles sampled) in the pediatric population. METHODS A retrospective analysis of 21 pediatric patients who underwent ultrasound before electrodiagnostic testing as part of a quality-improvement project was conducted and compared with an age-matched control group of 84 patients. RESULTS The ultrasound-first group underwent significantly fewer muscle samplings (P = 0.0002) and overall number of electrodiagnostic tests (P = 0.0010) than the control group. The ultrasound-first group also underwent fewer nerve stimulations, which approached statistical significance (P = 0.0600). CONCLUSIONS Using ultrasound first in the electrodiagnostic laboratory in pediatric patients could reduce the number of electrodiagnostic tests needed to arrive at a diagnosis.

Disulfiram toxicity can cause multiple neurologic problems, including a reversible distal sensorimotor axonal polyneuropathy. Although electrodiagnosis and biopsy results have been described in the diagnosis and management of patients with disulfiram associated polyneuropathy, neuromuscular ultrasound findings have not been reported. The authors present a case of electrodiagnostically confirmed axonal polyneuropathy with relative sural sparing secondary to disulfiram and describe the neuromuscular ultrasound findings in this individual. Ultrasound demonstrated distal enlargement with slight side-to-side asymmetry and normal proximal cross-sectional area in the lower extremity nerves. Neuromuscular ultrasound is another diagnostic modality that may be used to assist in the diagnosis of patients with polyneuropathy secondary to disulfiram.