[Peripheral nerve disorders--clinical pathological approaches].

Abstract

Clinical pathological approach is defined as combination of neurological, neurophysiological and neuroradiological findings for the interpretation of the morphology of the sural nerve. For this purpose, first, the usefulness of simultaneous biopsy of sural nerve and ipsilateral short peroneal muscle was presented. This method has helped establish the diagnosis of angitis or amyloidosis in some cases. Furthermore, motor-dominant clinical picture was ascertained by relative preservation of sural nerve in contrast with severe changes in intramuscular nerve fascicles. Second, histochemistry using UEA-1 lectin to detect somatic sensory C fibers was discussed. UEA-1 specifically binds to unmyelinated axons and small neurons in dorsal root ganglia as well as substantia gelatinosa of the spinal cord. Serial semithin and ultrathin sections were obtained. The semithin section was removed of epon and stained histochemically with UEA-1. Positive fibers in the semithin section was compared with the counterpart in the ultrathin sections. UEA-1 positive fibers were found to comprise 20% of all unmyelinated fibers and be randomly distributed among the entire nerve fascicles. The application of this technique to pathological specimens is now undergoing. Third, an autopsy case with sarin intoxication was reported as an example of systemic study of the peripheral nervous system. The patient was a 51-year-old man who inhaled sarin in the attack of Tokyo Subway. He fell into vegetative state and was passively maintained for 13 months. Peripheral sensory nerve showed typical pattern of dying back-type distal peripheral axonopathy. It might be indicated that peripheral nerve be carefully checked among the sarin victims. In conclusion, the aim of our approach is to combine all clinical information, introduce recent advance in neuroscience, and try to find possible cure to intractable neurological disorders.