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Abstract
Monoclonal gammopathy is encountered quite frequently in the general population. This type of hematologic abnormality may be mild, referred to as monoclonal gammopathy of undetermined significance or related to different types of hematologic malignancies. The association of a peripheral neuropathy with monoclonal gammopathy is also fairly common, and hemopathy may be discovered in an investigation of peripheral neuropathy. In such a situation, it is essential to determine the exact nature of the hematologic process in order not to miss a malignant disease and thus initiate the appropriate treatment (in conjunction with hematologists and oncologists). In this respect, nerve biopsy (discussed on a case-by-case basis) is of great value in the management of such patients. We therefore propose to present the objectives and main interests of nerve biopsy in this situation.
Glossary
- AD=
- amyloidosis deposits;
- AL=
- primary amyloidosis;
- BTU=
- Bühlmann titer units;
- CANOMAD=
- chronic ataxic neuropathy, ophthalmoplegia, IgM paraprotein, cold agglutinins and disialosyl antibodies;
- CIDP=
- chronic inflammatory demyelinating polyradiculoneuropathy;
- CMAP=
- compound muscle action potentials;
- CRAB=
- hypercalcemia, renal insufficiency, anemia, and bone lesions;
- DADS=
- distal acquired demyelinating symmetric;
- DIF=
- direct immunofluorescence;
- EFNS/PNS=
- European Federation of Neurological Societies/ Peripheral Nerve Society;
- EM=
- electron microscopy;
- GD=
- disialoganglioside;
- GQ=
- quadrisialoganglioside;
- GT=
- trisialoganglioside;
- HC=
- heavy chain;
- HNK1=
- human natural killer-1;
- Ig=
- immunoglobulin;
- LC=
- light chain;
- LM=
- light microscopy;
- LRW=
- London resin white;
- MAG=
- myelin-associated glycoprotein;
- MG=
- monoclonal gammopathy;
- MGUS=
- monoclonal gammopathy of undetermined significance;
- MYD88=
- myeloid differentiation primary response 88;
- NB=
- nerve biopsy;
- NCS=
- nerve conduction study;
- PN=
- peripheral neuropathy;
- POEMS=
- Polyneuropathy, Organomegaly, Endocrinopathy, presence of M-protein and Skin changes;
- SFN=
- small fiber neuropathy;
- SGLPG=
- sulfate-3-glucuronyl lactosaminyl paragloboside;
- SGPG=
- sulfate-3-glucuronyl paragloboside;
- SNAP=
- sensory nerve action potential;
- VEGF=
- vascular endothelial growth factor;
- WM=
- Waldenström macroglobulinemia;
- WML=
- widenings of the myelin lamellae
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
- Received June 18, 2020.
- Accepted in final form October 8, 2020.
- © 2020 American Academy of Neurology
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