Abstract Details

Title Nerve Biopsy Supports Ischemic Axonal Neuropathy in Meralgia Paresthetica

Topic Peripheral Nerve

Presentation(s) P02 - (-)

Poster/Presentation
Number 178

Objective

Background BACKGROUND: Pathologic descriptions of meralgia paresthetica (MP) are lacking. Utilizing a population-based approach, we recently confirmed an association between diabetes, obesity, advancing age and the common occurrence of MP (32.6 per 100,000 patient years). Many patients had monophasic, non-positional symptoms raising the question of an inflammatory or immune mononeuropathy.

Design/Methods DESIGN/METHODS: Utilizing a nerve biopsy database, four lateral femoral cutaneous nerve biopsies were identified in patients who underwent neurectomy for intractable MP pain. Autopsy nerve was obtained for control. Clinical features and testing were reviewed and correlated with the pathologic findings.

Results RESULTS: In the group undergoing neurectomy, preoperative symptoms included non-positional, severe intractable hypesthesias, burning pain and thigh numbness. The duration of symptoms prior to surgery ranged from 1 to 15 years. BMI's varied from 20 kg/m2-41 kg/m2 (normal to morbid obesity). No patients were diabetic. Lateral femoral cutaneous nerve conductions were abnormal in 3 of 4 patients. One patient had fusiform enlargement and T2 hyperintensity of the lateral femoral cutaneous nerve on MRI. At time of neurectomy, two patients had grossly abnormal enlargement of the lateral femoral cutaneous nerve with compression and scarring at and proximal to the biopsy site. Multifocal fiber loss, selective loss of large myelinated fibers, thinly myelinated profiles, perineurial thickening, subperineurial edema and Renault corpuscles were found. These features were not seen in the autopsied nerve. Three patients had varying degrees of intraneural and epineurial inflammation without vessel wall destruction. All patients reported symptomatic improvement after neurectomy.

Conclusions CONCLUSIONS: Meralgia paresthetica cases biopsied have axonal degeneration and regeneration, varying degrees of inflammation and features of chronic ischemia. In select patients, neurectomy may be helpful for symptomatic pain relief.

Authors/Disclosures
Sarah E. Berini, MD (Mayo Clinic) PRESENTER	Dr. Berini has nothing to disclose.
Robert Spinner	No disclosure on file
	No disclosure on file
	No disclosure on file
JaNean Engelstad	JaNean Engelstad has nothing to disclose.
Narupat Suanprasert (Mayo Clinic)	No disclosure on file
Ludwig Kappos, MD, FAAN (RC2NB, University Hospital Basel)	Dr. Kappos has nothing to disclose.
P. James B. Dyck, MD, FAAN (Mayo Clinic)	Dr. Dyck has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Akcea/Ionis.
Nathan P. Staff, MD, PhD, FAAN (Mayo Clinic)	Dr. Staff has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Stem Cell Research & Therapy. Dr. Staff has received research support from National Institutes of Health.
Christopher J. Klein, MD, FAAN (Mayo Clinic)	Dr. Klein has received personal compensation in the range of $500-$4,999 for serving as a Consultant for NMD Pharma.

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