What is the role of nerve biopsy in the workup of CNS lupus?

Updated: May 04, 2021
  • Author: Pradeep C Bollu, MD; Chief Editor: Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM  more...
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Nerve biopsy may be helpful in determining an initial diagnosis of active vasculitis when clinical findings are ambiguous because of the relatively high yield of nerve biopsy in early clinical vasculitis. However, in many cases of clinically confluent, symmetric polyneuropathy, the predominant pathology may be nonspecific demyelination, reducing the clinical value of the procedure. When more than one potential etiology is present in the case of a disabling polyneuropathy, biopsy may determine the predominant pathology, serving as a potential alternative to empiric treatment for one or more etiologies.

On histologic examination, active necrotizing vasculitis may involve epineurial arterioles. Often perivascular infiltrates are found without frank arterial necrosis. Immunofluorescent staining may demonstrate immunoglobulin or complement deposition on vessel walls. At times, the only findings are nonspecific demyelination or nerve fiber dropout.

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