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Nerve biopsy is the gold standard for diagnosis of PNL.
It should be distinguished from more frequently encountered mechanical causes of postsurgical neuropathy based on clinical suspicion, electrophysiological studies, MRI of the lumbosacral plexus, and nerve biopsy.
A study carried out in Malawi by Ponninguas and colleagues who compared the bacterial index in slit skin smear, skin biopsy and nerve biopsy.
The patient was also advised to undergo a sural nerve biopsy, but his parents did not agree because of financial constraints.
We included 17 axonal neuropathy (AN) patients, 11 vasculitic neuropathy (VN) patients and 12 hereditary neuropathy with liability to pressure palsy (HNPP) who had undergone sural and superficial peroneal nerve biopsy as part of the diagnostic work-up of their neuropathy and whose nerve biopsy specimens were suitable for the immunohistochemical analysis.
The researchers of this study point out that presently, nerve biopsy is the only way to confirm the diagnosis with certainty.
When intensive care unit history weaning difficulty from mechanical ventilator clinical manifestations in intensive care unit associated with SIRS symmetrical paresis pronounced in distal lower extremities absence of deep tendon reflexes evidence of distal sensory impairment presence of electrophysiologic results indicating axonal sensorimotor polyneuropathy and muscle and nerve biopsy results were taken into consideration he was diagnosed as critical illness polyneuropathy.
The prominent characteristics of the disease include fever due to anhidrosis, absence of sense of pain, painless ulcers in the structures inside the mouth and extremities, self-harm behavior, mild to severe mental retardation, myelination defect in the sural nerve biopsy and loss of small myelinized fibers.
There are no specific features and nerve biopsy reveals axonal degeneration with secondary demyelination.
A nerve biopsy was not considered for this patient because its main use is in the identification of specific lesions that are generally lacking in acquired, distal, symmetrical sensory neuropathy.
This can be evidenced in the sural nerve biopsy as a severe loss of small myelinated fibers, including the A delta fibers, and a decrease in the number of unmyelinated fibers (2,3).