Peripheral Nerve Neuropathology
Peripheral Nerve Neuropathology
What You'll Learn
- The two fundamental reaction patterns — axonal degeneration vs segmental demyelination — and how the biopsy shows them
- Immune/inflammatory neuropathies (GBS, CIDP, vasculitic) on tissue
- Hereditary neuropathies and their signatures (onion bulbs, tomacula)
- Infiltrative causes — amyloid, leprosy, sarcoid — and the biopsy tools that reveal them
The neuropathology view of nerve biopsy. Clinical evaluation of neuropathy lives in the Neuromuscular / Peripheral Nerve notes.
What You'll Learn
| Pattern | Histology | Teased fiber / EM |
|---|---|---|
| Axonal degeneration | Loss of myelinated fibers; digestion chambers (myelin ovoids); denervated bands of Büngner | Linear rows of myelin debris; axon lost |
| Segmental demyelination | Thinly myelinated fibers; onion bulbs with chronicity | Internode with myelin loss, axon intact |
| Regeneration | Regenerating clusters (small thinly myelinated fibers grouped) | — |
What You'll Learn
| Entity | Pathology | Clue |
|---|---|---|
| Guillain-Barré (AIDP) | Endoneurial edema + macrophage-mediated segmental demyelination, perivascular lymphocytes; roots/proximal | Post-infectious; albuminocytologic dissociation |
| CIDP | Chronic demyelination/remyelination, onion bulbs, endoneurial edema; patchy | Relapsing/progressive >8 wk |
| Vasculitic neuropathy | Epineurial vessel transmural inflammation + fibrinoid necrosis → ischemic axonal loss; wallerian degeneration of differing ages, asymmetric fascicular involvement | Mononeuritis multiplex; PAN, ANCA-vasculitis |
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