J Clin Neurol.  2018 Jan;14(1):73-80. 10.3988/jcn.2018.14.1.73.

Partial Conduction Block as an Early Nerve Conduction Finding in Neurolymphomatosis

• Park HJ
• Shin HY
• Kim SH
• Jeong HN
• Choi YC
• Suh BC
• Park KD
• Kim SM

• KMID: 2399602
• DOI: http://doi.org/10.3988/jcn.2018.14.1.73

Abstract

BACKGROUND AND PURPOSE
Neurolymphomatosis is a rare manifestation of hematological malignancy and is characterized by direct infiltration of the peripheral nervous system. The objective of this study was to identify the clinical and electrophysiological features of neurolymphomatosis.
METHODS
We retrospectively analyzed the medical records of 13 patients with neurolymphomatosis. Seven (54%) of the patients were men, and the median age at symptom onset was 60.0 years.
RESULTS
The most common type of underlying malignancy was diffuse large B-cell lymphoma (69%). Twelve patients had painful asymmetric neuropathies. The median survival time after diagnosis was 7 months, and 12 patients died during the study period. Thirty-eight motor nerve conduction studies (NCSs) were performed in the affected nerves. Ten and 28 motor nerves were classified into the conduction-block and simple-axon-degeneration groups, respectively. The median time interval between symptom onset and the NCS was significantly shorter in the conduction-block group than in the simple-axon-degeneration group (p=0.032). However, no significant differences in the motor nerve conduction velocities, terminal latencies, and distal compound muscle action potential amplitudes were identified between the conduction-block and simple-axon-degeneration groups. The conduction-block group showed excessive temporal dispersion in only five of the ten NCSs (50%). Follow-up NCSs revealed that partial conduction blocks had changed into axonal degeneration patterns.
CONCLUSIONS
This is the first study to analyze the electrophysiological features of patients with neurolymphomatosis. Our findings showed that a partial conduction block is not rare and is an early nerve conduction abnormality in neurolymphomatosis.

Keyword

neurolymphomatosis; lymphoma; leukemia; nerve conduction study; conduction block

MeSH Terms

Action Potentials
Animals
Axons
Diagnosis
Follow-Up Studies
Hematologic Neoplasms
Humans
Leukemia
Lymphoma
Lymphoma, B-Cell
Male
Marek Disease*
Medical Records
Neural Conduction*
Peripheral Nervous System
Retrospective Studies

Figure

• 

  Fig. 1 A partial conduction block in neurolymphomatosis. A: The median time interval between symptom onset and the NCS was significantly shorter in the conduction-block group than in the simple-axon-degradation group. B and C: A median motor NCS of patient 2 demonstrated a partial conduction block with excessive temporal dispersion (B), while an ulnar motor NCS of patient 6 revealed a partial conduction block without dispersion (C). NCS: nerve conduction study.

• 

  Fig. 2 Findings of follow-up NCSs of the affected nerves with a partial conduction block. In patient 2, the initial motor NCS of the left ulnar nerve demonstrated a partial conduction block (A), but the follow-up NCS performed 360 days later produced results compatible with axon degeneration (B). In patient 5, conduction blocks were found during the initial motor NCS of the left median (C) and ulnar (E) nerves, while the NCS performed 78 days later did not show potentials (D and F). NCS: nerve conduction study.

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