Marieke van Rosmalen

General discussion 139 8 Figure 8.1 Proposal of revision of diagnostic criteria for CIDP Clinical suspicion of CIDP Ultrasound available? Perform ultrasound 1 Perform NCS 3 Yes No No other diagnosis based on additional laboratory findings 2 Start of treatment Definite CIDP Perform NCS 3 t- Definite, probable or possible Inconclusive Definite CIDP Monitor disease course Definite Definite CIDP Probable Possible Inconclusive Probable CIDP ≥ 2 supportive criteria 4 Possible CIDP Perform MRI of brachial plexus 5 Start of treatment Definite CIDP Monitor disease course t- Consider alternative diagnosis ≥ 1 supportive criterion 4 T+ t+ T- T+ T- t+ ≥ 1 supportive criterion 4 No other diagnosis based on additional laboratory findings 2 This flow chart summarizes results from recent diagnostic nerve ultrasound and MRI studies on diagnosis of CIDP and integrates them in the current diagnostic criteria of the EFNS/PNS. 19 In the blue rectangle the position of MRI of the brachial plexus based on our study in chapter 4 of this thesis. 1 Examination of the median nerve in the forearms (> 10 mm 2 ), upper arms (> 13 mm 2 ) and C5 nerve root (> 8 mm 2 ). Abnormal when ≥ 1 measurement site is enlarged. 2 Additional laboratory examination consists of determination of protein in cerebrospinal fluid and exclusion of other (metabolic) causes of neuropathy (e.g. diabetes, hypothyroidism, liver or renal insufficiency, vitamin deficiencies). 3 Results of NCS should be interpreted according to the electrodiagnostic criteria of the EFNS/PNS guideline. 19 4 Supportive criteria of CIDP can be found in Table 8.1 . MRI should be quantitatively assessed. 5 Results of MRI examination should be quantitatively assessed and interpreted using the risk chart in chapter 4, Figure 4.3 . Abbreviations: CIDP = chronic inflammatory demyelinating polyneuropathy; NCS = nerve conduction studies; MRI = magnetic resonance imaging; T+ = positive result of test; T- = negative result of test; t+ = good treatment response; t- = no treatment response.