Histology of Neuropath Cases

Course overview

The pathological changes of most peripheral neuropathies (axonal degeneration, segmental demyelination or a combination of these) are not specific. In any active neuropathy, there are macrophages removing myelin and axon debris. Advanced axonal neuropathy shows loss of myelinated axons and increased endoneurial collagen. Some chronic demyelinative neuropathies show hypertrophic changes. Thus, in most neuropathies, the sural nerve biopsy can only establish the diagnosis of neuropathy and distinguish axonal from demyelinative and acute from chronic neuropathy, but cannot determine the cause of neuropathy. Only a few peripheral neuropathies show disease-specific pathological changes allowing a specific diagnosis. These neuropathies include acute and chronic inflammatory demyelinative neuropathies, hereditary motor and sensory neuropathies, vasculitis, sarcoid neuropathy, leprosy, amyloid neuropathy, neoplastic invasion of peripheral nerves, metachromatic leukodystrophy, adrenomyeloneuropathy, and giant axonal neuropathy.