Differential vagal nerve ultrasound signatures in patients with autoimmune and demyelinating neuropathies

IF 0.8 Q4 RHEUMATOLOGY

Egyptian Rheumatologist Pub Date : 2026-06-01 Epub Date: 2026-06-24 DOI:10.1016/j.ejr.2026.06.004

Amira Elsonbaty, Mohamed A. Abdalraziq, Doaa M. Mahmoud

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Abstract

Background

Ultrasound has emerged as a valuable tool for assessment of peripheral nerves affection in several immune mediated diseases. Vagus nerve involvement has been described in chronic inflammatory demyelinating polyneuropathy (CIDP) and Guillain–Barré syndrome (GBS) but has not been carefully investigated in systemic lupus erythematosus (SLE). Aim of the work: To evaluate vagus nerve ultrasonographic difference among adult patients with SLE, CIDP and GBS, focusing on size variability, fascicular distribution, and echogenicity compared to healthy controls. Patients and methods: This study was conducted on 59 SLE, 51 GBS and 13 CIDP patients as well as 119 controls. Mid cervical level of vagus nerve was assessed bilaterally by neuromuscular ultra sound for all participants.

Results

The mean vagal nerve cross-sectional area (CSA) was 2.6 ± 0.7 mm² in SLE, 3.5 ± 1 mm² in GBS, CIDP 4.5 ± 1.5 mm² and 2.6 ± 0.6 mm² in control. The CSA was similar between SLE and controls (p 0.223) with a significant vagus nerve enlargement in CIDP and GBS patients (p < 0.0001). Vagus nerve possessed a heterogeneous echotexture and irregularly distributed fascicles mainly in CIDP patients followed by GBS, but not in SLE, when compared to the uniform fascicular pattern in controls. The right vagus nerve was minimally enlarged; however, side-to-side difference evaluation revealed no significant asymmetry among the four groups (p > 0.05).

Conclusion

This study highlights the importance of neuromuscular ultrasound evaluation of vagus nerve among other usually studied nerves in assessing different autoimmune and demyelinating neuropathies and possibly including it in future validated diagnostic and follow up protocols.

Key Summary Points

•
Vagus nerve morphology is significantly altered in CIDP and GBS compared with healthy controls.
•
In lupus patients, vagus nerve size and structure appear preserved, suggesting a more benign course.
•
Neuromuscular ultrasound provides a rapid, non-invasive tool for detecting autoimmune neuropathic involvement.
•
Findings highlight the potential of ultrasound as an adjunct in early diagnosis and treatment monitoring.

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自身免疫性和脱髓鞘性神经病患者的迷走神经超声特征鉴别

超声已成为评估几种免疫介导疾病对周围神经影响的一种有价值的工具。迷走神经受累已被描述为慢性炎症性脱髓鞘性多神经病变（CIDP）和格林-巴勒综合征（GBS），但尚未仔细研究系统性红斑狼疮（SLE）。工作目的：评价成年SLE、CIDP和GBS患者迷走神经超声检查的差异，重点关注与健康对照相比的大小变异性、束分布和回声性。患者和方法：本研究纳入59例SLE、51例GBS和13例CIDP患者以及119例对照。采用神经肌肉超声对所有受试者进行双侧颈内中段迷走神经水平的评估。结果SLE患者迷走神经平均横截面积（CSA）为2.6±0.7 mm2， GBS患者为3.5±1 mm2， cdp患者为4.5±1.5 mm2，对照组为2.6±0.6 mm2。SLE患者的CSA与对照组相似（p 0.223）， CIDP和GBS患者的迷走神经明显扩大（p < 0.0001）。与对照组的均匀神经束模式相比，迷走神经主要在CIDP继发GBS患者中具有不均匀的回声结构和不规则分布的神经束，而在SLE患者中则没有。右侧迷走神经轻度扩张；然而，侧对侧差异评估显示四组之间没有明显的不对称性（p > 0.05）。结论本研究强调了神经肌肉超声评估迷走神经在其他常被研究的神经中评估不同自身免疫性和脱髓鞘神经病变的重要性，并可能将其纳入未来有效的诊断和随访方案。•与健康对照相比，CIDP和GBS患者的迷走神经形态发生了显著改变。•在狼疮患者中，迷走神经的大小和结构似乎得到了保留，表明其病程更为良性。•神经肌肉超声为检测自身免疫性神经病变提供了一种快速、无创的工具。•研究结果强调了超声作为早期诊断和治疗监测辅助手段的潜力。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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