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. 2021 Apr 20;96(16):e2078–e2089. doi: 10.1212/WNL.0000000000011792

Figure 3. Segmental Demyelination on Teased Fiber Preparations in Chronic Immune Sensory Polyradiculopathy (CISP)–Plus.

Figure 3

Teased myelinated nerve fiber preparations from patients with CISP-plus taken from proximal and distal nerves show chronic demyelination and remyelination at different stages and severities. (A, B) Dorsal rootlet biopsies show onion-bulb formations (thickened strands of multiple Schwann cell processes surrounding nerve fibers). (C) Fascicular sciatic biopsy and (D) sural biopsy show areas of ongoing demyelination and remyelination. (E) Sural biopsy demonstrates myelin reduplication (small tomaculae; thickened areas of myelin along the lengths of nerve fibers). (F, G) Serial longitudinal paraffin sections of a CISP-plus biopsy show abnormal amounts of scattered endoneurial inflammation on hematoxylin & eosin (F) and CD45 (G) preparations. The teased fiber changes show that in CISP-plus ongoing chronic demyelination and remyelination occurs at multiple nerve levels but are the most severe in the sensory roots.