Peripheral neurologic deficits are commonly found during physical examination of older patients. Losses of vibratory sensation in the lower extremities and ankle reflexes are so common that they are often listed in geriatric textbooks as normal physical findings in very old people. In this population, the detection of peripheral neuropathy, which may lead to a serious disability, is an important contribution to the health care but there is very little information in the literature about its actual prevalence and etiology. The epidemiological, clinical, morphological, electrophysiological data on the peripheral nervous system abnormalities in elderly are reviewed. A strategy of investigations is proposed to improve the identification of the etiology of their peripheral neuropathy.

Neuropathies du sujet âgé : étiologies et conduite pratique

There are few reports of amyloidosis diagnosed by deliberate biopsy of accessory salivary glands. Usually, a biopsy performed for dry mouth syndrome reveals an unsuspected amyloidosis. We report the case of 2 patients with lambda-type light chain monoclonal gammapathy complicated by generalized amyloidosis and in whom biopsy of the accessory salivary glands showed signs of amyloidosis. In the first patient accessory salivary gland biopsy was performed because these glands were enlarged, and the monoclonal dysglobulinaemia was subsequently diagnosed by serum immunoelectrophoresis. In the second patient with nephrotic syndrome, renal biopsy could not be carried out owing to the presence of a renal malformation; amyloidosis was confirmed by periumbilical fat aspiration, and a systematic biopsy of accessory salivary glands also showed evidence of amyloidosis. Biopsy of accessory salivary glands seems to be a particularly simple and safe method to detect generalized amyloidosis in patients with chronic inflammatory disease or monoclonal dysglobulinaemia.

Intérêt de la biopsie de glandes salivaires accessoires pour le diagnostic d'amylose

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Intérêt de la biopsie de glandes salivaires accessoires pour le diagnostic d'amylose