Neuromuscular

CIDP: Childhood onset, Chronic

Note: Biopsies are all from children who

Nerve: Hypomyelination & Onion Bulbs


Toluidine blue stain

Many thinly myelinated large axons
Small onion bulbs

Toluidine blue stain

Large axons surrounded by small onion bulbs

Toluidine blue stain

Nerve: Onion bulbs, Large


Toluidine blue stain

Large onion bulbs

Toluidine blue stain



Toluidine blue stain

Onion bulbs: Patchy distribution

Toluidine blue stain

Onion bulbs: Around axons with thicker myelin sheath

Nerve: Differential Axon Loss within a Fascicle


Toluidine blue stain

Patchy involvement within one fascicle


Toluidine blue stain

Region of fascicle with relatively
  abundant, thinly myelinated large axons

Toluidine blue stain

Region of fascicle with few large axons
Smaller myelinated and unmyelinated axons predominate

Nerve: Infantile onset neuropathy


Toluidine blue stain

Small axons: Very thin myelin sheath

Toluidine blue stain


CIDP: Type 1 predominance is common in muscle


ATPase, pH 9.4 stain

Type 1 muscle fiber predominance

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4/5/2016