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Figure 1: Marked symmetrical wasting of the small muscles of the hands (a and b). Ultrasonography of right median nerve at mid-arm (CSA: 52 mm2) and ulnar nerve at above elbow (CSA: 135 mm2) (c and d). Multiple lobulated hypo-echoic areas resembling the cross-section of a lotus root (d). Severe loss of myelinated fibers with myelin ovoid of axonal degeneration (arrow) (modified Gomori Trichrome 20X) (e) and in semithin section (Toluidine blue 20X) (f and d)

Figure 1: Marked symmetrical wasting of the small muscles of the hands (a and b). Ultrasonography of right median nerve at mid-arm (CSA: 52 mm<sup>2</sup>) and ulnar nerve at above elbow (CSA: 135 mm<sup>2</sup>) (c and d). Multiple lobulated hypo-echoic areas resembling the cross-section of a lotus root (d). Severe loss of myelinated fibers with myelin ovoid of axonal degeneration (arrow) (modified Gomori Trichrome 20X) (e) and in semithin section (Toluidine blue 20X) (f and d)