Grimm Lab

Neuromuscular Imaging Group

The group works on different projects concerning nerve imaging, particularly high-resolution ultrasound in neuromuscular disorders, such as polyneuropathies, motoneuronopathies and myopathies, and focal mononeuropathies, i.e. entrapment syndromes, nerve trauma and tumours. By the use of HRUS one can detect nerve inflammation, fibrosis or scar tissue. In many cases HRUS reveals nerve or fascicle area enlargement, decrease or increase of echointensity or nerve compression. Therapeutic response, change of nerve morphology during healing processes or further nerve increase correlating with pathology has been proven by our study groups in smaller studies, however many things remain unclear and further prospective, multicentric studies are necessary. Even in healthy persons, knowledges about nerve size, fascicular somatotopy and nerve elasticity are limited and thus further analyses are needed. 

Research Projects
Collaborations and Partners

1. Fortüne project for the investigation of peripheral nerve ultrasound in polyneuropathies

2. TUNAP (prospective study for the investigation of nerve ultrasound in nerve injuries)

3. follow-up examination in patients with inflammatory polyneuropathy

Tübinger Nerve Team: Prof. Schuhmann (Neurochirurgy), PD Dr. Kolbenschlag (HPRV BGU Klinik Tübingen), Dr. Lindig (Neuroradiology)

Prof. Hubertus Axer (Universitätsklinik Neurologie Jena), Ultrasound projects in neuropathies

Research Group
 Alexander Grimm
Alexander GrimmResearch Group Leader
Neuromuscular Imaging

+49 (0)7071

 Katharina Kneer
Katharina KneerPhysician
Neuromuscular Imaging

+49 (0)07071
29 68497


Original publications

Grimm A, Oertl H, Auffenberg E, Schubert V, Ruschil C, Axer H, Winter N. Differentiation Between Guillain-Barré Syndrome and Acute-Onset Chronic Inflammatory Demyelinating Polyradiculoneuritis-a Prospective Follow-up Study Using Ultrasound and Neurophysiological Measurements. Neurotherapeutics. 2019 Feb 12. doi: 10.1007/s13311-019-00716-5.

Rattay TW, Just J, Röben B, Hengel H, Schüle R, Synofzik M, Söhn AS, Winter N, Dammeier N, Schöls L, Grimm A. Nerve ultrasound characterizes AMN polyneuropathy as inhomogeneous and focal hypertrophic. Orphanet J Rare Dis. 2018 Nov 3;13(1)

Alexander Grimm, Hubertus Axer, Bianka Heiling, Natalie Winter. Nerve ultrasound normal values - readjustment of the ultrasound pattern sum score UPSS Clin Neurophysiol. 2018

Härtig F, Ross M, Dammeier NM, Fedtke N, Heiling B, Axer H, Décard BF, Auffenberg E, Koch M, Rattay TW, Krumbholz M, Bornemann A, Lerche H, Winter N, Grimm A. Nerve Ultrasound Predicts Treatment Response in Chronic Inflammatory Demyelinating Polyradiculoneuropathy-a Prospective Follow-Up. Neurotherapeutics. 2018 Feb 12. doi: 10.1007/s13311-018-0609-4.

Dohrn MF, Glöckle N, Mulahasanovic L, Heller C, Mohr J, Bauer C, Riesch E, Becker A, Battke F, Hörtnagel K, Hornemann T, Suriyanarayanan S, Blankenburg M, Schulz JB, Claeys KG, Gess B, Katona I, Ferbert A, Vittore D, Grimm A, Wolking S, Schöls L, Lerche H, Korenke GC, Fischer D, Schrank B, Kotzaeridou U, Kurlemann G, Dräger B, Schirmacher A, Young P, Schlotter-Weigel B, Biskup S. Frequent genes in rare diseases: panel-based next generation sequencing to disclose causal mutations in hereditary neuropathies. J Neurochem. 2017 Dec;143(5):507-522.

Grimm A,Winter N, Rattay TW, Härtig F, Dammeier NM, Auffenberg E, Koch M, Axer H. A look inside the nerve - Morphology of nerve fascicles in healthy controls and patients with polyneuropathy.Clin Neurophysiol. 2017 Dec;128(12):2521-2526.

Rattay TW, Winter N, Décard BF, Dammeier NM, Härtig F, Ceanga M, Axer H, Grimm A. Nerve ultrasound as follow-up tool in treated multifocal motor neuropathy. Eur J Neurol. 2017 Sep;24(9):1125-1134.

Winter N, Rattay TW, Axer H, Schäffer E, Décard BF, Gugel I, Schuhmann M, Grimm A. Ultrasound assessment of peripheral nerve pathology in neurofibromatosis type 1 and 2. Clin Neurophysiol. 2017 May;128(5):702-706.

Axer H, Grimm A, Pausch C, Teschner U, Zinke J, Eisenach S, Beck S, Guntinas-Lichius O, Brunkhorst FM, Witte OW. The impairment of small nerve fibers in severe sepsis and septic shock. Crit Care. 2016 Mar 15;20:64.

Rasenack M, Décard BF, Schädelin S, Grimm A, Fischer D, Hafner P.Ultrasonographic reference values for peripheral nerves and nerve roots in the normal population of children and adolescents: study protocol for an observational-prospective trial.  BMJ Open. 2016 Dec 9;6(12):e014662.

Grimm A, Rattay TW, Winter N, Axer H.Peripheral nerve ultrasound scoring systems: benchmarking and comparative analysis. J Neurol. 2017 Feb;264(2):243-253.

Grimm A, Vittore D, Schubert V, Lipski C, Heiling B, Décard BF, Axer H.Ultrasound pattern sum score, homogeneity score and regional nerve enlargement index for differentiation of demyelinating inflammatory and hereditary neuropathies. Clin Neurophysiol. 2016 Jul;127(7):2618-24.

Grimm A, Vittore D, Schubert V, Rasenack M, Décard BF, Heiling B, Hammer N, Axer H.Ultrasound aspects in therapy-naive CIDP compared to long-term treated CIDP. J Neurol. 2016 Jun;263(6):1074-82.

Athanasopoulou IM, Rasenack M, Grimm C, Axer H, Sinnreich M, Décard BF, Grimm A. Ultrasound of the nerves - An appropriate addition to nerve conduction studies to differentiate paraproteinemic neuropathies. J Neurol Sci. 2016 Mar 15;362:188-95.

Grimm A, Rasenack M, Athanasopoulou IM, Dammeier NM, Lipski C, Wolking S, Vittore D, Décard BF, Axer H. The modified ultrasound pattern sum score mUPSS as additional diagnostic tool for genetically distinct hereditary neuropathies. J Neurol. 2016 Feb;263(2):221-30.

Grimm A, Décard BF, Axer H, Fuhr P. The Ultrasound pattern sum score - UPSS. A new method to differentiate acute and subacute neuropathies using ultrasound of the peripheral nerves. Clin Neurophysiol. 2015 Nov;126(11):2216-25.

Grimm A, Décard BF, Schramm A, Pröbstel AK, Rasenack M, Axer H, Fuhr P. Ultrasound and electrophysiologic findings in patients with Guillain-Barré syndrome at disease onset and over a period of six months. Clin Neurophysiol.;127(2):1657-1663.

Grimm A, Décard BF, Athanasopoulou I, Schweikert K, Sinnreich M, Axer H. Nerve ultrasound for differentiation between amyotrophic lateral sclerosis and multifocal motor neuropathy. J Neurol. 2015;262(4):870-80.

Grimm A, Décard BF, Axer H. Ultrasonography of the peripheral nervous system in the early stage of Guillain-Barré syndrome J Peripher Nerv Syst. 2014 Sep;19(3):234-41.

Grimm A, Décard BF, Bischof A, Axer H.Ultrasound of the peripheral nerves in systemic vasculitic neuropathies. J Neurol Sci. 2014 Dec 15;347(1-2):44-9.

Grimm A, Prell T, Décard BF, Schumacher U, Witte OW, Axer H, Grosskreutz J.Muscle ultrasonography as an additional diagnostic tool for the diagnosis of amyotrophic lateral sclerosis.Clin Neurophysiol.;126(4):820-7.

Grimm A, Heiling B, Schumacher U, Witte OW, Axer H.Ultrasound differentiation of axonal and demyelinating neuropathies. Muscle Nerve;50(6):976-83.

Axer H, Grimm A, Porzelius C, Teschner U, Schumacher U, Witte OW, Brunkhorst FM   Impairment of small somatic and autonomic nerve fibres in intensive care unit patients with severe sepsis and critical illness polyneuropathy – a single center controlled observational study. BMC Neurol. 2013 Nov 1;13(1):159. 

Grimm A, Teschner U, Porzelius C, Ludewig K, Zielske J, Witte OW, Brunkhorst FM, Axer H.Muscle ultrasound for early assessment of critical illness neuromyopathy in severe sepsis. Crit Care. 7;17(5):R227

Meuth SG, Simon OJ, Grimm A,Melzer N, Herrmann AM, Spitzer P, Landgraf P, Wiendl H CNS inflammation and neuronal degeneration is aggravated by impaired CD200-CD200R-mediated macrophage silencing J Neuroimmunol. 2008 Feb;194(1-2):62-9 2,78

Kroner A, Grimm A, Johannssen K, Mäurer M, Wiendl H. The genetic influence of the nonclassical MHC molecule HLA-G on multiple sclerosis.Hum Immunol. 2007 May;68(5):422-5 2,28


Review articles / Guidelines

Walker FO, Cartwright MS, Alter KE, Visser LH, Hobson-Webb LD, Padua L, Strakowski JA, Preston DC, Boon AJ, Axer H, van Alfen N, Tawfik EA, Wilder-Smith E, Yoon JS, Kim BJ, Breiner A, Bland JDP, Grimm A, Zaidman CM. Indications for neuromuscular ultrasound: Expert opinion and review of the literature. Clin Neurophysiol. 2018 Dec;129(12):2658-2679.

Décard BF, Pham M, Grimm A. Ultrasound and MRI of nerves for monitoring disease activity and treatment effects in chronic dysimmune neuropathies - Current concepts and future directions.Clin Neurophysiol. 2018 Jan;129(1):155-167.

Grimm A., Axer H.Chronisch immunvermittelte Neuropathien – Diagnostik und TherapieFortschritte in Neurologie und Psychiatrie (epub ahead of print)

Grimm A. Der „Ultrasound pattern sum score“ – ein möglicher Algorithmus in der Anwendung des Nervenultraschalls bei Polyneuropathien Ultrasound Pattern Sum Score: A Potential Algorithm for Nerve Ultrasound in Polyneuropathies.   Klin Neurophysiol 2017; 48(02): 93-101

Telleman JA, Grimm A,Goedee S, Visser LH, Zaidman CM. Nerve ultrasound in polyneuropathies.Muscle Nerve. 2017 Dec 2. doi: 10.1002/mus.26029. [Epub ahead of print]

Hobson-Webb LD, Grimm A. Quantifying neuromuscular ultrasound in amyotrophic lateral sclerosis.Clin Neurophysiol. 2017 Jun;128(6):1030-1031.

Bäumer T, Grimm A, Schelle T .[Diagnostic nerve ultrasonography]. Radiologe. 2017 Mar;57(3):157-165.

Grimm A., Prell T., Witte OW., Axer H., Sonography of Muscles - A Useful Tool in the Diagnosis of Amyotrophic Lateral Sclerosis Klin Neurophysiol 2013; 44(02): 

Grimm A, Brunckhorst M, Axer HSepsis-induzierte CIP und CIMNeurotransmitter 24:36-43

Grimm A, Günther A, Witte OW, Axer H.[Critical illness polyneuropathy and critical illness myopathy].Med Klin Intensivmed Notfmed. 2012 Nov;107(8):649-58;

Kraft P, Beck M, Grimm A, Wessig C, Reiners K, Toyka KV. Amyotrophic lateral sclerosis: management of bulbar symptoms. Nervenarzt.  Nervenarzt. 2010 Oct;81(10):1218-25.


Case reports

Stefanou MI, Schubert V, Ruschil C, Winter N, Schuhmann MU, Ziemann U, Grimm A. Median nerve dissection after brachial artery catheterization revealed by high-resolution ultrasound. Clin Neurophysiol. 2019 Jul;130(7):1081-1082.

Heiling B, Grimm A,…. Axer H  Not your average Saturday night palsy - High resolution nerve ultrasound resolves rare cause of wrist drop CNN

Grimm A, Winter N, Wolking S, Vittore D, Biskup S, Axer H. Nerve enlargement in an unusual case of inflammatory neuropathy and new gene mutation-morphology is the key. Neurol Sci. 2017 Aug;38(8):1525-1527.

Weiss D, Zrenner B, Wolking S, Freilinger T, Grimm A. Macrodactylia lipomatosa with fibrolipomatous hamartomas: Macroscopic and ultrasound clues. Clin Neurophysiol. 2017 Jul;128(7):1315-1316.

Rasenack M, Proebstel AK, Athanasopoulou IM, Décard BF, Grimm A.  Nerve Hypertrophy in Primary Amyloidosis. Muscle Nerve. 2016 Sep;54(3):510-2.

Grimm A, Schäffer E, Just J, Schöls L, Kehrer C, Bevot A, Ziemann U, Krageloh-Mann I.  Thickening of the peripheral nerves in metachromatic leukodystrophy. J Neurol Sci. 2016 Sep 15;368:399-401.

Grimm A, Schubert V, Axer H, Ziemann U. Giant nerves in chronic inflammatory polyradiculoneuropathy. Muscle Nerve. 2017 Feb;55(2):285-289.

Décard BF, Fladt J, Axer H, Fischer D, Grimm A.Nerve ultrasound in Miller Fisher variant of Guillain-Barré syndrome. Muscle Nerve. 2015 Dec;52(6):1106-10.

Grimm A,Rasenack M, Athanasopoulou I, Peters N, Fuhr P. Long-term observations in asymmetric immune-mediated neuropathy with vagus hypertrophy using ultrasound of the nerves. J Neurol Sci. 2015 Sep 15;356(1-2):205-8.

Grimm A,Thomaser AL, Peters N, Fuhr P. Neurological picture. Vagal hypertrophy in immune-mediated neuropathy visualised with high-resolution ultrasound (HR-US). J Neurol Neurosurg Psychiatry. 2015 Nov;86(11):1277-8.

Décard BF, Grimm A, Andelova M, Deman A, Banderet B, Garcia M, Fuhr P. Hepatitis-E virus associated neuralgic amyotrophy with sustained plexus brachialis swelling visualized by high-resolution ultrasound. J Neurol Sci. 2015 Apr 15;351(1-2):208-10.

Rupprecht S, Grimm A, Schultze T, Zinke J, Karvouniari P, Axer H, Witte OW, Schwab M. Does the clinical phenotype of fatal familial insomnia depend on PRNP codon 129 methionine-valine polymorphism? J Clin Sleep Med. 2013 Dec 15;9(12):1343-5. doi: 10.5664/jcsm.3286.

Melzer N, Grimm A, Meuth SG, Solymosi L, Stoll G. A pure cerebellar syndrome with corresponding ponto-cerebellar atrophy in acquired hepatocerebral degeneration. J Neurol Sci. 2010 May 15;292(1-2):96-8.


Book chapters

Grimm A, Quantifizierung des Nervenultraschalls zur Unterscheidung Neurodepesche 

Grimm A, Quastorff B, Axer H   SOP Neurophysiologie – Muskelultraschall Buchner, Bischoff: SOPs Neurophysiologische Diagnostik

Grimm A; Axer H. Hochauflösender Ultraschall in der Darstellung des Plexus brachialis und der zervikalen Nervenwurzeln. The value of high-resolution ultrasound in the imaging of the plexus brachialis and the cervical nerve roots. Neurophysiol. Volume 36, Issue 4

Axer H, Zinke J, Axer M, Grimm A  Elektrophysiologische Diagnostik der Critical Illness Polyneuropathie und Critical Illness Myopathie Neurophysiologie Labor Volume 35, Issue 1

Grimm A, Witte OW, Axer H Muskelultraschall in der neurologischen Diagnostik – ein Überblick Neurophysiologie Labor Volume 35, Issue 1

Grimm A; Axer H. Nervenultraschall bei Polyneuropathie – sinnvoll oder nicht? Neurophysiol. Volume 36, Issue 3

Research group leader
Prof. Dr. Alexander Grimmalexander.grimm@med.uni-tuebingen.deAddress

Hertie Center of Neurology
Hertie Institute for Clinical Brain Research
Department Neurology and Epileptology

Hoppe-Seyler-Straße 3
72076 Tübingen

Phone: +49 (0)7071 29-80416