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Peripheral Nervous System Diseases

Peripheral Nervous System Diseases

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05/16/2012

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Peripheral Nervous System Diseases
Damage of peripheral nerves is manifested by sensory disturbances (neuropathictype of sensory disorders), motions (peripheral pareses) and vegetative-trophicfunctions. Disturbance of the function of peripheral nerves possibly is as a result of both the lesion of axon (axonal neuropathy) and its myelinic layer (demyelinatingneuropathy). The lesion of one nerve is defined as mononeuropathy, while simultaneous lesion of two somatical or peripheral nerves or it is more is as to polyneuropathy. Plexopathyis lesion of nervous plexus (cervical, brachial or lumbar- sacral) as a result of injuryor other reasons (chronic compression, diabetes mellitus, and infiltration bymalignant tumor, radiation therapy and other).Neuralgia is manifested by pain in the zone of innervations of nerve; without thedisturbances of its function. Radiculopathy is the lesion of cerebrospinal radix isdiscussed in the ‘Vertebrogenic neurologic disorder’ topic.
Mononeuropathy
Mononeuropathy is manifested by the peripheral of paresis of muscles, innervatedby lesioned nerve, the mononeuropathic type of sensory disorder and by vegetativedisturbances in the zone of innervation. Mononeuropathy most frequently is causedby injury of nerve or by its [sdavlenney] in the bone-fibrous- muscular canal (tunnelneuropathy). It is also possible as a result of disturbance of blood circulation andischemia of nerve with diabetes mellitus, rheumatoid arthritis, nodular periarteritis,amyloidosis, acromegaly, and also for the reason for direct infection with leprosy.Facial nerve more frequently lesioned cranial nerves, and from spinal nerves, lesionof median nerve in the region of carpal canal is the most commonly seen.
Neuropathy of facial nerve (Bell’s palsy)
Etiology and pathogenesis.
 The neuropathy of facial nerve in majority of thecases is caused by ischemia, edema and compression of nerve in the narrow bonecanal, it maybe caused by idiopathic and supposedly infectious (virus, possibly,herpetic) or infectious-allergic genesis. The frequency of disease is about 20 casesin 100 thousand people. The symptomatic forms of neuropathy are developed withthe injury of temporal bone, tumor of pontocerebellar angle, otitis, encircling herpesand others.
Clinical picture.
Bell’s palsy frequently is provoked by supercooling. At first, painis frequently noted in the mastoid process region, due to acute development of unilateral paresis or paralysis of mimic muscles. Face of patient is distorted, skinfolds are smoothed out on the side of lesion, and the angle of mouth descends.Patient cannot raise eyebrow, shut eye, while grining, mouth displaces to thehealthy side. When eating, food frequently the stick between cheek and gum, liquidpours out from the angle of mouth. Depending on level of lesion of facial nerve, dryeye or epiphora, disturbance of taste on the anterior 2/3 of tongue, hyperacousia onthe side of paralysis is seen. Complete restoration of Bell’s palsy is observed in 70-
 
80% of patients usually for 1 month. (less frequently 2-3); the rest, paresis remainsor, less frequent (3%), paralysis of the mimetic muscles. Prognosis is worse inelderly, with associated diabetes mellitus and/or arterial hypertonia.
Diagnosis
it is based on the clinical symptoms and usually it does not causedifficulties. If the lesion of mimetic muscles is combined with reduction in hearing,sensory disturbance on the person (lesion of trigeminal nerve), central paresis of extremities, cerebellar ataxia or other symptoms, which are not characteristic forneuropathy of facial nerve, is indicated MRI of head to eliminate of ponto-cerebellarangle tumor and other illnesses of brain.
Treatment.
More rapid restoration is noted with prednisolone on 60-80 mg/day forthe first 5-7 days with the subsequent gradual cessation for 10-14 days. Possibleuse of methylprednisolone (250-500 mg I/V 2 times a day for 3-5 days with thesubsequent application of prednisolone) in combination with rheopolyglucin (400 mlof I/V of 2 times a day for 3 days, and then 1 time/day for a week) and Pentoxifyllin(300 mg/day of I/V for 10 days) to improve microcirculation. taking into account theassumed role of herpes simplex virus in the development of disease, it is proposedto use acyclovir (on 200 mg of 5 times a day inward for 2-3 weeks. or the first 7days by parenteral from the calculation 5 mg/kg of 3 times a day, and then inward).From the first days, the gymnastics of mimic muscles, gluing from the adhesivetape is recommended, in order to avoid the overextension of the affected muscles.Late complications relating to the contracture of the denervated mimic musclesmay develped, which responds badly to treatment (reflexotherapy, massage,Carbamazepine).
Mononeuropathies of peripheral nerves of the extremities
 The clinical manifestations of the lesion of the peripheral nerves of extremities arepresented in the book ‘general neurology: symptoms of the lesion of spinal cord, itsradix and peripheral nerves”.
Neuropathy of median nerve. Carpal tunnel Syndrome
it comprises to 2/3 of all tunnel neuropathies. It appears as a result of compression of median nerve in thecarpal canal, formed by bones of carpal and by transverse palmar joint, which iscaused most often by thickening muscles and joints; congenital narrowing of carpalcanal plays the leading role. The syndrome of carpal canal can also be inmyxedema, acromegaly, diabetes mellitus, menopause, pregnancy, use of oralcontraceptives, rheumatoid arthritis, and also as a result of overload of radiocarpal joint (frequent flexure- extension of fingers). Women with CTS are seen 2 timesmore frequently.
Diagnosis
is based on clinical data and is confirmed by the results oelectromeyromyography (decrease velocity of conducting excitation on the mediannerve in the region of carpal canal) and electromyography (presence of thedenervative changes in the innervated by median nerve muscles).
Treatment
is directed toward decreasing load of radiocarpal joint, in many cases,by bandaging of carpal at night, and when symptoms manifest, immobilization of  joint for 2-4 weeks with the aid of tire. Also NSAIDs, analgesics, anti-edematousdrugs, and compression with dimexidom are used. Corticosteroids (with or without
 
novocaine) can be dripped into the carpal canal. When treatment is ineffective andprogressive atrophy of muscles, surgical decompression of nerve in the region of carpal canal is indicated.
Neuropathy of ulnar nerve
appears as a result of its injury or compression in theregion of elbow or, less frequently, radiocarpal joint. In its injury, resolve the injury,then carry out therapeutic gymnastics and massage; in tunnel neuropathy, thetreatment is the same, as carpal tunnel syndrome, and surgical decompression of nerve is also effective.
Neuropathy of radial nerve
usually appears after its injury (in fracture of humerus) or compression at the level of the lower divisions of humeral bone. At thelevel of brachial-axillary angle, compression of nerve can be caused by the incorrectuse of crutch. The lesion of nerve frequently develops acutely as a result of thecompression hand by head in the sleep, period of inconvenient pose (in alcoholicintoxication). Restoration with the injury occurs spontaneously after 2 months, withthe use massage and therapeutic gymnastics. If after 2 months, the restorationdoes not occur after injury, and also like tunnel neuropathy, surgical treatment isrecommended.
Neuropathy of ischial nerve
more frequently appears in the place of its passagethrough piriform muscle by mechanism of tunnel syndrome and is manifested bypain and paresthesias of leg and foot, and disturbance of the function of nerve ispossible. The palpation of piriformis muscle is painful with propagation of pain alongthe path of ischial nerve. The syndrome of piriformis muscle can be caused by the injury of sacral-iliac orbuttock region with post-traumatic spasm of muscle, and also by reflex muscletension during the compression, intervertebral disk of lower lumbar and first sacralof radix changed. In traumatic lesion, there is a possible spontaneous restorationafter 2 months, in spasm of piriformis muscle, novocaine blockade is used.
Neuropathy of femoral nerve
appears usually in the region of inguinal fold, as aresult of the injury (with formation of hematoma) or spontaneous hematoma, forexample, with the use of anticoagulants. The lesion of nerve is manifested by painin the inguinal region, which can spread to the anterior and medial surface of thigh,medial surface of leg and foot. The disturbance of nerve function appears in chroicdisease. Spontaneous restoration is possible after 2 months, with the use of therapeutic gymnastics and massage.
Neuropathy of n. cutaneus lateralis femoris (Rot disease)
appears in itscompression in the region of inguinal ligament, which more frequently caused byinjury, carrying of corset, bandage or tight belt or by the excess deposit of fat in thelower division of front abdominal wall and in thighs region, less frequent by tumor,ascites, and pregnancy. It is necessary to explain the reason for the compression of nerve and, if possibly, then remove it. In majority of cases, the disease does notcause serious sufferings to patient. In case of obesity, symptoms weaken withdecrease of mass of body. The introduction of local anesthetics and corticosteroidsinto the region of the passage of nerve at the level of front upper iliac crest can helpwith the expressed pain, in the rare cases surgical treatment is required.

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