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Fig 4.3
From: Møller: Sensory Systems, 2003
Epineurium
Perineurium
Endoneurium
Fascicles
Nerve fiber
Axon
Node of Ranvier
Schwann cell
Nerves:
• Neurapraxia
• Axonotmesis
• Neurotmesis
Nuclei:
• Altered discharge pattern (burst activity)
Causes of injury to peripheral
nerves
• Trauma
• Compression (entrapment)
• Irritation
• Metabolic disorders
• Inflammatory (neuritis)
• Virus
• Age related changes
Trauma to peripheral nerves
• Interruption of nerve trunk (neurotmesis)
• Interruption of axons (axonotmesis)
• Total conduction failure (neurapraxia)
• Impaired conduction (no morphologic
change)
Normal
Epineurium
Perineurium
Endoneurium
Axon
Total conduction failure
(neurapraxia)
• No function
• Recovers spontaneously over days or
weeks (when the cause is resolved)
• Results of spontaneous recovery are
almost always good
Interruption of axons
(axonotmesis)
• No function
• New axon grows from cell body
(spontaneously)
Axonotmesis
• No function
• Irreversible, grafting is required
Neurotmesis
Axon interrupted
(Wallerian
degeneration)
Interruption of
perineurial sheet
Interruption of
nerve trunk
Axonotmesis Epineurium
Perineurium
Endoneurium
Axon
Type 2
Neurotmesis
Type 3
Type 4
Type 5
Interrupted axons
• Synkinesis
• Hyperactivity
(Mostly caused by effect on central nervous
system structures)
Electrophysiological manifestations
of pathologies of peripheral nerves
Nerves:
• Increased conduction times
• Increased or decreased discharge activity
• Dispersion of neural activity
• Altered discharge pattern (burst activity)
Cause of neural pathologies
• Deprivation of input
• Overstimulation
Impaired conduction
• Motor nerves:
– Paralysis
– Spasm
– Electrophysiologic changes
Explanation
• Sensory nerves
– Numbness
– Tingling
– Pain
Explanation
A symptom is any morbid
phenomenon or departure from
the normal in structure, function,
or sensation, experienced by the
patient and indicative of disease.
Slightly injured nerves
(demyelination)
Threshold
EPSP
Threshold
EPSP
• Burst firing
Action potential
Threshold
Resting potential
• Ectopic activity
– After demyelination
– Diabetic neuropathy
– Adrenergic substances facilitate impulse
generation
Ectopic firing
• Burst
• Rhythmic
• After-discharges to stimulation