Radiculopathies and Neuropathies

2015 ◽  
Author(s):  
Kathy Chuang ◽  
William S David
Keyword(s):  
Nervous System ◽  
Peripheral Nerves ◽  
Cauda Equina ◽  
Clinical Manifestations ◽  
Cervical Radiculopathy ◽  
Lumbosacral Spine ◽  
Ultrasound Images ◽  
Spinal Segment ◽  
Nerve Roots ◽  
Pain Medications

“Radiculopathies” are disorders of nerve roots, whereas “neuropathies” are disorders of the peripheral nerve. These disorders may involve single roots or nerves, multiple roots or nerves, and even other aspects of the nervous system. This chapter reviews the anatomy and pathophysiology of the peripheral nervous system; the general approach to radiculopathies and neuropathies, including clinical manifestations and localization, diagnostic studies, and treatment; radiculopathies, including anatomy, cervical radiculopathy, lumbosacral radiculopathy, thoracic radiculopathy, and cauda equina syndrome; and neuropathies, including  mononeuropathies and polyneuropathies. Tables describe the innervation of select nerve roots and peripheral nerves, differences between root and nerve lesions, commonly used neuropathic pain medications, distinctive patterns of neuropathy with limited differential diagnoses, differential diagnosis of demyelinating polyneuropathy, drugs that may cause polyneuropathy, and neuropathies associated with diabetes mellitus. Figures show the anatomy of a spinal segment, nerve fascicles, ultrasound images of the median nerve, magnetic resonance imaging of the lumbosacral spine, the Spurling maneuver, and physical examination maneuvers for lumbosacral radiculopathies. This chapter contains 6 highly rendered figures, 8 tables, 77 references, and 5 MCQs.

Radiculopathies and Neuropathies

2015 ◽  
Author(s):  
Kathy Chuang ◽  
William S David
Keyword(s):  
Nervous System ◽  
Peripheral Nerves ◽  
Cauda Equina ◽  
Clinical Manifestations ◽  
Cervical Radiculopathy ◽  
Lumbosacral Spine ◽  
Ultrasound Images ◽  
Spinal Segment ◽  
Nerve Roots ◽  
Pain Medications

“Radiculopathies” are disorders of nerve roots, whereas “neuropathies” are disorders of the peripheral nerve. These disorders may involve single roots or nerves, multiple roots or nerves, and even other aspects of the nervous system. This chapter reviews the anatomy and pathophysiology of the peripheral nervous system; the general approach to radiculopathies and neuropathies, including clinical manifestations and localization, diagnostic studies, and treatment; radiculopathies, including anatomy, cervical radiculopathy, lumbosacral radiculopathy, thoracic radiculopathy, and cauda equina syndrome; and neuropathies, including  mononeuropathies and polyneuropathies. Tables describe the innervation of select nerve roots and peripheral nerves, differences between root and nerve lesions, commonly used neuropathic pain medications, distinctive patterns of neuropathy with limited differential diagnoses, differential diagnosis of demyelinating polyneuropathy, drugs that may cause polyneuropathy, and neuropathies associated with diabetes mellitus. Figures show the anatomy of a spinal segment, nerve fascicles, ultrasound images of the median nerve, magnetic resonance imaging of the lumbosacral spine, the Spurling maneuver, and physical examination maneuvers for lumbosacral radiculopathies. This review contains 6 highly rendered figures, 8 tables, and 77 references.

Autoimmune Neurologic Diseases in Children

2018 ◽  
Vol 38 (03) ◽  
pp. 355-370
Author(s):  
Michael Sweeney
Keyword(s):  
Nervous System ◽  
Autoimmune Diseases ◽  
Peripheral Nerves ◽  
Autoimmune Process ◽  
Rare Disorders ◽  
Nerve Roots ◽  
Neurologic Diseases ◽  
Neurologic Outcomes ◽  
The Brain

AbstractAutoimmune diseases of the nervous system in children are composed of a heterogeneous group of rare disorders that can affect the central or peripheral nervous system at any level. Presentations may occur in children of any age and are typically acute or subacute in onset. Consideration of an autoimmune process as the etiology of neurologic diseases in children is important, as it may lead to early initiation of immunotherapy and an improvement in long-term neurologic outcomes. The developing nervous and immune systems in children create unique challenges in diagnosis and treatment of these rare diseases. In this review, autoimmune diseases affecting the brain, spinal cord, nerve roots, peripheral nerves, neuromuscular junction, and muscle in children are described.

The Organization of the Nervous System

2016 ◽  
Author(s):  
Michael J. Aminoff
Keyword(s):  
Nervous System ◽  
Peripheral Nerves ◽  
Nerve Fibers ◽  
Sense Organs ◽  
Nerve Roots ◽  
Long Thoracic Nerve ◽  
System P ◽  
Health And Disease ◽  
To Receive ◽  
The Brain

Bell came up with a number of original concepts concerning the organization and operation of the nervous system in health and disease. The focus of Bell’s 1811 book was the brain, not the nerve roots. Bell suggested that parts of the brain differ in function; peripheral nerves are composed of nerve fibers with different functions; nerves conduct only in one direction; sense organs are specialized to receive only one form of sensory stimulus; and perception depends on the part of the brain activated. In later publications, he described a sixth (muscle or proprioceptive) sense and the circle of the nerves subserving it; movement and reciprocal innervation; and the long thoracic nerve (Bell’s nerve).

scholarly journals Role of redundant nerve roots in clinical manifestations of lumbar spine stenosis

2021 ◽  
Vol 12 ◽  
pp. 218
Author(s):  
Karim Rizwan Nathani ◽  
Komal Naeem ◽  
Hamid Hussain Rai ◽  
Muhammad Danish Barakzai ◽  
Haissan Iftikhar ◽  
...  
Keyword(s):  
Japanese Orthopaedic Association ◽  
Radiological Finding ◽  
Cauda Equina ◽  
Clinical Manifestations ◽  
Nerve Roots ◽  
Duration Of Symptoms ◽  
Canal Stenosis ◽  
Clinical Presentations ◽  
Preoperative Magnetic Resonance ◽  
Lumbar Spinal

Background: Redundant nerve roots (RNRs) are defined as elongated, thickened, and tortious appearing roots of the cauda equina secondary to lumbar spinal canal stenosis (LSCS). The study compared the clinical and radiological features of patients with LSCS with versus without RNR. Methods: This retrospective study was performed on 55 patients who underwent decompressive surgery for degenerative LSCS. Patients were divided into two groups based on the presence of RNR in their preoperative magnetic resonance imaging, as evaluated by a radiologist blinded to the study design. Medical records were reviewed for basic demographic, clinical MR presentation, and outcomes utilizing Japanese Orthopaedic Association (JOA) scores. Results: The mean age of enrolled patients was 57.1, with mean follow-up of 4.0 months. RNR was found in 22 (40%) of patients with LSCS. These patients were older than those patients without RNR (62.2 vs. 53.7). Interestingly, there were no statistically significant differences in clinical presentations, duration of symptoms, and outcomes using JOA scores between the two groups. Conclusion: RNR is a relatively common radiological finding (i.e., 40%) in patients with LSCS. It is more likely to be observed in older patients. However, no significant differences were noted in clinical presentation and functional outcomes with respect to the presence or absence of RNR.

CIDP PRESENTING AS MYELORADICULOPATHY

2021 ◽  
pp. 50-51
Author(s):  
Sundarachary. N.V ◽  
Mythri. A.
Keyword(s):  
Peripheral Nerves ◽  
Urge Incontinence ◽  
Cauda Equina ◽  
Cord Compression ◽  
Nerve Conduction Studies ◽  
Lower Limbs ◽  
Sensory Level ◽  
Nerve Roots ◽  
Sensory Disturbances ◽  
Progressive Disorder

Chronic inammatory demyelinating polyradiculoneuropathy (CIDP) is a relapsing or chronic progressive disorder which is one of the causes of hypertrophic neuropathy. Enlarged nerve roots were identied in few patients. We now report a case of CIDP with highly thickened or enlarged nerve roots severe enough to cause cord compression and myelopathy. A 38 year old woman presented with weakness and sensory disturbances in lower limbs with sensory level at L1 and bladder disturbances in form of urgency and urge incontinence . MRI showed a non enhancing isointense mass lesion from L1 to S1 causing compression over conus . During surgery the cauda equina nerve roots were found to be thickened , entangled with ' bag of worms' appearance. Nerve conduction studies showed all her peripheral nerves to be inexcitable. Her CSF protein was mildly elevated. Diagnosis of CIDP with thickened nerve roots was considered and she was started on steroids and subsequently showed improvement. Thus, CIDP may present with symptoms of myeloradiculopathy due to thickened nerve roots causing cord compression.

DIAGNOSTIC VALUE OF SPECIFIC ANTIBODY SYNTHESIS IN BRAIN OF PATIENTS WITH NEUROINFECTIONS

2019 ◽  
Vol 72 (8) ◽  
pp. 1437-1441
Author(s):  
Pavel Dyachenko ◽  
Igor Filchakov ◽  
Anatoly Dyachenko ◽  
Victoria Kurhanskaya
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Clinical Manifestations ◽  
Diagnostic Value ◽  
Diagnostic Challenge ◽  
Specific Antibodies ◽  
Intrathecal Synthesis ◽  
Varicella Zoster ◽  
Mrz Reaction ◽  
Wide Range

Introduction: Viral encephalitis accounts for 40-70% of all cases worldwide, central nervous system infections pose a diagnostic challenge because clinical manifestations are not typically pathognomonic for specific pathogens, and a wide range of agents can be causative. The aim: To assess the diagnostic value of intrathecal synthesis of specific antibodies in patients with inflammatory lesions of the central nervous system. Materials and methods: Within the framework of the study, two groups of 90 people in each were formed from the patients with neuroinfections admitted to our Center. Intrathecal synthesis (ITS) of total (unspecific) IgG in members of one of group (group of compare) was determined. Brain synthesis of specific antibodies (Ab) to some neurotropic pathogens (herpes simplex virus 1/2, cytomegalovirus, Epstein-Barr virus, varicella zoster virus, rubella virus, Borrelies) was studied in the second group of patients (group of interest). There were no statistically significant differences between groups by gender and age. Encephalitis and encephalomyelitis prevailed among patients of both groups Results: ITS of total IgG was established in 30 (33.3 ± 6.1 %) patients of the first group with IgG index more than 0.6 indicating on inflammatory process in CNS and no marked changes of CSF. ITS of specific Ab was determined in 23 of 90 (25.6 ± 4.6 %) patients included into group of interest. In more than half of cases Ab to several infectious agents were detected simultaneously. ITS of various specificity, in particular, to measles and rubella viruses, and VZV, known as MRZ-reaction, is characteristic of some autoimmune lesions of CNS, multiple sclerosis first of all. In fact, further research of 5 patients with MRZ-reaction confirmed their autoimmune failure of CNS. Detection of ITS in the CSF samples didn’t depend on concentration of specific Ab in serum and CSF and wasn’t followed by HEB dysfunctions which were observed with the same frequency in patients with or without ITS (13.0 % and 13.6 % respectively). Conclusion: Specific Ab synthesis to several neurotropic pathogens in the CSF of significant part of examined patients was established. Thus, diagnostic value of ITS of specific immunoglobulins seems to be limited to cases in which autoimmune damage of the CNS is suspected.

scholarly journals Neuralgic amyotrophy: an underrecognized entity

2021 ◽  
Vol 49 (4) ◽  
pp. 030006052110065
Author(s):  
Tae Uk Kim ◽  
Min Cheol Chang
Keyword(s):  
Clinical Practice ◽  
Magnetic Resonance ◽  
Clinical Manifestations ◽  
Clinical History ◽  
Cervical Radiculopathy ◽  
Sudden Onset ◽  
Clinical Findings ◽  
Magnetic Resonance Neurography ◽  
Essential Information ◽  
Neuralgic Amyotrophy

Neuralgic amyotrophy (NA) is markedly underdiagnosed in clinical practice, and its actual incidence rate is about 1 per 1000 per year. In the current article, we provide an overview of essential information about NA, including the etiology, clinical manifestations, diagnostic investigations, differential diagnosis, treatment, and prognosis. The causes of NA are multifactorial and include immunological, mechanical, or genetic factors. Typical clinical findings are a sudden onset of pain in the shoulder region, followed by patchy flaccid paralysis of muscles in the shoulder and/or arm. A diagnosis of NA is based on a patient’s clinical history and physical examination. Gadolinium-enhanced magnetic resonance imaging and high-resolution magnetic resonance neurography are useful for confirming the diagnosis and choosing the appropriate treatment. However, before a diagnosis of NA is confirmed, other disorders with similar symptoms, such as cervical radiculopathy or rotator cuff tear, need to be ruled out. The prognosis of NA depends on the degree of axonal damage. In conclusion, many patients with motor weakness and pain are encountered in clinical practice, and some of these patients will exhibit NA. It is important that clinicians understand the key features of this disorder to avoid misdiagnosis.

scholarly journals STUDIES ON THE NERVOUS SYSTEM IN DEFICIENCY DISEASES

1934 ◽  
Vol 59 (1) ◽  
pp. 21-34 ◽  
Author(s):  
H. M. Zimmerman ◽  
Ethel Burack
Keyword(s):  
Nervous System ◽  
Peripheral Nerves ◽  
Progressive Disease ◽  
Water Soluble ◽  
Persistent Vomiting ◽  
Fiber Tracts ◽  
Heat Stable ◽  
Loss Of Weight ◽  
The Central Nervous System ◽  
Deficiency Diseases

Adult dogs maintained on an artificial, balanced ration adequate in all dietary essentials as far as is known except water-soluble, heat-stable vitamin B2 (G) developed, after a sufficient time, a slowly progressive disease characterized by loss of weight, persistent vomiting and diarrhea, and marked muscular weakness, which ended fatally in from 200 to over 300 days. The clinical features of this condition, as pointed out in the discussion, are quite different from those characterizing the canine disease known as black tongue. The anatomic changes in this condition consist of marked demyelination of the peripheral nerves, including the vagus; degeneration of the medullary sheaths and replacement by gliosis of the posterior columns of the spinal cord, particularly the fasciculi graciles; degeneration of the medullary sheaths of the posterior and less often of the anterior nerve roots of the cord; occasionally slight degenerative changes in most of the other fiber tracts of the cord. Attention is called to the fact that degenerative lesions in the central nervous system similar or identical with these have frequently been described in pellagra in man.

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