Pattern Of Nerve Involvement Research Articles

ULNAR NERVE ABSCESS - A COMPRESSIVE SENSORY MOTOR NEUROPATHY

Introduction: Leprosy is characterized by a triad of hypoesthetic skin lesions, thickened peripheral nerves, and positive skin smear for Mycobacterium leprae. All peripheral nerve functions (sensory, motor, and autonomic) are disrupted in leprosy. The most severe and widespread impairment is in sensory functions. Varied kinds of leprosy show different patterns of nerve involvement. We would introduce a case report of ulnar nerve abscess Presentation of Case: in 21 years old gentlemen presented with swelling over distal third of right arm with tingling sensation over ulnar division right hand with inability to close right fist since last 1.5 years. In many developing nat Discussion: ions, like India, leprosy continues to be a widespread yet curable cause for peripheral neuropathy. Nerve abscess is an infrequent complication, usually associated with Type 1 reaction mostly in tuberculoid and borderline tuberculoid disease that can lead to irreversible nerve damage and deformities3. Leprosy-associated nerve abscess often requires surgical decompression and drainage of the abscess for possible restoration of nerve function2. We have Conclusion: encountered with a unique case of ulnar nerve abscess presenting as compressive neuropathy, due to external compression of swelling which presented as weakness of right hand. Leprosy is still a common and treatable causes of peripheral neuropathy; meticulous workup is a key factor to achieve prompt results

Congenital isolated unilateral third nerve palsy in children: the diagnostic contribution of high-resolution MR imaging.

To describe the neuroanatomical correlates of unilateral congenital isolated oculomotor palsy by means of high-resolution MRI. Children with a clinical diagnosis of congenital isolated oculomotr palsy and with a high-resolution MRI acquisition targeted on the orbits and cranial nerves were selected and included in the study. An experienced pediatric neuroradiologist evaluated all the exams, assessing the integrity and morphology of extraocular muscles, oculomotor, trochlear and abducens nerves as well as optic nerves and globes. Clinical data and ophthalmologic evaluations were also collected. Six children (age range: 1-16 years; males: 3) were selected. All patients showed, on the affected side (left:right = 5:1), anomalies of the III nerve and extraocular muscles innervated by the pathological nerve. One patient had complete nerve agenesis, two patients showed a diffuse thinning of the nerve, from the brainstem to the orbit and 3 patients showed a distal thinning of the oculomotor nerve, starting at the level of the cavernous sinus. In all cases atrophy of corresponding muscles was noticed, but the involvement of the affected muscles varied with the nervous pattern of injury. High-resolution MRI represents a valuable tool for the diagnosis of III nerve anomalies in unilateral congenital IOP, showing different patterns of nerve involvement and muscular atrophy.

The pattern of nerve involvement in type 1 diabetic patients with subclinical peripheral neuropathy

The pattern of nerve involvement in type 1 diabetic patients with subclinical peripheral neuropathy

Role of S-100 Immunostain as An Auxiliary Diagnostic Aid in Leprosy

Histopathologic diagnosis of leprosy is difficult when Bacillary Index (BI) is zero and neural involvement are not easily identifiable on routine Hematoxylin and Eosin stain. This study was undertaken to study the role of S-100 immunostaining in demonstrating different patterns of nerve involvement in various types of leprosy. Thirty one skin biopsies with clinico-histopathologic diagnoses of leprosy over a period of two years were included in the study. Ten cases of non-lepromatous granulomatous dermatoses (including eight cases of lupus vulgaris and two cases of erythema nodosum) were used as controls. Tissue sections from all cases and controls were stained with Hematoxylin and Eosin (H&E) stain, Fite stain and S-100 immunostain. The H&E stained slides were used to study the histopathological features, Fite stained slides for Bacillary Index and S-100 for nerve changes. Neural changes could be demonstrated in the entire spectrum of leprosy using S-100 immunostaining. The most common pattern of nerve destruction in the tuberculoid spectrum was fragmented and infiltrated whereas lepromatous spectrum showed mostly fragmented nerve twigs. Intact nerves were not detected in any of the leprosy cases. S-100 immunostain is a useful auxiliary aid to the routine H&E stain in the diagnosis of leprosy especially tuberculoid spectrum and intermediate leprosy.

P616: Neurophysiology and ultrasound in diagnosis of isolated peripheral nerve tumors. Literature revision and personal experience

Our work shows the association of neurophysiology and ultrasound in the assessment of peripheral nerve tumors. In these cases, neurophysiologic examination presents an important role to define the possible lack of function of the nerve. Ultrasonography allows us to visualize the peripheral nerves and underline the morphologic changes in nerve structure. We present a literature revision about ultrasound in peripheral nerve tumor study and a collection of 10 cases where the combined use of clinic, neurophysiology and ultrasound guided the diagnostic process of nerve tumors. All the patients presented a clinic pattern of nerve involvement and everyone was evaluated with neurophysiology which confirmed a mononeuropathy, but without the possibility of a sure diagnosis. The following ultrasound evaluation allowed to visualize a focal lesion, compatible with a nerve tumor. These cases show that neurophysiology and ultrasound together contribute in diagnosis of peripheral nerve tumors. Ultrasonography is not able to certainly define the type of tumor, but it gives suggestions about discrimination between schwannoma and neurofibroma. Nerve ultrasound is useful in the assessment of peripheral nerve tumors.

Inguinal neuritis is common in primary inguinal hernia

Establishing the existence of inguinal neuritis, and defining patterns of nerve involvement in primary inguinal hernia repair. A retrospective chart review of 100 consecutive primary inguinal hernia repairs by Lichtenstein technique with frequent ilioinguinal nerve removal was performed. Nerves suspected of containing neuritis had been sent for histological examination. Objective clinical parameters and nerve pathology reports were reviewed. An independent biostatistician reviewed the data. There were 34 cases of inguinal neuritis in these primary inguinal hernia repairs. The nerve most affected in primary repairs was the ilioinguinal nerve, accounting for 88% of the neuritis cases. Inguinal neuritis occurred mainly at the external oblique neuroperforatum-where the nerve pierces the external oblique fascia, accounting for 83% in primary repair. The only clinical parameter with statistical significance was hernia laterality (P = 0.04), 46% of the patients who had a hernia on the left also had inguinal neuritis. The overall incidence of inguinal neuritis was 34% in primary inguinal hernia repairs. The ilioinguinal nerve was most commonly affected in these primary inguinal hernia repairs, and inguinal neuritis was most likely to occur at the external oblique neuroperforatum.

Nerve Monitoring During Proximal Humeral Fracture Fixation: What Have We Learned?

The incidence of neurologic injury after proximal humerus fractures is variable, ranging from 6.2% to as much as 67%. However, it is unclear what factors might contribute to these injuries or whether they can be prevented by intraoperative nerve monitoring. Therefore, using intraoperative nerve monitoring, we assessed the incidence, pattern of nerve involvement, and predisposing factors for nerve injury before and during shoulder fracture fixation. We used continuous intraoperative monitoring of the brachial plexus in 37 patients undergoing open operative treatment of proximal humerus fractures. Impending intraoperative compromise of nerve function was signaled by sustained neurotonic EMG activity or greater than 50% amplitude attenuation of transcranial electrical motor evoked potentials (MEPs) (or both). When a nerve alert occurred, current surgical activity and arm and retractor position were recorded and adjustments were made to relieve tension. The intraoperative affected nerves included axillary (46%), combined (mixed plexopathy) (23%), radial (23%), musculocutaneous (4%), and ulnar (4%). Postoperatively, three patients had transient nerve palsies, which fully resolved within 3 weeks of surgery. Low body mass index (BMI) (22.7 ± 2.8), history of cervical spine disease, diabetes mellitus, and delay in surgical treatment (14 ± 2.9 days from time of injury) were associated with an increased incidence of nerve dysfunction. Our observations suggest transcranial electrical MEPs are sensitive indicators of impending iatrogenic injury to the brachial plexus or peripheral nerves (or both) during open operative treatment of proximal humerus fractures. The use of intraoperative nerve monitoring during these procedures may be considered for the prevention of nerve injury, particularly in patients with underlying cervical spine disease, low BMI, diabetes mellitus, and/or delay in surgical treatment greater than approximately 14 days. Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Toward an Efficient Method to Evaluate Peripheral Neuropathies

The diagnosis of peripheral polyneuropathies can be challenging. A structured diagnostic approach can help make the endeavor efficient and increases the diagnostic yield. This review is in two parts. In the first part, we present the elements of a structured approach that consists of a set of steps that leads to a full characterization of the clinical features of the neuropathy. Electrodiagnosis will be emphasized because it has a key role in accurately defining the pattern of nerve involvement and determining the underlying pathology. After characterization, a rational list of laboratory tests can be ordered. The second part of this review describes the clinical and pathologic features of common peripheral neuropathies. This review of neuropathies emphasizes how the structured approach can facilitate the diagnosis. The second part concludes with the practical experience from evaluating peripheral neuropathies, emphasizing the point that a diagnosis may not be forthcoming in a third or more of patients.