Other tumors of the neural crest

Peripheral nerve Cranial nerves, nerve roots, the nerve plexus and single nerves can be affected involvement in cancer in cancer patients. The table gives an overview over the most frequently patients affected nerves (Table 12). Table 12. Involvement of peripheral nerves in cancer patients Table 12. Involvement of peripheral nerves in cancer patients Base of skull metastasis Leptomeningeal carcinomatosis Head and neck tumors Surgery, mastectomy, neck dissection Critical illness neuropathy in...

Mercury neuropathy

Anatomy distribution Axonal degeneration with relative sparing of sensory fibers. Mercury metal vapor causes subacute, diffuse, predominantly motor neuropathy that may mimic AIDP. Alkyl mercury causes intense distal limb paresthesias, probably from CNS dysfunction. Elemental mercury may cause sensorimotor neuropathy. Biopsy shows axonal degeneration. CMAPs decreased more than SNAPs. Alkyl mercury shows normal EMG. Chelation therapy is of limited benefit. Degree of CNS recovery determines...

Myopathies associated with endocrinemetabolic disorders and carcinoma

Muscle from a patient with diabetes mellitus showing myolysis with degenerating fibers (arrow heads) This is variable and depends on the specific systemic disorder, however proxi- Distribution anatomy mal muscles are most usually affected. This is variable depending on the specific cause of myopathy. Most of these Time course myopathies progress slowly, although rapid progression of symptoms may be observed with thyrotoxicosis. If treated most endocrine related myopathies are self...

Herpes neuropathy

Herpes virus remains in a latent state in the dorsal root ganglion or trigeminal ganglion. Sensory disturbances occur with cutaneous eruptions. Post-herpetic neuralgia can involve three distinct pain situations lancinating, shock-like pain, a continuous burning or aching pain, or pain caused by innocuous stimuli (allodynia). All of these occur in a dermatomal distribution. Motor signs are infrequent (herpes zoster), and are caused by radiculopathy. Motor impairment occurs in the corresponding...

Neuralgic amyotrophy Parsonage Turner syndrome acute brachial neuritis

Clinically sudden onset and pain located in the shoulder, persisting up to 2 weeks. Weakness appears often when pain is subsiding. The distribution is in the proximal arm with involvement of the deltoid, serratus anterior, supra in-fraspinatus muscles. Other muscles that may be involved include those innervated by the anterior interosseus nerve, pronator teres muscle, muscles innervated by the musculocutaneous nerve and diaphragm. Bilateral involvement occurs in 20 . Prominent atrophy develops,...

Cutaneous femoris posterior nerve

Infrapiriform Foramen

Fibers come from the lower part of the lumbosacral plexus, roots S1-3. The fibers descend together with the inferior gluteal nerve through the greater sciatic notch, below the piriformis muscle. A branch leaves to the perineum and scrotum. The sensory area includes the lower buttock, parts of the labia or scrotum, dorsal side of the thigh and proximal third of the calf. The autonomic field is a small area above the popliteal fossa. Paresthesias and numbness over the lower part of the buttock...

Duchenne muscular dystrophy DMD

A Hematoxylin and eosin showing an increase in endomysial connective tissue (large arrows), inflammatory infiltrates (small arrows), and degenerating fibers (arrow head). B Normal dystrophin staining. C Loss of dystrophin staining in DMD Proximal muscles are more affected than distal muscles. Infants may have generalized hypotonia and be described as floppy. Progressive disorder resulting in significant disability in most children. DMD starts at age 3-5 years with...

Carbon disulfide neuropathy

In animals, CS2 causes paranodal retraction of myelin and focal axonal accu- Anatomy distribution mulation of 10 nm neurofilaments. Distal paresthesias, painful muscles, sensory loss. Symptoms Diminished distal strength, hyporeflexia. Sometimes absent corneal reflexes Clinical syndrome and optic neuropathy. High levels may cause encephalopathy, extrapyramidal signs dysfunction, and psychiatric dysfunction. Retinopathy with microaneurysms, hemorrhage, and exudates has been reported. CS2 is used...

Myasthenia gravis

Generalized myasthenia gravis, key features. A Ptosis B Attempted gaze to the right. Only right eye abducts incompletely. C Demonstrates proximal weakness upon attempt to raise the arms. D Holding the arms and fingers extended the extensor muscles weaken and finger drop occurs Adult group I Adult group II Adult group III Transient form acquired from MG mothers Localized, usually ocular Generalized, bulbar Acute fulminating, bulbar and generalized, respiration failing Late severe...

Brachialgias Differential diagnosis

Cervical radiculopathies with root avulsion Proximal mononeuropathies Axillary, suprascapular, long thoracic, musculo-cutaneous Fracture and dislocation (axillary, suprascapular nerve) Orthopedic and rheumatologic conditions Periarthropathia humeroscapularis Frozen shoulder Due to the variety of brachial plexus lesions no general statement can be given. Therapy Conservative therapy is aimed at pain management and inclusion of physiotherapy to avoid contractures and ankylosis. If no improvement...

Peripheral nerve tumors

Peripheral nerve tumors usually present with a slowly progressive mononeur- Clinical development opathy. Initially paresthesia, pain, followed by motor or sensory loss, or both occur. The tumors may be seen, palpated or detected in imaging. Mechanical factors e.g. sitting , stretching the sciatic nerve, walking if tumor is on the foot can exacerbate pain or paresthesias. Patient's often experience Tumor can be palpated or a mass can be seen e.g. supraclavicular fossa . Signs MRI can give a...

Mononeuropathy interdigital neuroma and neuritis

Terminal branch of tibial nerve at the head of III and IV metatarsal bone, and Anatomy toes. Pain in the forefoot, localized to the second and third interdigital space. Symptoms Numbness and paresthesias of adjacent toes may be present. Aggravated by Sometimes sensory loss at opposing side of affected toes. Pain may be provoked by compression of metatarsal 3,4 or 3,5.

Optic nerve

Optic nerve photomicrograph . The nerve is compressed by tumor cells in meningeal carcinomatosis, resulting in blindness of the patient. ON Optic nerv. TTumor Special sensory visual information from the retina Quality Light energy is transduced into electrical signals in the posterior layer of the Anatomy retina by receptor cells called rods and cones. Primary sensory neurons called bipolar cells receive signals from the rods and cones. Bipolar cells pass these signals onto secondary...

Arsenic neuropathy

Meese lines at the nail-bed, in case of arsenic poisoning and polyneuropathy courtesy Dr. Freymueller, Hermagor, Austria Massive exposure may demonstrate demyelinating polyradiculoneuropathy, distal axonopathy. Painful stocking-glove sensory neuropathy, motor neuropathy usually mild but can be severe. Malaise, nausea, vomiting, mucous membrane irritation. Hyperkeratosis, darkened skin, Mee's lines Fig. 15 , pitting edema. Acute massive exposure leads to vasomotor collapse and death....

Inclusion body myositis IBM

A Hematoxilin and eosin stained tissue showing a typical rimmed vacuole in the center small arrow and atrophy of muscle fibers large arrow . B Acid phosphatase stain showing rimmed vacuoles arrows Fig. 5. Inclusion Body Myositis. A Hematoxilin and eosin stained tissue showing a typical rimmed vacuole in the center small arrow and atrophy of muscle fibers large arrow . B Acid phosphatase stain showing rimmed vacuoles arrows Affects proximal and distal muscles in...

Glycogen storage diseases

Hydrolyse Glykogen

The muscle contains vacuoles filled with glycoprotein arrow Fig. 27. McArdles disease. Sub-sarcolemmal vacuoles with stained glycogen small arrows , and evidence of dener-vation atrophy large arrows There is either no weakness, or proximal muscles are involved. Distribution Slowly progressive in most cases. Time course Onset depends on the specific glycogen storage disease GSD and can range Onset age from infantile to adult onset as outlined below Clinical...

Demyelinating neuropathy associated with antiMAG antibodies

Demyelination occurs in sensory, and perhaps motor axons. Anatomy distribution Symptoms of ascending numbness and ataxia progress slowly over months to Symptoms years. Pain is usually minimal. Gait disorders occur in 50 of patients. Intention tremor may develop late in Clinical syndrome disease. Weakness is minimal. Sensory loss is symmetric. signs Anti-MAG IgM antibodies cause complement deposition on myelin sheaths in Pathogenesis animal models. Cellular infiltration of nerves is minimal,...

Cranial nerve examination in coma

Oculovestibular reflexes are dependent on functions of CN VIII, III, IV, and VI Metabolic and toxic causes often spare the light reflex. Lids must be passively held open anisocoria, examine consensual light reaction Early manifestation of herniation syndrome-decline of pupil, usually on the side of the mass. Followed by an ipsilateral mydriatic pupil. Differential diagnosis Miotic eye drops, organophosphates Extraocular movements are more sensitive to toxic and metabolic influences. Quick and...

Acute inflammatory demyelinating polyneuropathy AIDP Guillain Barre syndrome

X ray of the hands of a patient with long standing polyradiculitis. Note the severe osteoporosis Inflammatory reactions cause demyelination of peripheral axons. Classic AIDP presents with rapidly progressing, bilateral but not necessarily symmetric weakness. Paresthesias are reported early on, but weakness is the predominant feature. Patients can complain of difficulty with walking or climbing stairs. Weakness develops over a course of hours or days. Proximal weakness is more severe....

Differential diagnosis Coxarthrosis

Neurinoma Pelvic neoplasm Radiculopathy L2 Wartenberg syndrome - migrant sensory neuritis Therapy Anesthetics, local infiltration, steroids Local novocain infiltration Spontaneous recovery Surgical intervention only if pain persists Prognosis Short term depending on etiology References Jablecki CK 1999 Postoperative lateral femoral cutaneous neuropathy. Muscle Nerve 22 Staal A, van Gijn J, Spaans F 1999 The lateral cutaneous nerve of the thigh. Mononeuro-pathies. WB Saunders, London, pp 97-100...

Long thoracic nerve

Long Thoracic Nerve

Long thoracic nerve palsy after thoracic surgery. A Note winging of caudal edge of the scapula. B Scar after thoracic surgery Fibers stem from the ventral rami of C5-7, and travel through the dorsal part of Anatomy the plexus. The nerve traverses the middle scalene muscle, and then passes below the brachial plexus on the thoracic wall. The nerve contains motor fibers exclusively for the serratus anterior muscle Fig. 27 . Dull ache in the shoulder, affected shoulder seems lower,...

Vasculitic neuropathy systemic

Vasculitis Neuropathy

Sural nerve biopsy from a patient with isolated peripheral nerve vasculitis. A Infiltration of a perineurial vessel wall by multiple inflammatory cells including lymphocytes and macrophages black arrows . There is also evidence of pink fibrin deposits consistent with the presence of fibrinoid necrosis. B Teased fiber preparations showing multiple axon balls white arrows and evidence of empty strands consistent with axonal degeneration Fig. 4. Sural nerve biopsy from a patient with...

Focal myositis

This patient had a unilateral right calf hypertrophy in a case of focal myositis Fig. 7. Focal Myositis. A Atro-phic fibers arrows top left , inflammatory response arrows bottom left , hypertrophied fiber arrow head , increased connective tissue top right . B Lob-ulated fibers outlined by bands of collagen arrows Fig. 6. Calf hypertrophy. This patient had a unilateral right calf hypertrophy in a case of focal myositis May involve any muscle, although the quadriceps...

Kennedy Disease Disabilities

Bsma Kennedy

Early on, there is decreased recruitment and interference, with decreased motor unit action potential amplitudes. In 2-4 weeks, fibrillations will develop, with possible fasciculations. Over time, reinnervation will lead to polyphasic motor units. Nerve conduction velocities and sensory studies are normal. Imaging Inflammation of the anterior spinal cord may be detected with MRI. Post-polio syndrome The diagnosis of PPS is by exclusion of other conditions and demonstration of progressive...

Poliomyelitis

Poliomyelitis is a viral infection that causes the death of motor neurons in the Anatomy spinal cord and brainstem. During the acute phase of the infection, the virus may infect the cortex, thalamus, hypothalamus, reticular formation, brainstem motor and vestibular nuclei, cerebellar nuclei, and motor neurons of the anterior and lateral horns of the spinal cord, causing an inflammatory reaction. Death of motor neurons may result, leading to muscle atrophy. The motor neurons that survive recover...

Emg

High yield muscles are suggested for identification of lumbosacral radiculopathy. Most lesions occur at the L4 5 or L5 S1 level. Five limb muscles have been suggested for a reasonable screening the rectus femoris or adductor longus, tibialis anterior, gastrocnemius, gluteus maximus, and tibialis posterior or peroneus longus muscles. The examination of the paraspinal muscles is useful, but must be handled with caution in patients who have had a laminectomy and in older patients. Diabetics may...

Hereditary neuropathy with liability to pressure palsies HNPP

Teased fibers from a patient with hereditary neuropathy and pressure palsy HNPP showing a large sausage shaped myelin enlargment tomacula Peripheral nerves in HNPP exhibit segmental demyelination and tomacula Anatomy distribution Fig. 20 . Patients appear to have recurrent mononeuropathies that cause weakness and numbness, often following mild compression or trauma. These neuropathic episodes begin in adolescence. Men tend to present earlier than women. Some cases present in childhood,...

Episodic weakness of lumbosacral plexus Table

Diagnosis Laboratory exclude diabetes CT or MR angiography for suspected vascular lesions CSF when cauda equina lesion or inflammatory lesion is suspected Electrophysiology motor and sensory studies NCV, late response, needle EMG, evoked potentials Bulbocavernosus reflex Table 8. Episodic weakness of the lumbosacral plexus Episodic weakness of the lumbosacral plexus Cauda equina lesion Exacerbated walking Lumbar vertebrostenosis, Unaffected by bicycling forward, less symptoms Pain amp Sensory...

Bulbar muscular disordersDifferential diagnosis

Subclarian

For neuralgia amytriptyline, carbamazepine, gabapentin Therapy Kumral E, Afsar N, Kirbas D, et al 2002 Spectrum of medial medullary infarction clinical References and magnetic resonance imaging findings. J Neurol 249 85-93 Newsom-Davies J, Thomas PK, Spalding JMK 1984 Diseases of the ninth, tenth, eleventh, and twelfth cranial nerves. In Dyck PJ, Thomas PK, Bunge R eds Peripheral neuropathy. Saunders, Philadelphia, pp 1337-1350 Scheid W, Wieck H 1949 Klinische Befunde bei Diphteriel hmung im...

Differential diagnosis Borreliosis

Multiplex neuropathy Multiple sclerosis root lesions Referred pain Syringomyelia Depending on cause surgical, conservative Thoracic disc protrusion with spinal cord compression may have a poor prognosis. Raynor EM, Kleiner-Fisman G, Nardin R 2002 Lumbosacral and thoracic radiculopathies. In Katirji B, Kaminski HJ, Preston DC, Ruff RL, Shapiro B eds Neuromuscular disorders in clinical practice. Butterworth Heinemann, Boston Oxford, pp 859-883 Stewart JD 2000 Thoracic spinal nerves. In Stewart JD...

IgM paraproteinemia with antiMAG antibodies

Half of patients with MGUS develop antibodies against MAG myelin associated glycoprotein . Patients have a moderate to severe sensory loss with distal weakness. Nerve conduction velocities are significantly slowed with temporal dispersion and conduction block. These patients do not respond to therapy, but the disorder itself is usually indolent. Large fiber sensory function is lost, and there may be tremor. The disease presents as a sensorimotor neuropathy with predilection of large- Clinical...

Diabetic mononeuritis multiplex and diabetic polyradiculopathy amyotrophy

Anatomy distribution Diabetic mononeuritis multiplex DMM and diabetic polyradiculopathy DPR are due to the loss of motor and sensory axons in one or more named nerves or nerve roots. The term mononeuritis multiplex refers to multiple mononeuro-pathies in conjunction with polyneuropathy. Symptoms Patients experience proximal and distal weakness and sensory loss in specific named peripheral nerves including cranial or truncal nerves or nerve roots. The onset is sudden and usually extremely...

Bacterial and parasitic neuropathies

Borrelia Burgdorferi Lyme disease Clinical syndrome signs The earliest stage of Lyme disease stage I is characterized by the unique skin rash and symptoms of general infection. Neuroborreliosis begins in stage II of the disease. In stage II disease, the most common occurrence is lymphocytic meningoradi-culitis. Motor and sensory symptoms may occur variably and undulate in severity over the course of months. Half of patients have focal or multifocal cranial nerve disease, including the facial,...

Median nerve

Section at the distal end of the carpal tunnel. 1 Median nerve. 2 Ulnar nerve. 3 Deep ulnar nerve. 4 Flexor retinaculum. 5 Flexor tendons. 6 Flexor pollicis longus. 7 Abductor dig-iti minim muscle Fig. 9. Transsection of the median nerve and sural nerve inter-plantate in a 24 month follow up. A Orators hand prior to operation, B after 24 months the long flexors of the thumb and particularily the index finger show increased mobility Fig. 10. Acute carpal tunnel syndrome. A Local painful...

Neoplastic neuropathy

Sural nerve biopsy from a patient with lymphoma. A Infiltration of the peripheral nerve by collections of B cells, with disruption of normal sural nerve architecture. B Disruption of myelin, with myelin splaying, and partial loss of axons Fig. 9. Sural nerve biopsy from a patient with lymphoma. A Infiltration of the peripheral nerve by collections of B cells, with disruption of normal sural nerve architecture. B Disruption of myelin, with myelin splaying, and partial loss of axons There...

Fascioscapulohumeral muscular dystrophy FSHMD

Scapuloperoneal Muscular Dystrophy

A There is bilateral ptosis and facial weakness. B and C Prominent scapular winging in patients with FSH Fig. 17. FSHMD showing lobu-lated type 1 fibers white arrows that are smaller than the type 2 fibers succinic dehydro-genase FSHMD affects the face, scapula and proximal shoulder girdle and the lower extremities in a peroneal distribution. The disorder progresses slowly and is compatible with a normal life span even Time course in those who are symptomatic. FSHMD...

Pupillary size and equality

Clivustumor

Anisocoria indicates an inequality in pupil size between the right and left pupils. Light reflex direct indirect Horner's syndrome see Horner's syndrome Ciliospinal reflex see CN and Coma Pinpoint pupils May be a sign of opioid intoxication or a structural lesion of the pons pontine hemorrhage . Foodborne Cranial nerve duction appears first, then dilated fixed pupils not always present Optic nerve lesions swinging flashlight test - MS Adie tonic pupils Unilateral dilatation Raised intracranial...

Dermatomyositis DERM

Macrocephaly Capillary Malformation

Patient with dermatomyositis. There is evidence of a hyperememic rash on the upper chest, face and palm Fig. 4. Dermatomyositis. A Typical perifascicular regeneration arrows . B Necrotic capillaries demonstrated by dark precipitates on alkaline phosphatase arrow heads Usually affects proximal muscles and bulbar muscles. Progressive disorder with gradual onset in most cases. Any age, bimodal frequency 5-15 years and 45-65 years. Equally common in men and woman. Symptoms include myalgias,...

Hyperkyphosis Fshmd

Superficial Peroneal Nerve Motor Point

Introduction Tools Cranial nerves Olfactory nerve Optic nerve Oculomotor nerve Trochlear nerve Trigeminal nerve Abducens Facial nerve Acoustic Vestibular Glossopharyngeal Vagus nerve Accessory Hypoglossal nerve Cranial nerves and painful conditions - a Cranial nerve examination in Pupil Multiple and combined oculomotor nerve Plexopathies Cervical plexus and cervical spinal Brachial plexus Thoracic outlet syndromes Lumbosacral Cervical Thoracic radiculopathy Lumbar and sacral Cauda equina...

Phrenic nerve

Phrenic Nerve

Phrenic nerve is in the vicinity of the pericardium. 1 Right. Phrenic nerve. 2 Left. Phrenic nerve. 3 Anterior portion of Diaphragm The phrenic nerve fibers are from C3, 4, and 5. The connection with C3 may be via the inferior ansa cervical is cervical plexus . The nerve travels over the anterior scalenus muscle, dorsal to the internal jugular vein, and crosses the dome of the pleura to reach the anterior mediastinum. On the right side, it is positioned next to the superior vena cava...

Intercostobrachial nerve

Ilioinguinal Nerve Route Kidney Removal

Anatomy Originates from lateral cutaneous nerve of second and third intercostal nerves to innervate the posterior part of the axilla. This nerve often anastomizes with the medial cutaneous nerve of the upper arm from the medial cord of the brachial plexus . Symptoms Pain in the axilla, chest wall, or thorax. Often occurs one or two months after mastectomy. Reduced movement of the shoulder enhances pain. Signs Sensation is impaired in the axilla, chest wall, and proximal upper arm. Differential...

Investigations Plain radiographs

Iliohypogastric Nerve

CT and MRI do not detect fibrous bands, but are good to exclude other causes Electrophysiology to exclude CTS Characteristics low or absent sensory NCV of ulnar and medial cutaneous nerves. EMG abnormalities of muscles lower trunk Paraverterbrals are normal. 1. Conservative treatment posture correction, stretching may relieve problems. 2. Orthosis to elevate shoulder 3. Surgery resection of the first rib Due to cervical rib and vascular involvement subclavian artery compression with...

Hypoglossal nerve

Hypoglossal Nerve Test

A Left hypoglossal peripheral paresis. Note deviation of the tongue to the left. B Right sided hypoglossal paresis, in a patient with meningeal carcinomatosis. Midline of the tongue shifted to the right. C Amyloid tongue in a patient with multiple myeloma. Patient's subjective impression was, that the tongue was too big Fig. 14. Hypoglossal nerve lesions. A Left hypoglossal peripheral paresis. Note deviation of the tongue to the left. B Right sided...

Radial nerve

Radial Nerve Anatomy

Fig. 20. a 1 Radial nerve. b Sensory area of the posterior cutaneous and the superficial radial nerve Fig. 20. a 1 Radial nerve. b Sensory area of the posterior cutaneous and the superficial radial nerve Fig. 21. Radial nerve injury. Hand drop and wrist drop Fibers from C5-T1 spinal cord contribute to the radial nerve. Anatomy The nerve travels through the brachioaxillary angle, then along the spiral groove of the humerus, continuing in the anterior compartment of arm. At the elbow joint, it...

Musculocutaneous nerve

Coracobrachial Muscle

Fig. 3. 1 Musculocutaneous nerve. 2 Cutaneus antebrachii lateralis nerve. 3 Coracobrachial muscle. 4 Short head of biceps muscle. 5 Long head of biceps muscle. 6 Brachialis muscle Fig. 4. Biceps pathology. A Atrophy of the biceps brachii in a patient with neuralgic shoulder amyotrophy. Note the absent relief of the muscle. B Biceps tendon rupture. Typical clinical manifestation with flexion of the elbow Fig. 5. Nerve metastasis of a carcinoid tumor in the muscu-locutaneous nerve. A...

Autonomic

Surface Anatomy Lateral Malleous

Autonomic fibers travel with the tibial nerve. Lesion of the tibial nerve produces trophic skin changes and hyperkeratosis Fig. 46c . Hematoma in the popliteal fossa Morton's neuralgia Nerve sheath tumor Rupture of the popliteus muscle Stretch from ankle sprain Superior tibiofibular joint injury Synovial cyst Tendinous arch between soleus muscle Tarsal tunnel syndrome see below Laboratory tests Electrophysiology NCV, EMG Imaging Sciatic nerve lesion, radicular lesion. Fasciitis. Burning feet in...

Lumbar and sacral radiculopathy

Atrophy Paraspinal Muscles Image

Intervertebral foramen, 2. Dorsal root ganglion, a2 Section at L4-level, b1 1. Mediolateral prolaps, 2. Lateral prolapse, 3. Median prolapse, b2, b3 1. Mediolateral prolapse, b4 2. Lateral prolapse, 3. Median prolapse Fig. 6. Lumbar anatomy. a1 1. Intervertebral foramen, 2. Dorsal root ganglion, a2 Section at L4-level, b1 1. Mediolateral prolaps, 2. Lateral prolapse, 3. Median prolapse, b2, b3 1. Mediolateral prolapse, b4 2. Lateral prolapse, 3. Median prolapse...

Congenital myopathies

Fingerprint Body Myopathie

A Large nemalin rod inclusions arrows on Trichrome stain. B Electron microscopy-nemalin rod inclusion arrows Fig. 19. Nemaline myopathy. A Distal leg atrophy in a patient with nemaline myopathy. B Atrophy of the proximal arm muscles, neck muscles, and weakness of the facial muscles. C Bilateral hand wasting Fig. 20. Nemaline myopathy. A Large nemalin rod inclusions arrows on Trichrome stain. B Electron microscopy-nemalin rod inclusion arrows Fig. 21. Central Core...

Superior

Rectal Nerves Images

Misplaced injection, trauma, hemorrhage, arthroplasty, aneurysm. Inferior Rarely isolated, often associated with the sciatic nerve, occasionally with pudendal nerve. Colorectal carcinoma, injections, trauma. Sacral plexus lesion Hip and pelvic pathology Grisold W, Karnel F, Kumpan W, et al 1999 Iliac artery aneurysm causing isolated superior gluteal nerve lesion. Muscle Nerve 22 1717-1720 Rask MR 1980 Superior gluteal nerve entrapment syndrome. Muscle Nerve 3 304-307 Wilbourn AJ, Lesser M 1983...

Myotonia congenita

Percussion Myotonia Congenita

A Muscle myotonia in the hypoth-enar muscles. B Myotonic discharges in the EMG from affected muscle Fig. 34. Thomson's myotonia congenita. A Increased muscle bulk in the arms and chest in a patient with Thomson's disease. B Hypertrophy of the extensor digitorum brevis muscle Variable, may affect both limb and facial muscles. Progresses very slowly over a lifetime. Usually strength is spared. - Myotonia congenita Thomsen onset in infancy. - Myotonia congenita Becker...

Paraneoplastic neuropathy

Dorsal root ganglion pathology A and B show an example of an inflammatory paraneoplastic ganglionitis. B shows an infiltrate that is immunostained for T cells. C is a rare example of neoplastic infiltration of a DRG by lymphoma cells of a Burkitt-like lymphoma. This patient had additional meningeal infiltration Fig. 10. Dorsal root ganglion pathology A and B show an example of an inflammatory paraneoplastic ganglionitis. B shows an infiltrate that is immunostained for T cells. C is a...

Ulnar nerve

Ulnar Nerve Dorsal Branch Mri

Medial epicondyle and cubital tunnel. 1 Right ulnar nerve. 2 Medial epicondyle. 3 Aponeurosis. 4 Flexor carpi ul-naris Fig. 16. Medial epicondyle and cubital tunnel. 1 Right ulnar nerve. 2 Medial epicondyle. 3 Aponeurosis. 4 Flexor carpi ul-naris Fig. 18. Ulnar nerve lesion. A Complete transsection at lower arm level by a glass pane. Note the typically flexed finger 4 and 5. B Distal ulnar nerve lesion with a 50 year duration. C Distal ulnar lesion, after the exit of the branch to the...

Cephalic tetanus

May occur in lesions of the head and neck e.g., otitis . Symptoms are unilateral facial paralysis, trismus, facial stiffness, nuchal rigidity, and pharyngeal spasms. Caudal cranial nerves and oculomotor nerves may be affected. The incubation period is short, and it may progress to generalized tetanus. Diagnosis is based on clinical findings. The absence of a wound does not Diagnosis exclude tetanus, and anaerobic cultures are only positive in a third of cases. CSF is normal. EMG shows...

Cervical radiculopathy

Radiculopathy

Left hand C8 radiculopathy with atrophy in a patient with leukemic infiltration Fig. 2. Left hand C8 radiculopathy with atrophy in a patient with leukemic infiltration Fig. 3. Meningeal carcinomatosis with neoplastic deposits in C6 and C7. Extensor deficits of fingers 3, 4, 5 mimicks partial radial paralysis With exception of the upper two, the cervical vertebrae articulate with each other by an intervertrebral disc, plus a pair of smaller joints between articular facets and pedicles....

Diabetic amyotrophy Bruns Garland syndrome

This entity has several names, including diabetic femoral neuropathy, although usually more than the femoral nerve is affected. Diabetic amyotrophy is usually a unilateral but can be bilateral proximal plexopathy affecting the hip flexors, femoral nerve, and some adjacent structures. Vasculopathies, metabolic causes, or vasculitic changes have been described. A paper by Dyck 1999 summarizes the characteristic features it typically strikes elderly diabetic individuals between 36 and 76 years...

Distal myopathy

Uncharacterized distal myopathy showing a rimmed vacuole small arrow , degenerating fiber arrow head and minimal inflammation large arrow Characteristically affects distal leg or arm muscles. Slowly progressive and usually limited to distal muscles. May present in childhood, but typically is seen in early adulthood to middle age. The distal myopathies represent a genetically heterogenous group of disorders with certain shared clinical features. The classical syndromes described below...

Glossopharyngeal nerve

Branchial motor stylopharyngeus muscle. Quality Visceral motor otic ganglion, fibers to stimulate the parotid gland. Visceral sensory sensation carotid body and sinus. General sensory posterior one third of the tongue, skin of the external ear, and the internal surface of the tympanic membrane. Special sensory taste, from the posterior third of the tongue. The nuclei consist of the nucleus ambiguus, inferior salivatory nucleus, and Anatomy nucleus solitarius. The nerve emerges from the medulla...

Amyloidosis primary

Peripheral nerve amyloidosis. The biopsy shows a congo red stained section with evidence of apple green birefringence in amyloid deposits within endoneurial vessels Primary amyloidosis AL is a multi-organ systemic disease affecting the peripheral and autonomic nervous systems. Axonal degeneration, particularly of small myelinated and unmyelinated fibers is present with diffuse amyloid deposits infiltrating epineurial and endoneurial connective tissue. Initial neuropathic symptoms are...

Dorsal scapular nerve

Dorsal Scapular

Dorsal scapular nerve anatomy. 1 Dorsal scapular nerve. 2 Levator scapular muscle. 3 Minor rhomboid muscle. 4 Major rhomboid muscle The dorsal scapular nerve arises from fibers of C4, 5 and travels through the Anatomy medial scalene muscle and along the medial border of the scapula. This nerve is purely motor, and innervates the levator scapulae and rhomboid muscles Fig. 24 .

Subscapular nerve

Subscapular Nerve And What Does

Subscapular nerve anatomy. 1 Upper trunk. 2 Posterior cord. 3 Subscapular nerve. 4 Subscapular muscle. 5 Teres major muscle Nerve fibers arise from C5 and C6, and travel through the upper trunk and Anatomy posterior cord of the brachial plexus. The nerve innervates the subscapularis and teres major muscle, to secure the shoulder joint and provide inward rotation of the shoulder Fig. 26 . Compensation for the function of both muscles is provided by the pectoralis Symptoms major,...

Hereditary motor and sensory neuropathy type 1 Charcot MarieTooth disease type 1 CMT

Hereditary Motor Sensory

Sural nerve biopsy from a patient with HMSNIII De-jerine-Sottas disease . The biopsy shows evidence of severe de-myelination with thinly myelinated fibers and formation of multiple onion bulbs black arrows Fig. 17. CMT Foot deformity and pes cavus Fig. 18. CMT. A and B Claw hands. C and D Atrophic lower legs with foot deformity Fig. 19. CMT. Onion bulb formation in a nerve biopsy arrows CMT type 1 typically results in loss of peripheral nervous system myelin. Usually within the first...

Saphenous nerve lesions

Bursitis of pes anserinus Entrapment, medial side of knee Entrapment by a branch of the femoral artery Meniscectomy, arthroscopy Neurolemmoma EMG quadriceps and iliac muscles, include paraspinal, iliopsoas, hip adductor Diagnosis NCV femoral nerve latencies and CMAPs Sensory nerve conduction of the main trunk difficult Sensory nerve conduction of saphenal nerve Saphenous SEP stimulation inferomedial to patella is more reliable. Neuroimaging CT scan for psoas hematoma has to be done acutely if...

Differential diagnosis Radicular lesions C6 and C7

Thoracic outlet syndrome Thalamic infarcts Therapy Depends on the etiology and electrophysiology. CTS forearm splint at nighttime, ultrasound at wrist. In acute CTS, CTS with motor impairment, or persistent entrapment despite conservative therapy operative split of carpi transversum, either via endoscopic or open technique. Prognosis for both techniques is good 85 success . Atroshi R, Johnsson R, Ornstein R 1997 Endoscopic carpal tunnel release a prospective References assessment of 255...

Genetic Screening In

Postoperative abdominal surgery, post mastectomy, and thoracotomy Laboratory Fasting glucose, serology herpes, borreliosis Diagnosis CSF examination e.g., pleocytosis and antibodies in Lyme disease Imaging vertebral column plain X-ray, CT, MRI Electrophysiology NCV of intercostal nerves is difficult and not routinely done. EMG paraspinal muscles, intercostals, abdominal wall muscles Local painful conditions of the vertebral column disc herniation, spondylodis- Differential diagnosis Muscle...

Types of pathological discharges

Fasciculations resemble MUAPs in configuration, but have an irregular discharge pattern. They may be linked with a visible or palpable muscle twitch. They can be benign, or occur as part of a neuromuscular condition and are notably increased in ALS. CRDs bizarre high frequency discharges are caused by groups of adjacent muscle fibers discharging with ephaptic spread from one fiber to another. They are usually seen in chronic neurogenic and myopathic disease processes. They typically begin and...

Special applications

Qsart Autonomic Testing

- Investigations of the respiratory system diaphragm see Fig. 8 - EMG of the vocal cords also monitoring of thyroid surgery The interpretation of EMG is based on activity at rest, spontaneous activity, How to interpret EMG characteristics of MUAPs, and the pattern at maximum contraction. The concept of EMG is based on the fact that diseases of the neuromuscular system often induce changes in the architecture of the motor unit, which induces morphologic changes and the changes of electrical...

Olfactory nerve

Mediates olfaction defined as the sense of smell. Olfactory receptors are present in the superior nasal conchae and nasal septum. The unmyelinated axons pass through the cribiform plate to synapse in the olfactory bulb. The olfactory bulb is located beneath the surface of the frontal lobe. Axons leave the olfactory bulb as the olfactory tract and connect to prepyriform cortex. The term parosmia describes a qualitative change in smell while total loss of smell is known as anosmia. Disorders of...

Trauma

Abducens Nerve Function

Blow out fractures Gunshot wounds Penetrating trauma Trauma of the orbit Traumatic optic neuropathy Diagnosis Diagnosis is based on X-ray, CT, or MRI imaging, visual function and color discrimination tests, ophthalmoscopic exam, visual evoked potentials VEP , and electroretinogram ERG . Differential diagnosis Other causes of papilledema should be considered, including increased intracranial pressure ICP and pseudotumor cerebri. Treatment depends upon the cause of the lesion. Acheson J 2000...

Qualities

Sural Nerve Conduction Study

- Negative symptoms are numbness, loss of feeling, perception, and even anesthesia. - Positive symptoms are paresthesia, pins and needles, tingling, dysesthesia uncomfortable feeling or hyperpathia painful perception of a non-painful stimulus . Inadequate sensory stimuli can result in allodynia. The type of sensory disturbance gives a clue to the affected fibers. Loss of temperature and pain perception points to small fiber loss, whereas large fiber loss manifests itself in loss of vibration...