peripheral nerves &roots lession localisation
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LESIONS OF PERIPHERAL NERVES
AND ROOTS
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Peripheral nervous system
Part of nervous system outside CNS
Nerves from brain and spinal cord
PNS is divided into :1.Somatic
2.Autonomous
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Somatic nervous system Nerves from cns to skeletal muscles
1.spinal nerve a. 8 pairs of cevical nerves b. 12 pairs of thoracic nerves c. 5 pairs of lumbar nerves d. 5 pairs of sacral nerves e. 1 pair of coccygeal nerves
Attached to spinal cord by 2 roots - dorsal and ventral roots
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2. cranial nerves
Cell bodies in brain 12 pairs olfactory , optic , occulomotor ,
trochlear , trigeminal , abducens , facial , vestibulocochlear , glossopharyngeal , vagus , spinal accessory , hypoglossal nerves
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Autonomic nervous system
Supply all tissues other than skeletal muscles
ANS is divided into – 1.sympathetic consisting of thoracic and
lumbar ganglia
2.parasympethetic consisting of III,VII,IX,X cranial nerves and 2, 3,4
sacral segments of the spinal nerves
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Lesions of peripheral nerves and roots
Lesions/diseases affecting neve roots – radiculopathy
Lesions/diseases affecting nerve plexus- plexopathy
Lesions/diseases affecting individual nerves-
neuropathy
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neuropathy
It can be of
a. focal affecting a single nerve – mononeuropathy
b.multifocal affecting several nerves – mononeuropathy multiplex
c.generalised - polyneuropathy
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mononeuropathiesI. ENTRAPMENT NEUROPATHY Due to compression/or entrapment of
single nerve Pathology – presure damages myelin
sheath,axons and cause slowing of conduction
eg. median nerve – carpel tunnnel
syndrome ulnar nerve at elbow radial nerve compression common peroneal nerve compression lateraL cutaneous nerve of thigh
compression
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NERVE MUSCLE WEAKNESS
AREA OF SENSORY LOSS
MEDIAN NERVE(CARPEL TUNNEL SYN.)
ABDUCTOR POLLICIS BREVIS
LAT PALM &THUMB,INDEX MIDDLE ,LAT HALF OF 4TH FINGER
ULNAR (AT ELBOW)
ALL SMALL HAND USCLES EXCLUDING APB
MEDIAL PALM,LITTLE AND MEDIAL HALF OF 4TH FINGER
RADIAL SUPINATORWRIST & FINGER EXTENSORS
DORSUM OF THUMB
COMMON PERONEAL
DORSIFLEXION AND EVERSION OF FOOT – FOOT DROP
DORSUM OF FOOT
LATERAL CUTANEOUS NERVE OF THIGH
NILLATERAL BORDER OF THE THIGH
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II. TRIGEMINAL NEUROPATHY
Unilateral facial sensory loss
Associated with scleroderma,sjogren syndrome
Reactivation of varicella virus in trigeminal ganglion causes herpes zoster
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.III. FACIAL NERVE PALSY
Also called bell’s palsy
Causes – lesion within facial canal or maybe due to reactivation of latent herpes simplex virus 1 infection
Symptoms – pain around ears unilateral facial weakness deviation of angle of mouth
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.IV. HEMIFACIAL SPASM
Seen after middle age
Intermittent twitching around one eye spreading ipsilaterally to other parts of facial muscles
Spasms exacerbated by talking,eating or stress
Cause – an aberrant arterial loop irritating the nerve just outside the pons
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Mononeuropathy multiplex Involvement of several isolated nerves Nerves involved are widely seperated
leading to asymmetrical pattern Clinical pattern resemble polyneuropathy Due to involvement of vasa nervosum or
malignant infiltration of nerves causes ; acute – DM,
vasculitis,diphtheria,lymes disease,cryoglobinemia
chronic – DM,leprosy,paraprotinaemia,HIV,sarcoidosis
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polyneuropathy
Simultaneous involvement of many peripheral nerves
Symmetric and distal loss of functions
Distal lower limbs are involved first and later the distal upper limbs
Glove and stocking sensory loss
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.I . GUILLAIN-BARRE SYNDROME
Syndrome of acute paralysis In 70%of patients within 1-4 weeks after
respiratory infection or diarrhoea Pathology – CMI responses directed at
myelin proteins of spinal roots and nerves
- due to mimicry between epitopes in micro organisms and gangliosides
Release of cytokines block nerve conduction
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.Clinical features include
Distal paraesthesia & limb pain
Rapidly ascending muscle weakness
Facial and bulbar weakness
Ultimately respiratory weakness
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.
II . CHRONIC POLYNEUROPATHY
Most frequent
Two types - chronic demyelinating polyneuropathy
– hereditary and immune mediated -chronic axonal polyneuropathy
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Plexopathy
I . BRACHIAL PLEXOPTHY Trauma to the brachial plexus
Causes- infiltration from breat or apical lung tumour
-anatomical abnormalities According to site:- -upper plexus (root- C5/6) -lower plexus (root – C8/T1) -thoracic outlet syndrome (root – C8/T1)
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SITE ROOT AFFECTED
MUSCLES
SENSORY LOSS
UPPER PLEXUS
(erb-duchenne syndrome)
C5/6BICEPS,DELTOID,SPINATI,RHOMBOIDS,BRACHIORADIAALIS
PATCH OVER DELTOID
LOWER PLEXUS
(dejerine-klumpke syndrome)
C8/T1ALL SMALL HAND MUSCLES,ULNARWRIEST FLEXORS
ULNAR BORDER HAND/FOREARM
THORACIC OUTLET SYNDROME
C8/T1 SMALL HAND MUSCLES,ULNAR FOREARM
ULNAR BORDER HAND/FOREARM/UPPERARM
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.II . LUMBOSACRAL PLEXOPATHY
Causes – neoplastic infiltration compression by retroperitoneal
haematomas in patients with coagulopathy
Presents with painful wasting of quadriceps with weakness of knee extension and adduction, absent knee jerk
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radiculopathy
Causes : - - compression at or near spinal exit
foramen by prolapsed intervertebral disc -degenerative spinal disease
-infiltration by spinal and paraspinal tumour masses
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.Clinical features
Muscle weakness
Muscle wasting
Dermatomal sensory loss
Pain in the muscles whose motor roots are involved
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Thank you