Nani Kurniani
Faculty of Medicine Padjadjaran University / Dr. Hasan Sadikin General Hospital Bandung
location
degree
fiber nerve
Onset
Neuropathy
It is condition where perifer nerve gets dysfunction and distruction.
hiperalgesia
incomportable, burning sensation Clinical symptom : Distal gloves stocking hypesthesia Dermatomel
Neuropathy ( contd )
Example :
Cool on limb Postural syncope
Orthostatic hypotension
Hyperhidrosis
Diabetic neuropathies
C. Polyradiculopathy
Contd
Inherited polyneuropathy
C. Inherited polyneuropathy of mixed sensorimotor types
Approach
Peripheral nerve disorder LMN
Polyneuropathies
Mononeuropathies
Pathology :
Demyelinitation segmental
Severe axonal degeneration
Clinical symptoms
Diagnostic test : Lumbal puncture : elevated cerebrospinal fluid protein NCV - EMG Criteria to make a diagnosis of GBS : Rapid onset lead to frank paralysis : Leg and arms Sometimes respiratory muscle Accompanied by sensoric abnormalities Loss of deep tendon reflex / decrease Elevated cerebrospinal fluid protein, and normal cell Absence of other causes of peripheral neuropathy
Prognosis :
75 85 % spontaneus recovery 10 17 % recover with disability
8 % recurrent
5 % died
Diabetic Neuropathy
Complications of diabetes mellitus
Insidens 30 % - 70 % of DM patient
Clinical features
Diabetic opthalmoplegia Acute mononeuropathy
Diagnostic test
Blood glucose level test Nerve conduction study : NCV Therapy Maintenance of the blood glucose level Microangiopathy antiplatelet agregasi ASA Symptomatic theraphy for neuropathic pain
Psikotherapy, physiotherapy
Nutritional polineuropathy
Etiology : Deficiency vitamin in daily food Tight diet Malabsorption
Clinical features
Sensoric :
Paresthesia, hyperalgeria, hyperaesthesia Motoric : Paralysis Fisiologi reflex decrease Sistemic disorder : delirium anemi, etc
Diagnostic test
Mononeuropathy
Radial nerve Arises from the C. 5 8 Motor nerve innervated : the chief extensor of the fore arm, wirst, and finger Cause by external pressure in axilla and fracture humerus Pressure against some hard surface especially in sleep : saturday night palsy
Radial Nerve
Median nerve Arises from the C. 5 6 7 8 th I Its fairly common as a result of compression of the nerve by transverse carpal segment ( Carpal tunnel syndrome / CTS ) The symptoms : severe pain often weakly patient from sleep, usually in the thumb and index finger Athrophy M. Thenar Trauma axilla area ape hand
Median Nerve
Ulnar nerve
Arises from the C7 8 th I It is frequently injured by gunshot, wound in olecranon or head radius bone, most compressed at elbow, leprosy, diabetic neuropathy
Ulnar Nerve
Sciatic nerve
Derived from the L 4 5 S1 Its commonly by fracture of pelvis or femur, wound of the buttock and thigh.
In fossa poplitea the nerves devides : Common perineal nerve Tibial nerve
Sciatic nerve
The brachial plexus Formation of brachial plexus : Upper : from C5 6 Middle : from C7 8 Lower : from C8 Th. 1
Wound
Direct trauma Tumor or aneurysm
Syndrome )
Middle brachial syndrome Lower brachial syndrome ( Klumpke deyerine syndrome
Muscles affected
Quadriceps
Reflex affected
Straight leg raising
Knee jerk
May not increase pain
Posterior tibial
Aggravates root pain
Ankle jerk
Aggravates root pain
C4 5 C5
C5 6 C6
Deltoid; biceps
Triceps
Myopathy
Diseases concerning with sceletal muscles Symptoms of skeletal muscle disease : Falique Weakness
Atrophy
Muscle tic Cramps
Painfull
Electromyography
Nerve conduction study
Muscle biopsy
Muscle distrophy
Clinical manifestation
Physical diagnostic
Diagnostic test
Therapy
Genetic conseling
Polymyositis
Disorders of sceletal muscle Onset acute / subacute PA infiltration of muscle by lymphocyt
Etiology
Unknown idiopathic polymyositis / autoimmun Collagen vascular disease Infection
Drug
Systemic disease Endocrin disease Metabolic disease Toxic
Clinical manifestation No family history Progressition is measured in week / month Symptom may improve spontaniously Dysphagia, weakness neck / flexor muscle Arthralgia, myalgia
Myasthenia Gravis
Autoimmun disease Causes by transmission disorders on neuro muscular junction Acetyl cholin receptor ist attack by antibody Related with thymus gland
Clinical features Fluctuated weakness of certain voluntary muscle Viral, other infection, emotional, can worst the symptom
No sensory deficit
Classification
1. Ocular myasthenia : 20 % cases 2. A. Mild generalized myasthenia
- Slow progression
No crisis drug respons B. Moderate generalized myasthenia
Diagnostic test Tensilon test or prostigmin test Measurement of receptor antibody for acetylcholine Repetitive stimulating test : progressif decrement Single fiber electromyography X ray, CT Scan, MRI, for thymoma gland Differential diagnostic : Eaton lambert syndrome Follow lung carcinoma Myasthenia gravis related with drug, toxin Therapy : Anticholine esterase drug prostigmin Cortico steroid Thymectomy Plasma pharesis and immunosupressan Immunoglobulin
BIOPSY
Nani Kurniani
Faculty of Medicine Padjadjaran University / Dr. Hasan Sadikin General Hospital Bandung
Biopsy
Mitochondria disease
Nerve biopsy
Brain biopsy
An infasive test / high risk procedure No other diagnostic test