PERIPHERAL NEUROPATHY

PROF. RUCKMANI REDDY’S UNITDR.A.RAMALINGAM

• MONONEUROPATHY• MONONEUROPATHY MULITIPLEX• PLEXOPATHY

Diagnosis rests on the finding of motor, sensory or reflex changes confined to the

territory of - single nerve - several individual nerves[random fashion] - plexus or part of the plexus of nerves

MONONEUROPATHY

• Mononeuropathy is damage to a single nerve which results in loss of movment sensation, or other function of that nerve.

• Long-term pressure on the nerve due to swelling or injury can result in mononeuropathy. The myelin sheath or the axon is destroyed. This damage slows or prevents signals from traveling through the nerves.

• Mononeuropathy may involve any part of the body. Some of the common forms of mononeuropathy include:

• Axillary nerve dysfunction • Common peroneal nerve dysfunction • Carpal tunnel syndrome • Cranial mononeuropathy III; compression type • Cranial mononeuropathy III; diabetic type • Cranial mononeuropathy VI • Cranial mononeuropathy VII • Femoral nerve dysfunction • Radial nerve dysfunction • Sciatic nerve dysfunction • Ulnar nerve dysfunction

Median

Distal portion of the humerus

Elbow (pronator syndrome)

Elbow (anterior interosseous nerve syndrome, Kiloh Nevin syndrome)

Wrist (carpal tunnel syndrome)

Wrist (sublimis syndrome, pseudo-carpal tunnel syndrome)

Ulnar

Elbow (cubital tunnel syndrome, tardy ulnar palsy)

Wrist (ulnar tunnel syndrome, Guyons canal syndrome

Radial

Axilla (Saturday night palsy, sleep palsy)

Distal end of humerus

Elbow (posterior interosseous nerve syndrome)

Suprascapular

Shoulder

Plantar and interdigital

Foot (Mortons metatarsalgia)

Posterior tibial

Ankle (tarsal tunnel syndrome)

Common peroneal

Knee

Lateral femoral cutaneous

Anterior superior iliac spine (meralgia paraesthetica

Femoral

Inguinal region

Obturator

Obturator canal

Sciatic

Sciatic foramen (including piriformis syndrome)

Knee

Brachial plexus

Neck and shoulder (thoracic outlet syndrome), scalenus anticus syndrome)

MONONEUROPATHY MULTIPLEX

• Mononeuropathy multiplex refers to simultaneous or sequential involvement of individual noncontiguous nerve trunks, either partially or completely

• Affects peripheral nerves in a multifocal and random fashion

• Pattern of early symptoms is important in making the judgment that a particular neuropathy is indeed a mononeuropathy multiplex and not a polyneuropathy

• Common causes of mononeuritis multiplex include:• Blood vessel diseases such as polyarteritis nodosa • Connective tissue diseases such as rheumatoid arthritis or

systemic lupus erythematosus • Diabetes mellitus • Connective tissue disease is the most common cause of

mononeuritis multiplex in children.• Less common causes include:• Amyloidosis • Disorders of the blood (such as hypereosinophilia and

cryoglobulinemia) • Infections such as Lyme disease • Leprosy • Sarcoidosis • Sjogren syndrome • Wegener's granulomatosis

PLEXOPATHY

• Traumatic pathology of the brachial plexus• direct injury of the brachial plexus usually occurs by

direct peripheral traction (due to violent and extreme movement of the cervical spine violent displacement of the shoulder girdle relative to the trunk or shoulder girdle relative to the arm). The plexus may suffer elongation, finally leading to avulsion at its weakest place, which is the junction of the nerve roots and the spinal cord. As a result of tearing of the dura (and sometimes also the arachnoid), accompanying the spinal nerves in the neuroforamina, nerve root avulsion commonly occurs

• indirect traumatic injury of the brachial plexus, when it is compressed or irritated by a soft tissue haematoma, or hypertrophic callus originating from a clavicular fracture.

• Nontraumatic pathology of the brachial plexus• primary tumour: schwannoma head and neck • superior sulcus neoplasm: malignant neoplasm originating

from the apical lung; it often invades the superior thoracic wall and may grow into the brachial plexus (Pancoasts neoplasm). Other neoplasms possibly invading the brachial plexus are local extensions or recurrences of breast cancer, soft tissue sarcomas and lymphoma.

• brachial neuritis: possibly related to an infection or an autoimmune condition[also Parsonage Turner syndrome]

• brachial plexopathy after irradiation. It is most often seen in patients treated for breast cancer. It is clinically and also radiologically difficult to differentiate from recurrent tumour. The presence of a mass lesion in or near the brachial plexus indicates tumour recurrence in most cases

• thoracic outlet syndrome