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Peripheral nerves &roots lession localisation

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  • 1.  Part of nervous system outside CNS Nerves from brain and spinal cord PNS is divided into :1.Somatic2.Autonomous
  • 2.  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 root s
  • 3. 2. cranial nerves Cell bodies in brain 12 pairs olfactory , optic , occulomotor , trochlear , trigeminal , abducens , facial , vestibulocochlear , glossopharyngeal , vagus , spinal accessory , hypoglossal nerves
  • 4.  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
  • 5.  Lesions/diseases affecting neve roots – radiculopathy Lesions/diseases affecting nerve plexus- plexopathy Lesions/diseases affecting individual nerves- neuropathy
  • 6.  It can be of a. focal affecting a single nerve – mononeuropathy b.multifocal affecting several nerves – mononeuropathy multiplex c.generalised - polyneuropathy
  • 7. I. 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
  • 8. NERVE MUSCLE AREA OF SENSORY WEAKNESS LOSS MEDIAN NERVE LAT PALM(CARPEL ABDUCTOR POLLICIS &THUMB,INDEXTUNNEL SYN.) BREVIS MIDDLE ,LAT HALF OF 4TH FINGER MEDIAL PALM,LITTLEULNAR (AT ALL SMALL HAND USCLES AND MEDIAL HALFELBOW) EXCLUDING APB OF 4TH FINGERRADIAL SUPINATOR DORSUM OF THUMB WRIST & FINGER EXTENSORSCOMMON DORSIFLEXION AND DORSUM OF FOOTPERONEAL EVERSION OF FOOT – FOOT DROPLATERAL LATERAL BORDER OFCUTANEOUS NIL THE THIGHNERVE OFTHIGH
  • 9. II. TRIGEMINAL NEUROPATHY Unilateral facial sensory loss Associated with scleroderma,sjogren syndrome Reactivation of varicella virus in trigeminal ganglion causes herpes zoster
  • 10. 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
  • 11. 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
  • 12.  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
  • 13.  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
  • 14. 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
  • 15. Clinical features include Distal paraesthesia & limb pain Rapidly ascending muscle weakness Facial and bulbar weakness Ultimately respiratory weakness
  • 16. II . CHRONIC POLYNEUROPATHY Most frequent Two types - chronic demyelinating polyneuropathy – hereditary and immune mediated -chronic axonal polyneuropathy
  • 17. 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)
  • 18. SITE ROOT AFFECTED SENSORY LOSS MUSCLESUPPER PLEXUS BICEPS,DELTOID C5/6 ,SPINATI,RHOM PATCH OVER(erb-duchenne BOIDS,BRACHIO DELTOIDsyndrome) RADIAALISLOWER PLEXUS ALL SMALL C8/T1 HAND ULNAR BORDER(dejerine-klumpke MUSCLES,ULNA HAND/FOREARsyndrome) RWRIEST M FLEXORSTHORACIC ULNAR BORDEROUTLET C8/T1 SMALL HAND HAND/FOREARSYNDROME MUSCLES,ULNA M/UPPERARM R FOREARM
  • 19. 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
  • 20.  Causes : - - compression at or near spinal exit foramen by prolapsed intervertebral disc -degenerative spinal disease -infiltration by spinal and paraspinal tumour masses
  • 21. Clinical features Muscle weakness Muscle wasting Dermatomal sensory loss Pain in the muscles whose motor roots are involved
  • 22. Thank you