Peripheral nerves &roots lession localisation

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Peripheral nerves &roots lession localisation

  1. 1.  Part of nervous system outside CNS Nerves from brain and spinal cord PNS is divided into :1.Somatic2.Autonomous
  2. 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. 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. 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. 5.  Lesions/diseases affecting neve roots – radiculopathy Lesions/diseases affecting nerve plexus- plexopathy Lesions/diseases affecting individual nerves- neuropathy
  6. 6.  It can be of a. focal affecting a single nerve – mononeuropathy b.multifocal affecting several nerves – mononeuropathy multiplex c.generalised - polyneuropathy
  7. 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. 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. 9. II. TRIGEMINAL NEUROPATHY Unilateral facial sensory loss Associated with scleroderma,sjogren syndrome Reactivation of varicella virus in trigeminal ganglion causes herpes zoster
  10. 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. 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. 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. 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. 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. 15. Clinical features include Distal paraesthesia & limb pain Rapidly ascending muscle weakness Facial and bulbar weakness Ultimately respiratory weakness
  16. 16. II . CHRONIC POLYNEUROPATHY Most frequent Two types - chronic demyelinating polyneuropathy – hereditary and immune mediated -chronic axonal polyneuropathy
  17. 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. 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. 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. 20.  Causes : - - compression at or near spinal exit foramen by prolapsed intervertebral disc -degenerative spinal disease -infiltration by spinal and paraspinal tumour masses
  21. 21. Clinical features Muscle weakness Muscle wasting Dermatomal sensory loss Pain in the muscles whose motor roots are involved
  22. 22. Thank you

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