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Peripheral Nerve Examination
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
Mohammed Tahir Ansari, Santanu Kar, Devansh Goyal, Dyuti Deepta Rano, Rajesh Malhotra
HFU is especially helpful in trauma scenarios and compressive neuropathy syndromes. The nerve fascicles can be visualized, and interpretations can be made as 1) Complete transection/incomplete injury. 2) End neuroma/neuroma in continuity/fascicle disruptions due to fibrosis. 3) Intraneural hematoma/traction injury. 4) External compression by fracture end, bone fragment, screw or another hard. 5) Compressive neuropathy due to any aberrant compressive lesion, etc. [38–40]. Magnetic resonance neurography (MRN)
Vulval Pain
Published in Tony Hollingworth, Differential Diagnosis in Obstetrics and Gynaecology: An A-Z, 2015
Pudendal neuralgia is pain in the distribution of the pudendal nerve (the anogenital area including the vulva, Fig. 2), typically described as superficial, burning, or paraesthesia. It can be unilateral or bilateral and radiate deep or into the thighs. Pudendal neuralgia most commonly results from pudendal nerve entrapment or damage, but can be caused by herpes neuralgia, stretch neuropathy, and radiotherapy. Diagnosis may be clinical or involve electrophysiological studies or magnetic resonance neurography. Treatment may involve a combination of conservative measures, such as physiotherapy, chiropractic, and acupuncture, and pharmacological treatments, including tricyclic antidepressants and gabapentin. Pudendal nerve blocks may also be used both therapeutically and diagnostically.
MR neurography of the brachial plexus in adult and pediatric age groups: evolution, recent advances, and future directions
Published in Expert Review of Medical Devices, 2020
Alexander T. Mazal, Ali Faramarzalian, Jonathan D. Samet, Kevin Gill, Jonathan Cheng, Avneesh Chhabra
MRN has emerged as a safe and useful modality in the neonatal population to characterize the location and grade of brachial plexus injury. Brachial plexus injuries occur in approximately 0.3 to 3.6 per 1,000 live births due to traction of the neck or upper extremity during passage through the birth canal [52–56]. In a study by Smith et al., MRN was found to correlate significantly with both physical exam and EMG findings in this population and correlated more strongly with physical exam findings than did EMG [41]* (reference 41 is believed to be of importance to readers, as it uniquely provides an objective comparison of MRN, EMG, and physical exam findings in pediatric age groups). In this study, all infants with brachial plexus injury were identified to have abnormal imaging findings on MRN. Abnormal imaging findings may include regions of abnormal T2 hyperintense signal of involved nerve segments, focal or diffuse enlargement of involved trunks or cords, visualization of end-bulb or neuroma in continuity at the injury site, and pseudomeningocele, etc. (Table 1). The utility of MRN in the setting of pediatric brachial plexus injury rests primarily in its ability to identify the minority (10%) of patients who ultimately will require surgery, most notably those suffering from avulsion or other pre-ganglionic injuries, which do not heal without microsurgical intervention [54,57].
Value of nerve biopsy in the management of peripheral neuropathies
Published in Expert Review of Neurotherapeutics, 2018
Stéphane Mathis, Laurent Magy, Gwendal Le Masson, Laurence Richard, Antoine Soulages, Guilhem Solé, Fanny Duval, Karima Ghorab, Jean-Michel Vallat, Mathilde Duchesne
The approach to the evaluation of PN first includes electrophysiological diagnosis (EDX) and biological testing, sometimes with lumbar puncture [6]. EDX, considered as an extension of the clinical assessment, helps determine the site of the lesion and the localization of the injury (‘axonal’ or ‘neuronal’ when destruction of the perikaryon, ‘demyelinating’ or at the nodes of Ranvier for ‘nodo-paranodopathy’) [7], but not the cause of the PN. In most cases, clinicians use routine laboratory tests to identify the common causes of PN, but further diagnostic tests are sometimes needed: biological testing (immunological tests, anti- ganglioside antibodies, antineuronal antibodies, etc.), genetic testing (Charcot-Marie-Tooth disease or others), lumbar puncture, bone marrow biopsy, accessory salivary gland biopsy, or other tests [6]. New technologies (magnetic resonance neurography, diffusion tensor imaging, nerve ultrasonography, skin biopsy, etc.) have also been developed for the assessment of PN [8]. Nevertheless, despite these emerging technologies, nerve biopsy (NB) is still of value for the diagnosis of PN in certain circumstances.
A Comparative Study on the Diagnostic Utility of Corneal Confocal Microscopy and Tear Neuromediator Levels in Diabetic Peripheral Neuropathy
Published in Current Eye Research, 2020
Shyam Sunder Tummanapalli, Tushar Issar, Natalie Kwai, Jana Pisarcikova, Ann M. Poynten, Arun V. Krishnan, Mark D. P. Willcox, Maria Markoulli
The current objective methods for screening and diagnosing DPN include nerve conduction studies, magnetic resonance neurography, quantitative sensory testing and intraepidermal nerve fiber density. Nerve conduction studies are considered to be the most reliable measure of peripheral nerve function and is able to detect large nerve fiber damage.7 Magnetic resonance neurography is a non-invasive objective tool that allows the visualization of structural signs of large peripheral nerve damage in DPN.8 Small fiber neuropathy can be assessed by using quantitative sensory testing and intraepidermal nerve fiber density in skin biopsies.5,9–11