Neuromuscular Disorders
Louis Solomon, David Warwick, Selvadurai Nayagam in Apley and Solomon's Concise System of Orthopaedics and Trauma, 2014
Classification by anatomical level and distribution is the simplest. In over 40% of cases no specific cause has been found! Radiculopathy – involvement of nerve roots, most commonly by vertebral trauma, intervertebral disc herniation and nerve root infections like herpes zoster.Plexopathy – e.g. brachial plexus injury or viral infection (neuralgic amyotrophy).Distal neuropathy – involvement of neurons in distinct peripheral nerves: Mononeuropathy – involvement of a single nerve, (e.g. nerve injury, or nerve compression). •■ Multiple mononeuropathy – involvement of several nerves (e.g. leprosy).Polyneuropathy – widespread symmetrical dysfunction (e.g. diabetic neuropathy, alcoholic neuropathy and various hereditary neuropathies).
The neurologic approach
Stanley Berent, James W. Albers in Neurobehavioral Toxicology, 2012
The peripheral nervous system is, in general, a sensitive indicator of nervous system involvement from neurotoxic chemicals (Albers & Bromberg, 1995). Numerous neurotoxicants produce recognizable peripheral nervous system effects as part of their overall involvement when given in sufficient dose and over a sufficient period. The concept that the peripheral nervous system is sometimes involved as part of more generalized nervous system or systemic toxicity is important because the most objective and quantifiable evaluation techniques available to the neurologist measure peripheral nervous system performance. The characteristic peripheral nervous system abnormality following neurotoxic exposure is peripheral neuropathy. ‘Neuropathy’ is a general term that literally means ‘sick nerve’. The term is used to denote damage to the peripheral nervous system. ‘Mononeuropathy’ indicates involvement of a single peripheral nerve. ‘Mononeuropathy multiplex’ indicates involvement of multiple individual nerves. ‘Polyneuropathy’ indicates diffuse or generalized involvement of most or all nerves. The terms ‘neuropathy’, ‘peripheral neuropathy’, and ‘polyneuropathy’ are used interchangeably in reference to generalized involvement of the peripheral nervous system. There are several different types of peripheral neuropathy, including those classified as sensory, motor, sensorimotor, and/or autonomic, depending on the predominant class of nerve fiber involved.
Neurological Disease
John S. Axford, Chris A. O'Callaghan in Medicine for Finals and Beyond, 2023
Mononeuropathy (dysfunction of a single peripheral nerve) is usually caused by local compression or trauma, but there may be increased vulnerability to such lesions because of an otherwise subclinical generalized neuropathy. Most commonly involved sites are the median nerve at the wrist (carpal tunnel syndrome); the ulnar nerve at the elbow; the common peroneal nerve at the fibular head; and the lateral cutaneous nerve of the thigh (meralgia paraesthetica). Carpal tunnel syndrome is common, and causes pain in the hand, especially at night, which may be relieved by rubbing or shaking the hand. There can be sensory loss in the lateral side of the hand and weakness and wasting of the thenar eminence muscles (abductor pollicis brevis, opponens pollicis, flexor pollicis brevis). Carpal tunnel syndrome is more common in pregnancy, hypothyroidism, rheumatoid arthritis and acromegaly.
Clinical manifestations and genetic analysis of a family with neurofibromatosis type 2
Published in Acta Oto-Laryngologica, 2022
Victoria Y. Wang, Te-Yi Liu, Te-Yung Fang, Ya-Hui Chen, Chi-Jung Huang, Pa-Chun Wang
Patients with NF2 often remain asymptomatic until the second or third decades of their lives, with tinnitus, hearing impairment, and imbalance being the most common clinical manifestations (involving the eighth cranial nerve). Mononeuropathy can involve the facial nerve and 3–5% of patients can develop severe polyneuropathy [2]. Members with disease from the participating family exhibited classic otological symptoms such as hearing impairment, tinnitus, dizziness, and cataracts (Table 1), but their medical histories could only be traced back 20 years – the actual times of symptom onsets were unknown (Table 2). Lesions such as cafe-au-lait spots, cutaneous neurofibroma, axillary freckling, optic glioma, and Lisch nodules are not frequent symptoms in NF2 (as they are in NF1) [9,10], which could not be observed from this studied family. No neurogenic spinal tumor or muscle wasting was discovered in this cohort either.
Systemic Lupus Erythematosus and Third Nerve Palsy: Unusual Presentation and Review of the Literature
Published in Neuro-Ophthalmology, 2022
Divya Natarajan, Mohan Kannam, M Vishnu Vardhan Reddy, Virender Sachdeva
SLE is known to have various ocular manifestations, either because of an inflammatory process or as a complication of medical therapy (corticosteroids, hydroxychloroquine).1 Fortunately, Neuro-ophthalmological manifestations are less common. Prior reports suggest eye movement abnormalities are reported in 7% to 37% of patients with established SLE.2,3 Like our report, a few authors have described mononeuropathy i.e., isolated cranial nerve palsy, either as the presenting manifestation or during the course of SLE (Table 2). All cases of isolated third nerve palsy reported were complete palsies, unlike our case which had an incomplete third nerve palsy. Our case is also unique in that the mononeuropathy was the one of her early symptoms and the diagnosis of SLE was still unestablished. Further, our patient had otherwise normal neurological examination and neuroimaging. Careful clinical examination with attention to laboratory parameters, pancytopaenia, elevated ESR, and normal neuroimaging suggested an immunological cause and prompted us to seek an immunology consultation. Further work-up established the diagnosis.
Clinical and pathologic characteristics of pauci-immune anti-myeloperoxidase antibody associated glomerulonephritis with nephrotic range proteinuria
Published in Renal Failure, 2018
Peng-Cheng Xu, Tong Chen, Shan Gao, Shui-Yi Hu, Li Wei, Tie-Kun Yan
Clinical data included the following: gender, age (years), time from onset (days) and the level of Birmingham Vasculitis Activity Score (BVAS). Acute kidney injury (AKI) was defined by Kidney Disease Improving Global Outcomes (KDIGO) in 2012 [20]. Fever was defined as body temperature >38.5 °C. Weight loss was defined as loss of >2 kg over 1 months preceding diagnosis. Extra-renal manifestations included following items. Skin involvement was defined as new skin lesions during the active period of AAV which could not be explained by any other cause. Mucous/Eye involvement included oral/genital ulcer, conjunctivitis, uveitis and fundus hemorrhage. Ear involvement included hearing loss and otitis media. Nasal involvement included sinusitis, nasal polyposis and epistaxis. Lung involvement was diagnosed when there was hemoptysis or chest x-ray and/or computed tomography revealed nodule or infiltration. Digestive tract involvement was diagnosed based on the existence of gastrointestinal bleeding or the positive result of fecal occult blood. Peripheral neuropathy was diagnosed if new mononeuropathy or multiple mononeuropathies occurred. Neuropathy was diagnosed once other causes of neuropathy were excluded.
Related Knowledge Centers
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