Focal Neuropathies

Cover
Series Page
	Series page
Copyright
	Copyright
Handbook of Clinical Neurology 3rd Series
	Available titles
Foreword
	Foreword
Preface
	Preface
Contributors
	Contributors
1
	Hallmarks of peripheral nerve injury and regeneration
		Introduction11Abbreviations used in the chapter are listed at the end of the chapter before References section.
			Peripheral nerve anatomy
			Nerve injuries and hallmarks of regeneration
		Wallerian and Wallerian-Like Degeneration and Path-Clearing
			Axon and myelin degeneration
			Regenerative path-clearing
		Cellular and Molecular Reprogramming of the Distal Nerve Stump
			The dynamics of SCs and macrophages
		Local Translation, Intra-Axonal Transport, and Axon Guidance
			Local translation and axon guidance
			Molecular guidance and preferential reinnervation of targets
			Intra-axonal transport
			Axon myelination
		Regenerative Priming of Neurons
			Regeneration associated genes
			Satellite glial cells and resident macrophages
			Growth suppressors and neuron loss
		Molecular Mechanisms for Nerve Regeneration and Potential Therapeutic Opportunities
			Pharmacological opportunities for nerve repair
			Nonpharmacological opportunities for nerve repair
		Summary
		Acknowledgments
		Reference
2
	The role of imaging in focal neuropathies
		Introduction
		Basic Principles of Nerve Ultrasound
		Basic Principles of Magnetic Resonance Neurography
		Ultrasound or MR Neurography
		Imaging of the Median Nerve
		Imaging of the Ulnar Nerve
			Imaging in Leprosy
		Imaging of the Radial Nerve
		Imaging of the Brachial Plexus
			Imaging in Neuralgic Amyotrophy
		Imaging of the Common Fibular Nerve
		Imaging of the Tibial Nerve
		Imaging of the Sciatic Nerve, Femoral Nerve, and Lumbosacral Plexus
		Imaging of the Lateral Femoral Cutaneous Nerve
		Imaging in Peripheral Nerve Trauma
		Imaging of Peripheral Nerve Tumors
		Imaging in Inflammatory Neuropathies
		Conclusions
		References
3
	The role of electrodiagnosis in focal neuropathies
		Introduction
		Role of EDX Testing in Mononeuropathies
		Pathophysiology of Nerve Injury Relevant to EDX Findings
		Role of NCS in Mononeuropathies
		Motor NCS
			Motor NCS in focal demyelination
				Conduction velocity slowing
				Conduction block
				Temporal dispersion
			Axon loss
		Role of Short-Segment Stimulation ``Inching´´ Motor NCS Studies
		Sensory NCS
		Limitations and Pitfalls of NCS
			Technical and physiologic pitfalls mimicking mononeuropathies
			Limitations of proximal NCS techniques
			Sensitivity in mild or intermittent symptoms
			Errors in localization
		Role of Needle Electromyography (EMG) in Mononeuropathies
		Types and Significance of Needle EMG Abnormalities
			Fibrillation potentials
			Fasciculation potentials
			Complex repetitive discharges (CRDs)
			Voluntary motor unit potentials (MUPs) in mononeuropathies
				Reduced recruitment
				MUP morphology changes
		Limitations and Pitfalls of Needle EMG
			Sensitivity in mild or intermittent symptoms
			Errors in localization
		Role of EDX in Grading Severity of Mononeuropathies
		Role of EDX Testing in Monitoring Mononeuropathies
		EDX Testing Compared to Nerve Imaging in Mononeuropathies
		Summary
		References
4
	Carpal tunnel syndrome
		Introduction
		Anatomy
			Structure of the carpal tunnel
			Median nerve anatomy
			Anatomical variants
		Carpal Tunnel Syndrome
			Epidemiology
			Clinical characteristics
			Pathophysiology
			Risk factors for carpal tunnel syndrome
				Occupational-related risk factors
				Female sex
				Increased BMI
				Age
				Tenosynovitis
				Connective tissue diseases
				Polyneuropathy
				Amyloidosis
				Endocrine disease
				Carpal canal deformity
				Genetic risk factors
				Other causes
		Diagnosis
			Clinical assessment
			Electrodiagnostic testing (EDX)
				Sensory studies
				Sensory comparison studies
				Motor studies
				Motor comparison studies
				Motor short segment study
				Needle electromyography (EMG)
				Grading severity
			Neuroimaging
				X-ray and computed tomography (CT)
				Ultrasound (US)
				Static cross sectional US
				Dynamic cross-sectional US
				Doppler US
				US elastography
				Magnetic resonance imaging (MRI)
				Signal intensity
				Diffusion tensor imaging and MR tractography
		Management
			Non-surgical
				Ergonomic tools
				Splints
				Nerve and tendon gliding
				Corticosteroids
			Surgical intervention
				Indications
				Open carpal tunnel release (OCTR)
				Minimally invasive carpal tunnel release
				Endoscopic carpal tunnel release
				Outcomes
				Complications
			Management recommendations
		Controversies and Avenues for Future Research
		Conclusion
		References
5
	Other median neuropathies
		Introduction
			Anatomical features of the median nerve
				Origin and pathway
				Motor and sensory innervations
			Approaches to median nerve injury workup
				Electrodiagnostic studies
				Ultrasonography
					Case 1
				Magnetic resonance imaging
		Congenital Variants
			Anatomical variations related to the carpal tunnel
				Martin-Gruber anastomosis
				Riche-Cannieu anastomosis
		Hereditary and Acquired Disorders
			Median neuropathies associated with multiple nerve disorders
				Hereditary neuropathy with liabilities to pressure palsy
				Multifocal acquired demyelinating sensory and motor neuropathy
				Multifocal motor neuropathy
				Neuralgic amyotrophy
		Focal Lesions of the Median Nerve
			Proximal nerve lesions
				Medial brachial compartment syndrome
				Anterior dislocation of the shoulder
				Humerus fracture
				Brachial artery pseudoaneurysm
				Pronator teres syndrome
				Ligament of Struthers lesion
				Anterior interosseous nerve neuropathy
				Direct median nerve trauma
					Case 2
					Case 3
			Distal nerve lesions
				Palmar cutaneous branch
				Recurrent motor branch
			Mimics of median neuropathy
		Conclusion
		References
6
	Ulnar neuropathy
		Introduction
		Anatomy
		Clinical Features
		Pathogenesis of Ulnar Nerve Injury
		Natural History of Ulnar Neuropathy
		Diagnosis
			Neurophysiology
				Motor conduction slowing
				Conduction block
				First dorsal interossei recording
				Short-segment incremental studies
				Sensory nerve conduction studies
				Ulnar neuropathy at the wrist
				Needle electromyography (EMG)
				Limitations
			Imaging
				Ultrasound
			MRI
		Management
			Conservative management
			Perineural injections
			Surgical management
			Controversies and avenues for future research
			Management recommendation
		Conclusion
		Acknowledgment
		References
7
	Radial neuropathy
		Introduction
			Anatomy
			Clinical features
			Electrodiagnosis and imaging
			Etiologies
			Radial neuropathies in anatomically vulnerable sites
			Etiologies not specific to the radial nerve
			Polyneuropathy presenting with radial neuropathy
			Management
				Orthoses
				Medication for neuropathic pain
				Surgical exploration
				Nerve grafting and tendon or nerve transfers
		Conclusions
		References
8
	Axillary and musculocutaneous neuropathies
		Introduction
		Axillary Neuropathy
			Anatomy
			Clinical features
			Electrodiagnostic evaluation
			Disorders
			Management
		Musculocutaneous Neuropathy
			Anatomy
			Clinical features
			Electrodiagnostic evaluation
			Disorders
			Management
		Acknowledgment
		References
9
	Fibular (peroneal) neuropathy
		Introduction
		Anatomy
		Clinical Features of Fibular Neuropathy
		Etiology of Fibular Neuropathy
			Compression
			Entrapment
			Trauma
			Occupational neuropathy
			Tumors, cysts, and other mass lesions
			Acute compartment syndrome
			Chronic exertional compartment syndrome
			Systemic disorders and diffuse nerve disease
			Fibular neuropathy at the ankle
		Electrodiagnosis of Common Fibular Neuropathy
		Imaging
		Management
		Prognosis of Fibular Neuropathy
		Summary
		References
10
	Sciatic and tibial neuropathies*
		Introduction
		Anatomy: Sciatic Nerve
		Anatomy: Fibular Nerve
		Anatomy: Tibial Nerve
			Trauma
		Distal Sciatic Nerve Injuries with Primarily Fibular>Tibial Nerve Involvement
			Tumor
		Compressive Neuropathies
		Tarsal Tunnel and Ankle
			Infection
			Bracing
		Nerve Reconstruction and the Electromyographer
		Summary
		References
11
	Femoral and obturator neuropathies
		The Femoral Nerve
			Anatomy
			Clinical features
			Injuries
				Orthopedic surgery
				Hematoma
				Abdominal and pelvic surgery
				Cannulation
				Anesthesia
				Tumors and masses
				Infection
				Diabetes
				Pregnancy
				Other
			Investigations
			Treatment
			Prognosis
		The Obturator Nerve
			Anatomy
			Clinical features
			Injuries
				Surgery
				Pregnancy
				Compressive lesions
				Nerve entrapment
				Other
			Investigations
			Treatment
			Prognosis
		Conclusion
		References
12
	Meralgia paresthetica
		Nerve Anatomy
		Clinical Features
		Epidemiology and Risk Factors
		Types of Injuries
			Spontaneous causes
			Iatrogenic (postsurgical) causes
				Total hip replacement surgery
				Posterior lumbar spine surgery
				Other surgeries
		Investigations
		Treatment and Prognosis
			Neurolysis
			Neurectomy
		Conclusion
		References
13
	Piriformis syndrome
		Introduction
		Nomenclature
		Anatomy
		Etiology
		Clinical Presentation: Symptoms and Signs
		Provocative Physical Examination Maneuvers
		Diagnostic Criteria
			Electrodiagnostic studies
		Ultrasound
		Bone Scan
		Magnetic Resonance Imaging
		MR Neurography
		Treatment
		Injections (Diagnosis and Treatment)
		Injection Techniques
		Epidural Injections
		Hydrodissection
		Surgery
		Conclusions
		References
14
	Surgery for mononeuropathies
		Introduction
		Relevant Nerve Surgical Anatomy and Structure
		Brief Biology of Nerve Injury and Regeneration
		Nerve Injury Grading and Consequences for Surgical Management
		Routine Stepwise Approach
			Etiology of nerve entrapments
		General Approach to Evaluation and Management
		Imaging
		Surgical Considerations in Nerve Entrapment
		Nerve Injury Surgery and Timing of Intervention
		Nerve Transfers
		Neuroma and Neuroma-in-continuity Specific Considerations
		Excision and Grafting
			Split repair
			Autograft
			Allograft
			Augmented nerve transfer
		Nerve and Tendon Transfer Combined Approach
			Median nerve mononeuropathy
			Ulnar nerve mononeuropathy
			Radial nerve mononeuropathy
			Postoperative management
		Innovative Current and Future Directions
			Electrical stimulation
			Regenerative peripheral nerve interface and targeted muscle reinnervation
		References
15
	Peripheral nerve tumors
		Schwannoma
			Definition
			Clinical/imaging
			Gross–microscopic findings
			Subtypes (clinically relevant)
		Neurofibroma
			Definition
			Clinical/imaging
			Gross-micro
			Subtypes (clinically relevant)
		Perineurioma
			Definition
		Hybrid Nerve Sheath Tumor
			Definition
			Clinical and imaging findings
		Malignant Peripheral Nerve Sheath Tumor
			Definition
			Clinical imaging
			Gross–microscopic findings
			Subtypes (clinically relevant)
		Malignant Melanotic Nerve Sheath Tumour
			Definition
			Clinical and imaging findings
			Gross and microscopic findings
		Cauda Equina Neuroendocrine Tumor (Previously Paraganglioma)
		References
16
	Focal inflammatory neuropathies
		Introduction
		Focal Autoimmune Neuropathies
			Focal CIDP
		Focal Nonsystemic Vasculitic Neuropathies
			Diabetic and nondiabetic radiculoplexus neuropathies
				Lumbosacral radiculoplexus neuropathy
				Cervical radiculoplexus neuropathy
				Thoracic radiculoneuropathy
			Postsurgical inflammatory neuropathy
			Neuralgic amyotrophy/inflammatory brachial plexus neuropathy
		Etiology and pathogenesis
		Investigations
			Electrophysiologic studies
			Neuroimaging
			Laboratory
			Nerve biopsy
		Treatment and Prognosis
		Sarcoidosis
		Focal Infectious Neuropathies
			Leprosy
			Lyme disease
			Herpes zoster
			Human immunodeficiency virus (HIV)
		References
Index
	Index