臂丛神经损伤的膈神经传导测定结果分析

目的 评估膈神经传导功能测定方法的临床应用价值. 方法 对292例臂丛神经损伤患者进行膈神经诱发电位的检测,根据积水潭医院肌电图室建立的正常值将其分为传导功能正常组与传导功能异常组,比较2组膈神经诱发电位的潜伏期和波幅. 结果 传导功能正常组膈神经诱发电位的潜伏期较异常组明显降低,波幅较异常组明显增加,差异有统计学意义(P＜0.05). 结论 膈神经运动传导功能测定方法简便、易行.安全可靠,是一种临床了解膈神经功能的可靠方法.     

神经梅毒的磁共振成像表现

目的 提高对神经梅毒MRI表现的认识,探讨MRI在诊断神经梅毒中的价值与局限性.方法 总结了临床与实验室证实的11例神经梅毒患者经1.5T超导MR进行检查(9例增强,2例平扫)的结果.结果 2例梅毒树胶肿患者表现为脑内占位性病灶(1例左小脑半球,1例右额叶),呈不均匀强化;1例麻痹性痴呆患者示右额、颞、顶叶局部脑萎缩,伴脑内多发腔梗;1例脑膜梅毒患者脑表面颅板下及大脑镰、小脑幕脑膜强化明显,双侧海马区见条状强化;1例脊膜血管梅毒患者胸腰段MRI示脊髓增粗,髓内异常信号,不均匀强化;6例脑膜血管梅毒患者均为不同程度的血管炎表现,脑叶多发病灶,颞顶叶、额顶叶、顶枕叶、双侧丘脑、中脑等处或基底节及侧脑室旁多个大小不等的异常长T1、长T2信号,其中3例病灶呈不均匀强化,1例伴脑膜强化.结论 神经梅毒在MRI上无特异性表现,但MRI是显示其病变范围、病变性质以及治疗后随访的有效方法.     

神经梅毒26例磁共振成像表现

目的 分析不同临床类型神经梅毒的MRI表现.方法 回顾性研究26例神经梅毒患者的临床及MRI资料,描述各种临床类型神经梅毒的MRI表现.结果 26例神经梅毒患者中,17例MRI有异常表现.其中脑膜血管型梅毒7例,主要表现为脑部多发的缺血灶、梗死灶,少数表现为脑炎样改变;麻痹性痴呆6例,主要表现为额、颞叶萎缩,少数伴有脑缺血灶、颗粒性室管膜炎及海马硬化;脊髓膜血管梅毒3例,主要表现为下颈段至下胸段脊髓轻度肿胀,其内可见多发的缺血灶;脊髓痨1例,其脑部MRI表现为缺血灶.9例患者MRI表现正常,其中脑膜型梅毒4例,脊髓痨5例.结论 不同临床类型神经梅毒的MRI表现具有一定特征,但缺乏特异性,临床上容易误诊.     

神经超声联合神经磁共振成像在周围神经病诊断及治疗中的意义

周围神经病是由不同病因引起周围神经系统结构和功能损害的疾病的总称,可累及感觉、运动及自主神经,致残率高,严重影响患者的生活质量。早期的诊断及治疗对改善其预后具有重要意义。目前周围神经病的诊断主要依据病史、临床体征、实验室检验及肌电图检查等,其中,实验室检验及肌电图检查在周围神经病的诊断中具有重要价值,但由于检查结果常常具有滞后性和易受外界因素干扰而无法协助早期诊断及治疗。随着影像学的发展,神经超声及神经磁共振成像在周围神经病的诊治过程中发挥越来越重要的作用,有可能成为周围神经病的常规临床诊断及评估疗效的一种无创、可重复、直观有效的新方法。[国际神经病学神经外科学杂志,2023,50(4):71-75]     

神经电生理对外伤性臂丛神经损害的诊断

目的探讨神经电生理对外伤性臂丛神经损害的诊断价值。方法对47例有周围神经临床症状的患者行针极肌电图(EMG)、运动神经传导速度(MCV)和感觉神经传导速度(SCV)的检测,并与实验室正常值对比。结果全臂丛神经损害17例,根性损伤12例,上、中干损伤11例,中、下干损伤7例。结论神经电生理是外伤性臂丛神经损害的客观检查方法。     

分娩引起臂丛神经损伤相关因素的分析

新生儿臂丛神经损伤是新生儿产伤中一种常见类型,其大多由于难产处理不当或手术操作不当所致,其发病率为0.50%～0.85%[1].绝大多数臂从神经损伤患儿经保守治疗可恢复,但严重损伤者将遗留不同程度的运动功能障碍,因此预防新生儿臂丛神经损伤十分重要.     

磁共振神经成像在周围神经疾病的临床应用

磁共振成像技术的进展已经使周围神经疾病的诊断从传统的临床和电生理检查向解剖学研究转化。磁共振神经成像能够获取周围神经纵切面和横切面的影像,来直接观察神经内外的病灶。磁共振神经成像作为一种敏感的非侵入性技术,可用于诊断周围神经的神经压迫症、炎症、创伤、康复和系统性神经疾病。这就要求神经科医生与放射科医生一样,也要熟识该领域各种新技术的影像表现。本文将对磁共振神经成像在周围神经疾病的临床应用以及目前存在的问题和磁共振实验研究作一综述,包括相应的技术介绍。     

放射性臂丛神经损伤一例

<正>放射性臂丛神经损伤(RIBRI)是指患者的靶区域在接受常规分割或大分割放射治疗后出现的臂丛神经损伤,常见于乳腺癌、肺尖癌及头颈部恶性肿瘤患者。本病潜伏期为数个月至数年,最长者可达30年,患者就诊时多已为疾病后期,预后不良。1病例报告患者女,68岁,主因"进行性左上肢无力伴肌萎缩2.5年,加重半年"于2015-11-10就诊。患者于30个月前出现左上肢上抬无力,并伴有麻木、疼痛,且进行性     

神经梅毒的临床及磁共振成像特点

目的探讨神经梅毒的临床及磁共振成像特点.方法对本院收治的7例神经梅毒患者的临床资料、实验室检查、磁共振成像结果进行回顾性分析.结果临床常以间质型梅毒,尤其以脑膜血管梅毒常见,临床表现缺乏特异性;血清学检查以梅毒螺旋血凝集试验特异性较高,而脑脊液梅毒诊断实验阳性率低于血清;头部MRI以梅毒树胶肿表现典型.结论神经梅毒早期误诊率高,临床表现多样,应结合实验室及磁共振成像检查综合分析.     

运动疗法治疗臂丛神经损伤的疗效观察

小儿臂丛损伤,常由于产程过长和产伤所致,出现臂丛神经交配的肌肉部分或全部瘫痪[1],如不能有效对患肢进行干预治疗,会导致患肢出现运动感觉等方面的功能性障碍,严重影响患肢正常化的生长发育,直接导致患儿生活自理能力下降.本文对32例臂丛神经损伤患儿进行分组训练治疗及临床观察,现总结如下.     

3T Magnetic Resonance Neurography of Tibial Nerve Pathologies

Diagnosis of tibial neuropathy has been traditionally based on clinical examination and electrodiagnostic studies; however, cross‐sectional imaging modalities have been used to increase the diagnostic accuracy and provide anatomic mapping of the abnormalities. In this context, magnetic resonance neurography (MRN) offers high‐resolution imaging of the tibial nerve (TN), its branches and the adjacent soft tissues, and provides an objective assessment of the neuromuscular anatomy, abnormality, and the surrounding pathology. This review describes the pathologies affecting the TN and illustrates their respective 3 Tesla (T) MRN appearances with relevant case examples.     

Effect of Co-Morbid Conditions on Persistent Neuropathic Pain after Brachial Plexus Injury in Adult Patients

MethodsThe medical records of patients diagnosed with BPI referred to a pain center between 2006 and 2010 were reviewed for 2 years retrospectively. Data regarding patient demographics, injury and surgical profiles, characteristics of NeuP and its severity, and treatment received were compared between patients with and without manifesting co-morbid conditions. The NeuP and pain intensity assessments were based on the DN4 questionnaire and a numerical rating scale, respectively.ResultsOf the 45 patients studied, 24 patients presented with one of the following co-morbid conditions: myofascial pain (21%), psychiatric disorder (17%), phantom limb pain (4%), complex regional pain syndrome (21%), and insomnia (37%). Tramadol was required by 20 patients with co-morbidity and, 9 patients without co-morbidity (p<0.001). The mean pain score after 2 years was higher in patients with co-morbidity than in those without co-morbidity (p<0.05).ConclusionsPersistent pain following BPI was more common in patients manifesting other painful conditions or psychiatric co-morbidity. A higher proportion of the patients in the co-morbid group required tramadol as a second-line of agent for pain relief.     

Magnetic Resonance Neurography: Improved Diagnosis of Peripheral Neuropathies

Peripheral neuropathies account for the most frequent disorders seen by neurologists, and causes are manifold. The traditional diagnostic gold-standard consists of clinical neurologic examinations supplemented by nerve conduction studies. Due to well-known limitations of standard diagnostics and atypical clinical presentations, establishing the correct diagnosis can be challenging but is critical for appropriate therapies. Magnetic resonance neurography (MRN) is a relatively novel technique that was developed for the high-resolution imaging of the peripheral nervous system. In focal neuropathies, whether traumatic or due to nerve entrapment, MRN has improved the diagnostic accuracy by directly visualizing underlying nerve lesions and providing information on the exact lesion localization, extension, and spatial distribution, thereby assisting surgical planning. Notably, the differentiation between distally located, complete cross-sectional nerve lesions, and more proximally located lesions involving only certain fascicles within a nerve can hold difficulties that MRN can overcome, when basic technical requirements to achieve sufficient spatial resolution are implemented. Typical MRN-specific pitfalls are essential to understand in order to prevent overdiagnosing neuropathies. Heavily T2-weighted sequences with fat saturation are the most established sequences for MRN. Newer techniques, such as T2-relaxometry, magnetization transfer contrast imaging, and diffusion tensor imaging, allow the quantification of nerve lesions and have become increasingly important, especially when evaluating diffuse, non-focal neuropathies. Innovative studies in hereditary, metabolic or inflammatory polyneuropathies, and motor neuron diseases have contributed to a better understanding of the underlying pathomechanism. New imaging biomarkers might be used for an earlier diagnosis and monitoring of structural nerve injury under causative treatments in the future.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13311-021-01166-8.     

Spinal Cord Stimulation in the Management of Pain from Brachial Plexus Avulsion

This is a retrospective study of four patients suffering from brachial plexus root avulsion of traumatic origin. Spinal cord stimulation was used to treat pain in all patients. A seven‐contact electrode was percutaneously introduced in the epidural cervical space and under fluoroscopic control, advanced to the level were stimulation provoked a tingling sensation in the painful region. A stimulation trial was performed for 2 weeks and during this period the patients showed significant pain relief, so the system was permanently implanted. A significant difference of more than three points in the pain between the first and the last follow‐up (0–9 months) on the Visual Analog Scale was obtained with a steady and progressive decrease of the pain scores.     

Magnetic Resonance Imaging of Multiple Sclerosis

Although conventional magnetic resonance imaging (cMRI) is widely used for diagnosing multiple sclerosis (MS) and monitoring disease activity and evolution, the correlation between cMRI and clinical findings is far from strict. Among the reasons for this "clinical-MRI paradox," a major role has been attributed to the limited specificity of cMRI to the heterogeneous pathological substrates of MS and to its inability to quantify the extent of damage in the normal-appearing tissue. Modern quantitative MRI techniques have the potential to overcome some of the limitations of cMRI. Metrics derived from magnetization transfer and diffusion-weighted MRI enable one to quantify the extent of structural changes occurring within and outside macroscopic MS lesions with increased pathological specificity over cMRI. Magnetic resonance spectroscopy can add information on the biochemical nature of such changes, with the potential to improve significantly our ability to monitor inflammatory demyelination and axonal injury. Finally, functional MRI might provide new insights into the role of cortical adaptive changes in limiting the clinical consequences of white-matter structural damage. This review outlines the major contributions given by MRI-based techniques to the diagnostic work-up of MS patients, to the understanding of the pathobiology of the disease, and to the assessment of the effects of new experimental treatments.     

磁共振管壁成像在颅内动脉夹层中的应用价值

颅内动脉夹层即颅内血管壁内血肿,是导致中青年缺血性或出血性卒中的重要病因,因血 管管径细小,走行迂曲,颅内动脉夹层诊断较困难。磁共振管壁成像作为一种无创性、无放射性检 查手段,可直接观察到动脉夹层所致的特征性壁内血肿信号,因而对颅内动脉夹层的诊断、鉴别诊断 及随访具有重要作用。本文将对磁共振管壁成像在颅内动脉夹层中的应用价值做一简要综述。     

Diffusion Tensor and Functional Magnetic Resonance Imaging of Diffuse Axonal Injury and Resulting Language Impairment

Diffuse axonal injury (DAI) is a common aftermath of brain trauma. The diagnosis of DAI is often difficult using conventional magnetic resonance imaging (MRI). We report a diffusion tensor imaging (DTI) study of a patient who sustained DAI presenting with language impairment. Fractional anisotropy (FA) and DTI tractography revealed a reduction of white matter integrity in the left frontal and medial temporal areas. White matter damage identified by DTI was correlated with the patient's language impairment as assessed by functional MRI (fMRI) and a neuropsychological exam. The findings demonstrate the utility of DTI for identifying white matter changes secondary to traumatic brain injury (TBI).