scholarly journals Focal neuropathy

2020 ◽  
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Author(s):  
Michael Donaghy

Some causes of focal peripheral nerve damage are self-evident, such as involvement at sites of trauma, tissue necrosis, infiltration by tumour, or damage by radiotherapy. Focal compressive and entrapment neuropathies are particularly valuable to identify in civilian practice, since recovery may follow relief of the compression. Leprosy is a common global cause of focal neuropathy, which involves prominent loss of pain sensation with secondary acromutilation, and requires early antibiotic treatment. Mononeuritis multiplex due to vasculitis requires prompt diagnosis and immunosuppressive treatment to limit the severity and extent of peripheral nerve damage. Various other medical conditions, both inherited and acquired, can present with focal neuropathy rather than polyneuropathy, the most common of which are diabetes mellitus and hereditary liability to pressure palsies. A purely motor focal presentation should raise the question of multifocal motor neuropathy with conduction block, which usually responds well to high-dose intravenous immunoglobulin infusions.


2000 ◽  
Vol 5 (3) ◽  
pp. 5-6
Author(s):  
Charles N. Brooks

Abstract Previous issues of The Guides Newsletter have presented overviews of electrodiagnostic evaluation, including electromyography, nerve conduction studies, and somatosensory-evoked responses. This article contains suggestions for nonelectromyographers who read reports and identify questionable uses of electrodiagnosis, specifically for the evaluation of radiculopathy and focal neuropathy (eg, nerve entrapments), the two most common presentations. Some subtle abnormalities (eg, changes in motor unit recruitment pattern, changes in firing rate, or reduction in motor units recruited) often are overinterpreted by poorly trained or inexperienced electromyographers. Nerve conduction studies often are overused and may accompany the electromyogram without apparent indication, but they are nearly useless in diagnosing radiculopathy and should be included only for nerve entrapment or differential diagnosis of plexus injury. Nerve conduction studies often are accompanied by F waves and H reflexes. The F wave helps assess proximal portions of nerves and is used primarily in the diagnosis of Landry-Guillain-Barré syndrome but has poor sensitivity and specificity in evaluation of radiculopathy or entrapment neuropathy. The H reflex is used primarily in S1 radiculopathy evaluation. The article includes six questions a clinician should bear in mind while interpreting the electrodiagnostic report. Improperly trained physicians may report false positive or negative results, so examiners should be aware of the qualifications of physicians to whom they refer their patients.


Author(s):  
Sang Ho Oh ◽  
Su Hyun Choi ◽  
Young Woo Kim

An epidermoid cyst is a slow-growing benign neoplasm that commonly occurs in the hand. Herein, we report a rare case of an epidermoid cyst with focal neuropathy in the left ring finger of a 38-year-old woman. Preoperatively, the patient complained of erythema, swelling, and paresthesia on her fingertips. On ultrasonography and magnetic resonance imaging, ulnar digital nerve thickening and inflammation around the nerve were observed, and a neurogenic tumor-like schwannoma was expected. An excisional biopsy with neurectomy of the involved sensory branch of the ulnar digital nerve was performed under brachial plexus block. During the operation, there is such an uncommon morphology, yellowish debris under the epineurium of the ulnar digital nerve sensory branch was involved with the epidermoid cyst and seemed to be propagating along the sensory branch from the skin surface. After the operation, the paresthesia and swelling resolved. Over the 6-month follow-up in the outpatient clinic, no complications and recurrences occurred. Thus, we reported a rare intraneural epidermoid cyst (occurred along the digital nerve) in the finger, and we believe that considering the anatomical characteristics and the surrounding structures is important during mass excision.


2017 ◽  
Vol 23 (1) ◽  
Author(s):  
Ayşen Süzen Ekinci ◽  
Şeyma Çiftçi ◽  
İbrahim Aydoğdu
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2010 ◽  
Vol 1 (1) ◽  
Author(s):  
Denis Čerimagić ◽  
Ervina Bilić

AbstractCarpal tunnel syndrome (CTS) is a compressive focal neuropathy of the median nerve (NM) at the wrist. We hypothesize that reverse Phalen’s test rather than the previously commonly proposed classic Phalen’s maneuver was a logical maneuver in the diagnosis of CTS from the anatomic, pathophysiological and electrophysiological viewpoint. Dorsal flexion of the hand results in an increase in the flexor retinaculum tension (RFT), extension of the finger long flexor muscle tendons and consequential NM entrapment between the tendons and flexor retinaculum (RF). Thus, the carpal tunnel (CT) volume is reduced, the intra-tunnel pressure is increased, while the RF to NM distance is decreased. On Phalen’s maneuver, the forced palmar hand flexion entails opposite consequences i.e. reduced RFT, relaxation of the finger long flexor muscle tendons, decreased pressure upon NM, slight increase in the CT volume, decreased intra-tunnel pressure and increased RF to NM distance. The hypothesis can be tested by a conductive NM study, preferably at three positions: mid-position (palmar/volar angle 180 degrees); forced dorsal flexion (palmar/volar angle about 270 degrees); and forced palmar (volar) flexion (palmar/volar angle about 90 degrees). Relative to mid-position, “deterioration” of electroneurography (ENG) finding is observed in dorsal flexion, whereas “improvement” of ENG finding is recorded in palmar flexion.


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