Peripheral Neuropathy：周围神经病变.pptVIP

Peripheral Neuropathy Neurology Rotation Lecture Series Last Updated by Lindsay Pagano Summer 2013 Case Presentation You are consulted by the NICU to see a 3500 g newborn male with decreased movement of his right upper extremity. born at 39 weeks via SVD, vacuum assist Pregnancy complicated by LGA, mom with IDDM Complicated by nuchal cord x1, shoulder dystocia with left humeral fracture Apgars 0, 2, 6 at 1, 5, 10 minutes of life, respectively Resuscitated, intubated, and brought to the NICU PE: normal except for S Neuro: normal except for MS: mildly sedated Motor: RUE with hypotonia, internally rotated, with elbow extension and forearm pronation; no spontaneous motion of RUE Sensory: no movement of RUE to pain Reflexes: trace-absent in RUE Differential? Brachial Plexus Injuries Injuries to nerve roots arising from C5-T1 from traction, compression, tear or avulsion 0.5-2 per 100 live births More common in term infants More common in RUE Associated with LGA, GDM, AMA, shoulder dystocia, clavicular fractures Also seen in nontraumatic births, and in utero Erb’s Palsy Injury to superior trunk, C5-6 “waiter’s tip”: internal rotation and adduction of the shoulder, elbow extension, forearm pronation, finger flexion Klumpke’s Palsy Injury to inferior trunk, C8-T1 Elbow flexion, forearm supination, wrist extension, claw deformity of the hand +/- Horner Syndrome due to sympathetic fiber involvement Prognosis Recovery over 3-6 months is predictive of overall recovery; PT/OT important May require surgery to reanneal or graft the injured nerves (earlier [by 6 months] is better) Bell’s Palsy Acute facial nerve palsy of unknown etiology; may be congenital 2/10,000 per year Onset over hours of unilateral facial palsy Includes the ENTIRE face (LMN) May also include hyperacusis, decreased tearing, loss of taste May be associated with OM Lyme Mob?us syndrome (with ocular abduction palsy) Viral infections: varicella, zoster, coxsackie Diagnosis: clinical Treatment: No clear eviden