多發(fā)性單神經(jīng)病

1、multiple mononeuropathy1. Neurol Neuroimmunol Neuroinflamm. 2015 Nov 12;3(1):e180. doi:10.1212/NXI.0000000000000180. eCollection 2016.Vasculitic neuropathy following exposure to minocycline.Baratta JM(1), Dyck PJ(1), Brand P(1), Thaisetthawatkul P(1), Dyck PJ(1),Engelstad JK(1), Goodman B(1), Karam

2、C(1).Author information: (1)Departments of Physical Medicine & Rehabilitation (J.M.B.) and Neurology(C.K.), The University of North Carolina, Chapel Hill; the Department ofNeurology (P.J.B.D., P.B., P.J.D., J.K.E.), Mayo Clinic, Rochester, Department of Neurological Sciences (P.T.), University of Ce

3、nter, Omaha; and the Department of Neurology (B.G.), Mayo Clinic, Scottsdale,AZ.OBJECTIVE: To report 3 patients with minocycline-induced autoimmunity resultingin peripheral nerve vasculitis.METHODS: We report 3 patients who, during minocycline treatment for acnevulgaris, developed subacute onset of

4、pain and weakness caused by vasculitis insingle and multiple mononeuropathy patterns.RESULTS: Each patient underwent either a nerve or muscle biopsy that confirmedvasculitis. One patient additionally developed systemic symptoms (includingfever, fatigue, and night sweats) and another had a posterior

5、circulation stroke.Symptoms developed with either early or prolonged use of minocycline. Despitewithdrawal of minocycline, patients needed long-term immunotherapy to gainneurologic improvement.CONCLUSIONS: Our findings suggest that the typical neuropathy associated withminocycline use is painful sin

6、gle or multiple mononeuropathy due to peripheralnerve vasculitis, which may also be accompanied by presumed CNS vasculitis(presenting as stroke).PMCID: PMC4645168PMID: 26601119 PubMed2. JAMA Neurol. 2015 Dec 1;72(12):1510-8. doi: 10.1001/jamaneurol.2015.2347.The Importance of Rare Subtypes in Diagno

7、sis and Treatment of PeripheralNeuropathy: A Review.Callaghan BC(1), Price RS(2), Chen Author information: (1)Department of Neurology, University of Michigan, Ann Arbor. (2)Department ofNeurology, University of Pennsylvania, Philadelphia. (3)Department ofNeurosurgery, University of Michigan, Ann Arb

8、or.IMPORTANCE: Peripheral neuropathy is a prevalent condition that usually warrants a thorough history and examination but has limited diagnostic evaluation.However, rare localizations of peripheral neuropathy often require more extensivediagnostic testing and different treatments.OBJECTIVE: To desc

9、ribe rare localizations of peripheral neuropathy, including theappropriate diagnostic evaluation and available treatments.EVIDENCE REVIEW: References were identified from PubMed searches conducted on May29, 2015, with an emphasis on systematic reviews and randomized clinical trials. Articles were al

10、so identified through the use of the authors own files. Searchterms included common rare neuropathy localizations and their causes, as well as epidemiology, pathophysiology, diagnosis, and treatment.FINDINGS: Diffuse, nonlength-dependent neuropathies, multiple mononeuropathies,polyradiculopathies, p

11、lexopathies, and radiculoplexus neuropathies are rareperipheral neuropathy localizations that often require extensive diagnostictesting. Atypical neuropathy features, such as acute/subacute onset, asymmetry,and/or motor predominant signs, are frequently present. The most common diffuse, nonlength-de

12、pendent neuropathies are Guillain-Barr syndrome, chronicinflammatory demyelinating polyneuropathy, multifocal motor neuropathy, andamyotrophic lateral sclerosis. Effective disease-modifying therapies exist formany diffuse, nonlength-dependent neuropathies including Guillain-Barr syndrome,chronic inf

13、lammatory demyelinating polyneuropathy, multifocal motor neuropathy,and some paraprotein-associated demyelinating neuropathies. Vasculitic neuropathy(multiple mononeuropathy) also has efficacious treatment options, but definitive evidence of a treatment effect for IgM anti-MAG neuropathy and diabeti

14、camyotrophy (radiculoplexus neuropathy) is lacking.CONCLUSIONS AND RELEVANCE: Recognition of rare localizations of peripheralneuropathy is essential given the implications for diagnostic testing andtreatment. Electrodiagnostic studies are an important early step in thediagnostic evaluation and provi

15、de information on the localization andpathophysiology of nerve injury.PMID: 26437251 PubMed - in process3. Ann Rehabil Med. 2015 Oct;39(5):833-7. doi: 10.5535/arm.2033. Epub 2015 Oct 26.Multiple Lower Extremity Mononeuropathies by Segmental Schwannomatosis: A CaseReport.Kwon Author information: (1)D

16、epartment of Rehabilitation Medicine, College of University of Korea, Seoul, Schwannoma is an encapsulated nerve sheath tumor that is distinct fromneurofibromatosis. It is defined as the occurrence of multiple schwannomaswithout any bilateral vestibular schwannomas. A 46-year-old man with multiplesc

17、hwannomas involving peripheral nerves of the ipsilateral lower extremitypresented with neurologic symptoms. Electrodiagnostic studies revealed multiplemononeuropathies involving the left sciatic, common peroneal, tibial, femoral andsuperior gluteal nerves. Histologic findings confirmed the diagnosis

18、 ofschwannoma. We reported this rare case of segmental schwannomatosis thatpresented with neurologic symptoms including motor weakness, which was confirmed as multiple mononeuropathies by electrodiagnostic studies.PMCID: PMC4654091PMID: 26605183 PubMed4. Muscle Nerve. 2015 Jul;52(1):151-2. doi: 10.1

19、002/mus.24617.Brachioplasty-associated multiple mononeuropathies.Thawani SP(1), Bieri P(2), Herskovitz S(2).Author information: (1)Peripheral Neuropathy Center, The Neurological Institute of New York, ColumbiaUniversity Medical Center, New York, New York, USA. (2)Albert Medicine, Montefiore Medical

20、Center, Bronx, New York, PMID: 25703458 PubMed - indexed for MEDLINE5. Neuron. 2015 Jun 3;86(5):1215-27. doi: 10.1016/j.neuron.2015.05.005. Epub 2015May 21.Robust Axonal Regeneration Occurs in the Injured CAST/Ei Mouse CNS.Omura T(1), Omura K(1), Tedeschi A(1), Riva P(1), Painter MW(1), Rojas L(1),M

21、artin J(1), Lisi V(2), Huebner EA(1), Latremoliere A(1), Yin Y(1), BarrettLB(1), Singh B(1), Lee S(1), Crisman T(3), Gao F(3), Li S(4), Kapur K(1),Geschwind DH(3), Kosik KS(2), Coppola G(3), He Z(1), LI(1), Costigan M(5), Woolf CJ(6).Author information: (1)F.M. Kirby Neurobiology Center, Boston Chil

22、drens Hospital and Harvard MedicalSchool, Boston, Molecular, Cellular, and Developmental Biology, University of Barbara, Santa Barbara, Neurology, Semel Institute for Neuroscience and Human Behavior, David GeffenSchool of Medicine, University of California, Los Angeles, Los Angeles, USA. (4)Departme

23、nt of Neurology, David Myeloma Research Consortium, Semel Institute for Neuroscience and Human Behavior,University of California, Los Angeles, Los Angeles, Neurobiology Center, Boston Childrens Hospital and Harvard Boston, MA 02115, USA; Anaesthesia Department, Boston Childrens Hospital andHarvard M

24、edical School, Boston, michael.costigan. (6)F.M. Kirby Neurobiology Center, BostonChildrens Hospital and Harvard Medical School, Boston, address: clifford.woolf.Axon regeneration in the CNS requires reactivating injured neurons intrinsicgrowth state and enabling growth in an inhibitory environment.

25、Using an inbredmouse neuronal phenotypic screen, we find that CAST/Ei mouse adult dorsal rootganglion neurons extend axons more on CNS myelin than the other eight strainstested, especially when pre-injured. Injury-primed CAST/Ei neurons alsoregenerate markedly in the spinal cord and optic nerve more

26、 than those fromC57BL/6 mice and show greater sprouting following ischemic stroke. Heritabilityestimates indicate that extended growth in CAST/Ei neurons on myelin isgenetically determined, and two whole-genome expression screens yield the Activintranscript Inhba as most correlated with this ability

27、. Inhibition of Activinsignaling in CAST/Ei mice diminishes their CNS regenerative capacity, whereas itsactivation in C57BL/6 animals boosts regeneration. This screen demonstrates that mammalian CNS regeneration can occur and reveals a molecular pathway thatcontributes to this ability.Copyright 2015

28、 Elsevier Inc. All rights reserved.PMCID: PMC4458182 Available on 2016-06-03PMID: 26004914 PubMed - indexed for MEDLINE6. Neurosci Lett. 2015 Jun 2;596:3-13. doi: 10.1016/j.neulet.2015.02.038. Epub 2015 Feb 19.Advances in diagnostics and outcome measures in peripheral neuropathies.Merkies IS(1), Fab

29、er CG(2), Lauria G(3).Author information: (1)Department of Neurology, Spaarne Hospital, Hoofddorp, The Netherlands;Department of Neurology, Maastricht University Medical Center, Maastricht, TheNetherlands. (2)Department of Neurology, Maastricht Maastricht, The Netherlands. (3)3rd Neurology Unit, IRC

30、CS Foundation CarloBesta Neurological Institute, Milan, glauriaistituto-besta.it.Peripheral neuropathies are a group of acquired and hereditary disorderspresenting with different distribution and nerve fiber class involvement. Theoverall prevalence is 2.4%, increasing to 8% in the elderly population

31、. However, the frequency may vary depending on the underlying pathogenesis and associationwith systemic diseases. Distal symmetric polyneuropathy is the most common form, though multiple mononeuropathies, non-length dependent neuropathy and small fiberneuropathy can occur and may require specific di

32、agnostic tools. The use ofuniform outcome measures in peripheral neuropathies is important to improve thequality of randomized controlled trials, enabling comparison between studies.Recent developments in defining the optimal set of outcome measures ininflammatory neuropathies may serve as an exampl

33、e for other conditions.Diagnostic and outcome measure advances in peripheral neuropathies will bediscussed.Copyright 2015 Elsevier Ireland Ltd. All rights reserved.PMID: 25703220 PubMed - indexed for MEDLINE7. Muscle Nerve. 2015 Jun;51(6):838-45. doi: 10.1002/mus.24478. Epub 2015 Apr 24.Carpal tunne

34、l syndrome severity staging using sonographic and clinical measures.Roll Author information: (1)Division of Occupational Science and Occupational Therapy, University ofSouthern California, Los Angeles, California, Rehabilitation Sciences, The Ohio State University, Columbus, INTRODUCTION: Ultrasonog

35、raphy may be valuable in staging carpal tunnel syndromeseverity, especially by combining multiple measures. This study aimed to develop a preliminary severity staging model using multiple sonographic and clinicalmeasures.METHODS: Measures were obtained in 104 participants. Multiple categorizationstr

36、uctures for each variable were correlated to diagnostic severity based onnerve conduction. Goodness-of-fit was evaluated for models using iterativecombinations of highly correlated variables. Using the best-fit model, apreliminary scoring system was developed, and frequency of misclassification was

37、calculated.RESULTS: The severity staging model with best fit (rho 0.90) includedpatient-reported symptoms, functional deficits, provocative testing, nervecross-sectional area, and nerve longitudinal appearance. An 8-point scoring scaleclassified severity accurately for 79.8% of participants.CONCLUSI

38、ONS: This severity staging model is a novel approach to carpal tunnelsyndrome evaluation. Including more sensitive measures of nerve vascularity,nerve excursion, or other emerging techniques may refine this preliminary model. 2014 Wiley Periodicals, Inc.PMCID: PMC4388767 Available on 2016-06-01PMID:

39、 25287477 PubMed - indexed for MEDLINE8. Pharm Biol. 2015 Jun;53(6):838-48. doi: 10.3109/13880209.2014.943247. Epub 2014Nov 28.Effect of curcumin in mice model of vincristine-induced neuropathy.Babu A(1), Prasanth KG, Balaji B.Author information: (1)Department of Pharmacology, PSG College of Pharmac

40、y , Coimbatore, Tamil Nadu ,India.CONTEXT: Curcumin exhibits a wide spectrum of biological activities which includeneuroprotective, antinociceptive, anti-inflammatory, and antioxidant activity.OBJECTIVE: The present study evaluates the effect of curcumin invincristine-induced neuropathy in a mice mo

41、del.MATERIALS AND METHODS: Vincristine sulfate (0.1 mg/kg, i.p. for 10 consecutivedays) was administered to mice to induce neuropathy. Pain behavior was assessedat different days, i.e., 0, 7, 10, and 14 d. Sciatic nerve total calcium,superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase

42、 (GPx), reducedglutathione (GSH), nitric oxide (NO), and lipid peroxidation (LPO) were alsoestimated after the 14th day of study. Pregabalin (10 mg/kg, p.o.) and curcumin(15, 30, and 60 mg/kg, p.o.) were administered for 14 consecutive days.RESULTS: Curcumin at 60 mg/kg significantly attenuated the

43、vincristine-inducedneuropathic pain manifestations in terms of thermal hyperalgesia (p 0.001) and allodynia (p 0.001); mechanical hyperalgesia (p 0.001); functional loss (p 0.001); and in the delayed phase of formalin test (p 0.001). Curcumin at 30 and60 mg/kg exhibited significant changes (p 2 poun

44、ds. Multiple logistic regression models examined relationshipsbetween peak, most recent, and time-weighted average exposures and incident CTS, adjusting for age, gender, and body mass index.RESULTS: 710 subjects (64.1%) completed follow-up NCS; 31 incident cases of CTSoccurred over 3-year follow-up.

45、 All models describing lifting or forcefulgripping exposures predicted future CTS. Vibrating tool use was predictive insome models.CONCLUSIONS: Self-reported exposures showed consistent risks across differentexposure models in this prospective study. Workers self-reported job demands canprovide usef

46、ul information for targeting work interventions. 2014 Wiley Periodicals, Inc.PMCID: PMC4501479PMID: 25223617 PubMed - indexed for MEDLINE22. J Foot Ankle Surg. 2014 Nov-Dec;53(6):763-7. doi: 10.1053/j.jfas.2014.06.013.Epub 2014 Aug 14.Multiple locations of nerve compression: an unusual cause of pers

47、istent lowerlimb paresthesia.Ang CL(1), Foo LS(2).Author information: (1)Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.Electronic address: med80199. (2)Department of Orthopaedic Surgery,Singapore General Hospital, Singapore.A paucity of appreciation exists that the double

48、crush phenomenon can accountfor persistent leg symptoms even after spinal neural decompression surgery. Wepresent an unusual case of multiple locations of nerve compression causingpersistent lower limb paresthesia in a 40-year old male patient. The patientslower limb paresthesia was persistent after

49、 an initial spinal surgery to treatspinal lateral recess stenosis thought to be responsible for the symptoms. It waslater discovered that he had peroneal muscle herniations that had causedsuperficial peroneal nerve entrapments at 2 separate locations. The patientobtained much symptomatic relief afte

50、r decompression of the peripheral nerve. Thedouble crush phenomenon and multiple levels of nerve compression should beconsidered when evaluating lower limb neurogenic symptoms, especially afterspinal nerve root surgery.Copyright 2014 American College of Foot and Ankle Surgeons. Published byElsevier

51、Inc. All rights reserved.PMID: 25128915 PubMed - indexed for MEDLINE23. J Hand Surg Am. 2014 Nov;39(11):2181-87.e4. doi: 10.1016/j.jhsa.2014.07.019. Epub2014 Sep 13.Carpal tunnel syndrome diagnosis and treatment: a survey of members of theAmerican Society For Surgery of the Hand.Lane LB(1), Starecki

52、 M(2), Olson A(2), Kohn N(2).Author information: (1)Departments of Orthopaedic Surgery, North Shore University Hospital,Manhasset, NY; Long Island Jewish Medical Center, New Hyde Park, NY;Biostatistics Unit, Feinstein Institute for Medical Research, North Shore-LIJHealth System, Manhasset, NY. Elect

53、ronic address: handnwrist.(2)Departments of Orthopaedic Surgery, North Shore University Hospital,Manhasset, NY; Long Island Jewish Medical Center, New Hyde Park, NY;Biostatistics Unit, Feinstein Institute for Medical Research, North Shore-LIJHealth System, Manhasset, NY.PURPOSE: In 2007 and 2009, th

54、e American Academy of Orthopaedic Surgeons released Clinical Practice Guidelines (CPG) for diagnosis and treatment of carpal tunnelsyndrome (CTS) based upon review of the literature. The lack of consistentlyhigh-level evidence resulted in several recommendations, some strongly supported,some weakly

55、supported, and others controversial. We postulated that a survey ofAmerican Society for Surgery of the Hand (ASSH) members would provide insightinto practice patterns among hand surgeons treating CTS and demonstrate theextent to which the CPG influenced practice behavior.METHODS: A multiple-choice q

56、uestionnaire including detailed commonly observedclinical scenarios was developed, pre-tested, and approved by our institutionalreview board and the ASSH Web site committee chair. An anonymous electronicsurvey was emailed to ASSH members.RESULTS: Surveys were sent to 2,650 eligible ASSH members, and

57、 27% responded.Seventy-two percent would advise a patient to have carpal tunnel release (CTR) ifthe patient had both classic history/examination of CTS and complete relieffollowing cortisone injection. Forty-seven percent responded that in thisscenario electrodiagnostic testing (EDX) is rarely or ne

58、ver necessary torecommend CTR. Seventy-nine percent of respondents were at least slightly morelikely to order EDX based on CPG recommendations. Of these respondents, 57%replied that this was because of potential medicolegal ramifications.CONCLUSIONS: Although the CPG recommended EDX before surgery,

59、and although mostresponding ASSH members use EDX to advise CTR, a majority answered that asupporting history and physical examination alone can be sufficient to recommend surgery, that a positive response to a cortisone injection can be sufficientindication for CTR, that EDX is not necessary in all

60、cases of CTS, and that they would perform CTR in face of normal EDX if cortisone temporarily resolvedsymptoms. Among respondents more likely to order EDX based on the CPG, 57%answered that it was in some circumstances due to potential medicolegalramifications.TYPE OF STUDY/LEVEL OF EVIDENCE: Economi