1
|
Kamel I, Zhao H, Koch SA, Brister N, Barnette RE. The Use of Somatosensory Evoked Potentials to Determine the Relationship Between Intraoperative Arterial Blood Pressure and Intraoperative Upper Extremity Position–Related Neurapraxia in the Prone Surrender Position During Spine Surgery. Anesth Analg 2016; 122:1423-33. [DOI: 10.1213/ane.0000000000001121] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
2
|
Loffredo MA, Yan JG, Kao D, Zhang LL, Matloub HS, Riley DA. Persistent reduction of conduction velocity and myelinated axon damage in vibrated rat tail nerves. Muscle Nerve 2009; 39:770-5. [DOI: 10.1002/mus.21235] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
3
|
Notturno F, Caporale CM, Di Muzio A, Uncini A. Persistent multifocal conduction block in vasculitic neuropathy with IgM anti-gangliosides. Muscle Nerve 2007; 36:547-52. [PMID: 17405140 DOI: 10.1002/mus.20778] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A 30-year-old man with essential cryoglobulinemia presented with an axonal neuropathy and was found to have vasculitis at nerve biopsy. After 44 months, in accord with clinical deterioration, motor conduction studies showed excessive temporal dispersion multifocally, with partial conduction block persisting for 3 years. Antibody testing showed the presence of IgM anti-GM1, anti-GD1a, and anti-GM2 antibodies. Transitory conduction block has been reported occasionally in patients with vasculitis. The persistent multifocal conduction abnormalities found in this patient were more likely due to a superimposed immunomediated demyelination rather than to chronic nerve ischemia secondary to vasculitis.
Collapse
Affiliation(s)
- Francesca Notturno
- Department of Human Motor Sciences, University G d'Annunzio and Neuromuscular Diseases Unit, Institute of Aging, Foundation University G d'Annunzio, Via dei Vestini, I-66013, Chieti-Pescara, Italy
| | | | | | | |
Collapse
|
4
|
Baba M, Nukada H, McMorran D, Takahashi K, Wada R, Yagihashi S. Prolonged ischemic conduction failure after reperfusion in diabetic nerve. Muscle Nerve 2006; 33:350-5. [PMID: 16320311 DOI: 10.1002/mus.20474] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Diabetic nerve exhibits morphological vulnerability to ischemia and reperfusion, in contrast to its physiological resistance to ischemic conduction failure (RICF). To examine the sequence of ischemic conduction failure after reperfusion in diabetic nerve, we measured sciatic-tibial nerve conduction before and during 30-180 min of ischemia and after reperfusion for up to 1 week in streptozocin (STZ)-induced diabetic rats. RICF in diabetic rats was confirmed during ischemia. After reperfusion, control nerves showed an immediate recovery in amplitude of compound muscle action potential (CMAP) following ischemia for 120 min or less, and delayed recovery after 150 min of ischemia. In contrast, recovery in diabetic nerves was delayed even after 1 h of ischemia. Ischemia for 75 min in diabetic nerve resulted in either delayed or no recovery of the CMAP upon reperfusion. Following ischemia for 90 or 120 min, axonal degeneration was observed in diabetic nerve. Thus, severe ischemia for 60 or 75 min causes prolonged ischemic conduction failure in diabetic nerve, compared with 150 min in control nerve. In conclusion, diabetic nerve shows delayed recovery of ischemic conduction failure after brief ischemia, compared to controls, suggesting that patients with diabetic neuropathy have a worse prognosis when faced with nerve ischemia.
Collapse
Affiliation(s)
- Masayuki Baba
- Department of Neurology, Hirosaki University School of Medicine, 5 Zaifu-cho, Hirosaki 036-8562, Japan.
| | | | | | | | | | | |
Collapse
|
5
|
Levin KH. Neuropathy of ischemia. Muscle Nerve 2002; 26:435-7. [PMID: 12362408 DOI: 10.1002/mus.10248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
6
|
Abstract
Although the neuropathology of ischaemic fibre degeneration is relatively well known, its pathogenesis is poorly understood. One of the presumed mechanisms is oxidative stress, causing the breakdown of the blood-nerve barrier (BNB) and ending in lipid peroxidation. We evaluated the effect of ischaemia and reperfusion on the sciatic-tibial nerve of the rat and investigated the biochemical, pathological, and functional evidence of BNB disruption and lipid peroxidation. The distal portion and trifurcation of the sciatic nerve were rendered ischaemic by clamping the femoral vessels for 3 h and followed by varying durations of reperfusion. Reperfusion resulted in an increase in lipid peroxidation beginning from the first hour and increasing until the seventh day, followed by a gradual decline over the following weeks. Nerve oedema and ischaemic fibre degeneration (IFD) consistently became more severe and prominent with reperfusion, indicating that oxidative stress damages the BNB and causes IFD. Results of functional testing by the sciatic function index correlated with other parameters as walking track analysis results got worse as reperfusion periods increased. Impairment of walking patterns was more striking after the first day and continued up to the third week. These data indicate that severe ischaemia of the peripheral nerve results in reperfusion injury, functional impairment, and disruption of the BNB. Microvascular events, which may occur during reperfusion, may be important in amplifying the nerve fibre degeneration that initiated during ischaemia.
Collapse
Affiliation(s)
- A Saray
- Department of Plastic Surgery, Mersin University, Mersin, Turkey.
| | | | | | | |
Collapse
|
7
|
Abstract
The diagnosis of neurogenic claudication (NC) remains uncertain when no definite signs of radicular lesions are found in electrophysiological testing. However, the functional deficit could be demonstrated during the brief time in which the patients complain of pain and weakness in the muscles of the lower limbs after walking. We have used electrophysiological testing of the H reflex and the F wave to document the transient functional derangement expected to occur at the radicular level in patients with NC after walking. We examined the recruitment curve of the soleus H reflex, and the chronodispersion of the posterior tibial nerve F wave, at rest and after a walking exercise that triggered their symptoms in 10 patients with NC, with no positive electrophysiological findings of radicular lesion. The same studies were performed in 5 age-matched healthy volunteers, used as control subjects, who were asked to walk for 30 min. At rest before walking, no abnormalities were found in any of the patients. After walking, the H wave showed a transient increase in its threshold with respect to that of the M wave in 7 patients (70%). Such abnormality lasted for a mean period of 7 min. In 2 of these patients there was also an increase in the F-wave chronodispersion. Our data suggest that nerve conduction is transiently blocked in large myelinated fibers at a radicular level in patients with NC after walking. Partial interruption of the H-reflex circuit could be one of the pathophysiological mechanisms underlying NC.
Collapse
Affiliation(s)
- P Pastor
- Departament de Medicina, Hospital Clinic, Universitat de Barcelona, Spain
| | | |
Collapse
|
8
|
Nagamatsu M, Schmelzer JD, Zollman PJ, Smithson IL, Nickander KK, Low PA. Ischemic reperfusion causes lipid peroxidation and fiber degeneration. Muscle Nerve 1996; 19:37-47. [PMID: 8538668 DOI: 10.1002/mus.880190103] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Although the neuropathology of ischemic fiber degeneration (IFD) is relatively well known, its pathogenesis is poorly understood. One putative mechanism of IFD is oxidative stress, causing a breakdown of the blood-nerve barrier (BNB) and lipid peroxidation. We evaluated the effect of ischemic reperfusion of rat sciatic-tibial nerve seeking biochemical and pathologic evidence of BNB disruption and lipid peroxidation. Ischemia, caused by the ligation of the supplying arteries to sciatic-tibial nerve, was maintained for 3 h, followed by reperfusion. Reperfusion resulted in an increase in nerve lipid hydroperoxides, greatest at 3 h, followed by a gradual decline over the next month. Nerve edema and IFD consistently became more severe with reperfusion, indicating that oxidative stress impairs the BNB (edema) and causes IFD. Reduced reperfusion was greatest over distal sciatic nerve and midtibial nerve at day 7. The most ischemic segment (midtibial), of nonreperfused ischemic nerves (duration 3 h), underwent both edema and IFD that was as pronounced as those of other segments after reperfusion, and underwent a smaller increase with reperfusion, suggesting that ischemia alone can also cause IFD and edema. The type of fiber degeneration was that of axonal degeneration.
Collapse
Affiliation(s)
- M Nagamatsu
- Department of Neurology, Mayo Foundation, Rochester, Minnesota 55905, USA
| | | | | | | | | | | |
Collapse
|
9
|
Wertsch JJ, Oswald TA, Roberts MM. Role of Intraneural Topography in Diagnosis and Localization in Electrodiagnostic Medicine. Phys Med Rehabil Clin N Am 1994. [DOI: 10.1016/s1047-9651(18)30507-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
10
|
Hömberg V, Reiners K, Toyka KV. Reversible conduction block in human ischemic neuropathy after ergotamine abuse. Muscle Nerve 1992; 15:467-70. [PMID: 1314328 DOI: 10.1002/mus.880150409] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Conduction block [a significant reduction in compound muscle action potential (CMAP) amplitude after proximal compared to distal stimulation] is often found in demyelinating neuropathies, including inflammatory neuropathies and degenerative neuropathies, such as "liability to pressure neuropathy." There is experimental evidence that a transient conduction block can occur in rats after ischemic lesions of peripheral nerves are induced either by ligation of arterial vessels supplying nerve trunks, or by injection of arachidonic acid into peripheral arterial vessels. Conduction block has also recently been described in cases with necrotizing vasculitis. To date, however, no example of a reversible conduction block has been reported in human ischemic neuropathy.
Collapse
Affiliation(s)
- V Hömberg
- Department of Neurology, Heinrich-Heine-University of Düsseldorf, Germany
| | | | | |
Collapse
|
11
|
Abstract
Serial F waves were elicited before and after ambulation in 2 patients with neurogenic claudication. In both patients dynamic changes in F wave parameters consisting of either unelicitability or increased latencies occurred postexercise. The time course of these changes and their subsequent rapid reversibility over 15 minutes suggest ischemic-induced conduction block and slowing in proximal motor axons. These physiological changes may account for some of the dynamic neurological symptoms of this disorder. Moreover, F wave exercise testing may provide corroborative information for the diagnosis of neurogenic claudication.
Collapse
Affiliation(s)
- S F London
- Department of Neurology, University of Colorado Health Sciences Center, Denver 80262
| | | |
Collapse
|
12
|
Shields RW, Harris JW, Clark M. Mononeuropathy in sickle cell anemia: anatomical and pathophysiological basis for its rarity. Muscle Nerve 1991; 14:370-4. [PMID: 1851248 DOI: 10.1002/mus.880140412] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Peripheral neuropathy is a rare complication of sickle cell disease. We report a young black woman with sickle cell anemia who developed a proximal median mononeuropathy in the setting of sickle cell crisis. The clinical and electrodiagnostic features are consistent with an ischemic mechanism from the sickling process. The pathophysiological basis for the rarity of this complication may be related to the rich anastomotic microvasculature of peripheral nerve and the unique large size of the capillaries of this vascular network.
Collapse
Affiliation(s)
- R W Shields
- Department of Neurology, Case Western Reserve University, Cleveland Metropolitan General Hospital, Ohio
| | | | | |
Collapse
|
13
|
Abstract
Thirty-two patients with a mononeuropathy multiplex associated with a systemic necrotizing vasculitis were studied. The main abnormality was a loss of motor and sensory axons confirmed by electrophysiological and histological methods. A conduction block was observed in five patients, but only one was at a usual site of compression. Based on previous pathological studies and the experimental data in human and animals, the mechanism of the block is proposed to be ischemic. It is suggested that a conduction block in one nerve in a neuropathy with two or more individual nerves affected and with electrophysiological features of axonal degeneration may be due to a vasculitis.
Collapse
Affiliation(s)
- A Ropert
- Service d'Explorations Fonctionnelles du Système Nerveux, Hôpital de Bicêtre, France
| | | |
Collapse
|
14
|
Schmelzer JD, Zochodne DW, Low PA. Ischemic and reperfusion injury of rat peripheral nerve. Proc Natl Acad Sci U S A 1989; 86:1639-42. [PMID: 2922402 PMCID: PMC286754 DOI: 10.1073/pnas.86.5.1639] [Citation(s) in RCA: 120] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
A rat model of severe nerve ischemia was used to study the effects of ischemia and reperfusion on nerve conduction, blood flow, and the integrity of the blood-nerve barrier. Conduction failure was consistently found in the sciatic-tibial nerve during 1- and 3-hr ischemic periods. Recovery of the compound muscle action potential was prompt and complete upon reperfusion following 1 hr of ischemia. However, after 3 hr of ischemia, recovery in the proximal portion of the sciatic nerve was less than 10%, and conduction block occurred in the distal portion of the nerve. Nerve blood flow was restored to only 55% and 45% of resting values following 1 and 3 hr, respectively, of ischemia and did not recover even after 2 hr of reperfusion. The blood-nerve barrier was not statistically impaired to the passage of [14C]sucrose following 1 hr of ischemia but was significantly impaired after 3 hr of ischemia. The permeability-surface area product was consistently greater following 1 hr of reperfusion than during the immediate reperfusion period. These data indicate that severe ischemia of peripheral nerve results in reperfusion injury, conduction block, and blood-nerve barrier disruption. Microvascular events, which may occur during reperfusion, may be important in amplifying the nerve fiber damage that began during ischemia.
Collapse
Affiliation(s)
- J D Schmelzer
- Department of Neurology, Mayo Foundation, Rochester, MN 55905
| | | | | |
Collapse
|
15
|
Low PA, Lagerlund TD, McManis PG. Nerve blood flow and oxygen delivery in normal, diabetic, and ischemic neuropathy. INTERNATIONAL REVIEW OF NEUROBIOLOGY 1989; 31:355-438. [PMID: 2557297 DOI: 10.1016/s0074-7742(08)60283-4] [Citation(s) in RCA: 163] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- P A Low
- Department of Neurology, Mayo Clinic, Rochester, Minnesota 55905
| | | | | |
Collapse
|
16
|
Abstract
Incomplete infarction of the tibial nerve was produced in 37 rats by injecting arachidonic acid into the femoral artery. Sciatic-tibial motor nerve conduction studies were performed 1, 2, 3 and 7 days later. In all animals the evoked motor responses were of low amplitude and morphological examination showed axonal degeneration. In 20 rats the response elicited by proximal stimulation was of lower amplitude than the distal response indicating focal conduction block in a proportion of those axons which had survived the ischemia and were not degenerating distally. The conduction block resolved over several days and in all but one rat had disappeared by 7 days. Morphological examination of semithin sections and single teased myelinated axons revealed no evidence of segmental demyelination. The rapid resolution of conduction block and the lack of significant segmental demyelination suggest that it has a metabolic basis. We suggest that hypoperfusion of the subperineurial region of the proximal tibial nerve, the region surrounding the infarct through which surviving axons pass, may be sufficient to temporarily block impulse transmission in these surviving axons without producing morphological changes.
Collapse
Affiliation(s)
- G J Parry
- Department of Neurology, Hahnemann University, Philadelphia, PA 19102
| | | |
Collapse
|
17
|
|