RESUMEN
SUMMARY: The objective of this study was to analyze the potential for compression of the median nerve (MN) caused by the bicipital aponeurosis (BA), the humeral and ulnar heads of the pronator teres muscle (PTM) and the arcade of the flexor digitorum superficialis muscle (FDS) in recently deceased cadavers. In this analysis 20 forearms of 10 recently deceased adult male cadavers were dissected. Dissections were performed in the institution's autopsy room or anatomy laboratory. The short and long heads of the biceps brachii muscle, as well as the BA were identified in all upper upper limbs. The BA received contribution from the short and long heads of the biceps brachii muscle. In 12 upper limbs the BA was wide and thickened and in 8 it was supported by the MN. In 5 upper limbs, the BA was wide but not very thick, and in 3 it was narrow and not very thick. We identified the existence of the FDS muscle arcade in all dissected upper limbs. A fibrous arcade was identified in 4 forearms, a muscular arcade in 14 and a transparent arcade in 2 upper limbs. In all of them, we recorded that the arcade was in contact with the MN. We recorded the humeral and ulnar heads of the PTM in all dissected upper limbs, with the presence of fibrous beams between them along their entire length. The MN was positioned between the humeral and ulnar heads of the PTM in all upper limbs. In eight upper limbs (40 %), we identified that the BA had thickness and contact with the MN with the potential to cause its compression. Compression between the humeral and ulnar heads of the PTM by the fibrous connections has the potential to cause nerve compression in all upper limbs (100 %). We did not identify that the anatomical structure of the FDS arcade had the potential to cause compression in the MN.
El objetivo de este estudio fue analizar la potencial compresión del nervio mediano (NM) causado por la aponeurosis bicipital (AB), las cabezas humeral y cubital del músculo pronador redondo (MPR) y la arcada del músculo flexor superficial de los dedos (MFS). En este análisis se diseccionaron 20 antebrazos de 10 cadáveres masculinos de individuos adultos fallecidos recientemente. Las disecciones se realizaron en la sala de autopsias o en el laboratorio de anatomía de la Institución. En todos los miembros superiores se identificaron las cabezas corta y larga del músculo bíceps braquial, así como la AB. La AB recibió contribución de las cabezas corta y larga del músculo bíceps braquial. En 12 miembros superiores la AB era ancha y engrosada y en 8 estaba sostenida por el NM. En 5 miembros superiores la AB era ancha pero poco gruesa, y en 3 era estrecha y de menor grosor. Identificamos la existencia de la arcada muscular MFS en todos los miembros superiores disecados. Se identificó una arcada fibrosa en 4 antebrazos, una arcada muscular en 14 y una arcada delgada y transparente en 2 miembros superiores. En todos ellos registramos que la arcada estaba en contacto con el NM. Registramos las cabezas humeral y cubital del MPR en todos los miembros superiores disecados, con presencia de haces fibrosos entre ellas en toda su longitud. El NM estaba situado entre las cabezas humeral y cubital del MPR en todos los miembros superiores. En ocho miembros superiores (40 %), identificamos que la AB era gruesa y tenía contacto con el NM con potencial para causar su compresión. La compresión entre las cabezas humeral y ulnar del MPR, por las conexiones fibrosas, tiene el potencial de causar compresión nerviosa en todos los miembros superiores (100 %). No identificamos que la estructura anatómica de la arcada MFS tuviera el potencial de causar compresión del NM.
Asunto(s)
Humanos , Masculino , Adulto , Antebrazo , Nervio Mediano , Anomalías Musculoesqueléticas , Síndromes de Compresión Nerviosa/patología , Cadáver , Disección , CodoRESUMEN
En órganos dañados, el ácido láctico (AL) modifica la respuesta inmune innata e inflamatoria, induciendo una menor expresión de citoquinas pro-inflamatorias, que provocan, la modulación del reclutamiento de células inmunes. El daño por compresión del nervio isquiático (NI) desencadena una respuesta inflamatoria y un aumento exponencial del infiltrado inflamatorio de células inmunes, produciendo la destrucción de axones y pérdida funcional del nervio. El objetivo de este estudio es evaluar el efecto agudo de la inyección de AL, sobre la proporción de células inmunes en la fase inflamatoria temprana, en el sitio de lesión del NI post compresión. Para ello, se utilizaron 15 ratas machos Sprague Dawley adultas, en tres grupos de compresión nerviosa. Un grupo control, un grupo control negativo con placebo (100 µL PBS) y un grupo experimental con inyección de 100 µL de AL [20mM]. Al tercer día los NI se analizaron histológicamente y se estableció la proporción de células inmunes en el sitio de lesión. Los resultados muestran que la inyección intraneural de AL provoca una disminución en el porcentaje de linfocitos y un aumento en el porcentaje de macrófagos. Este es el primer trabajo de inyección intraneural de AL y demuestra el efecto modulador del AL sobre las células inmunes en el sistema nervioso periférico.
In damaged organs, lactic acid (LA) modifies the innate and inflammatory immune response, inducing a lower expression of pro-inflammatory cytokines, which provoke the modulation of immune cell recruitment. Damage by compression of the sciatic nerve (SN) triggers an inflammatory response and an exponential increase in the inflammatory infiltrate of immune cells, producing the destruction of axons and functional loss of the nerve. The objective of this study is to evaluate the acute effect of the injection of LA, on the proportion of immune cells in the early inflammatory phase, in the site of SN post-compression injury. For this, 15 adult Sprague Dawley rats were used in three groups of nervous compression. A control group, a negative control group with placebo (100 mL PBS) and an experimental group with injection of 100 mL of LA [20mM]. On the third day, the SNs were histologically analyzed and the proportion of immune cells at the injury site was established. The results show that the intraneural injection of LA causes a decrease in the percentage of lymphocytes and an increase in the percentage of macrophages. This is the first work of intraneural injection of LA and demonstrates the modulating effect of LA on immune cells in the peripheral nervous system.
Asunto(s)
Animales , Masculino , Ratas , Nervio Ciático/efectos de los fármacos , Nervio Ciático/inmunología , Ácido Láctico/farmacología , Síndromes de Compresión Nerviosa/patología , Nervio Ciático/patología , Linfocitos/efectos de los fármacos , Citocinas/inmunología , Citocinas/metabolismo , Ratas Sprague-Dawley , Ácido Láctico/administración & dosificación , Inflamación/inmunología , Macrófagos/efectos de los fármacosRESUMEN
OBJECTIVE: To evaluate the effects of right sciatic nerve compression and cryotherapy on muscle tissue. METHODS: We used 42 male Wistar rats, subdivided in the following Groups Control, Injury 3, Injury 8 and Injury 15 submitted to nerve compression and euthanized in the 3rd, 8th and 15th day after surgery. The Cryotherapy Injury 3 was entailed treatment with cryotherapy by immersion of the animal in recipient for 20 minutes during 1 day, then animals were euthanized at the 3rd day after surgery, and the Cryotherapy Injury 8 and the Cryotherapy Injury 15 was treated for 6 days, and euthanized at the 8th and 15th day after surgery. Functional evaluation was performed by the grasping strength of the right pelvic limb. The right tibialis anterior muscles were evaluated for mass, smaller diameter and cross-sectional area. In the Cryotherapy Injury 8 and the Cryotherapy Injury 15 groups, the hydroxyproline was dosed in the right soles. RESULTS: In the compression there was a significant difference in the Injury Groups compared with the Control Group (p<0.05). In the smaller diameter, the compression in Control Group was higher than Injury 8 (p=0.0094), Injury 15 (p=0.002) and Cryotherapy Injury 15 (p<0.001) groups. The comparison between groups with euthanasia in the same post-operative period, a significant difference (p=0.0363) was seen in day 8th after surgery, and this result in Cryotherapy Injury Group was greater than Injury Group. In the fiber area, Control Group was also higher than the Injury 8 (p=0.0018), the Injury 15 (p<0.001) and the Cryotherapy Injury 15 (p<0.001). In hydroxyproline, no significant difference was seen between groups. CONCLUSION: Nerve damage resulted in decreased muscle strength and trophism, the cryotherapy delayed hypotrophy, but this effect did not persist after cessation of treatment.
Asunto(s)
Crioterapia/métodos , Síndromes de Compresión Nerviosa/patología , Síndromes de Compresión Nerviosa/terapia , Nervio Ciático/patología , Neuropatía Ciática/patología , Neuropatía Ciática/terapia , Animales , Modelos Animales de Enfermedad , Hipertrofia/fisiopatología , Masculino , Debilidad Muscular/fisiopatología , Síndromes de Compresión Nerviosa/fisiopatología , Distribución Aleatoria , Ratas Wistar , Valores de Referencia , Reproducibilidad de los Resultados , Nervio Ciático/fisiopatología , Nervio Ciático/cirugía , Neuropatía Ciática/fisiopatología , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVE: This study aims to investigate morphological alterations caused by partial sciatic nerve ligation (PNL) and the efficacy of a moderate-intensity swimming training as therapeutic strategy for nerve regeneration. METHODS: A number of 30 male adult mice were equally divided in control, 14 days after PNL (PNL 14 days), 42 days after PNL (PNL 42 days), 70 days after PNL (PNL 70 days) and 5-week exercise training after 7 days post-lesion (PNL trained 35 days) groups. PNL trained 35 days group began with a 10-min session for 3 days and this time was gradually increased by 10 min every three sessions until the animals had swum for 50 min per session. Morphoquantitative analysis was carried out to assess nerve regeneration in each group. RESULTS: PNL 14 days group exhibited less degenerating signs than PNL 42 days group, where most post-lesion alterations were visualized. Nerve area and minimum diameter were significantly lower (p < 0.05) than control group. PNL 70 days group showed a greater degree of regenerating fibers and similar morphometric parameters to control group. PNL trained 35 days demonstrated signs of regeneration, reaching control group values in the morphometric analysis. DISCUSSION: PNL promotes great histopathological changes, which became more visible at 42 post-injury days. A natural nerve-regeneration tendency was observed throughout time, as observed in PNL 70 days group; nevertheless, moderate swimming training was found to be a therapeutic resource for nerve regeneration, accelerating such process from a morphoquantitative perspective. ABBREVIATIONS: ANOVA: One-way analysis of variance; BDNF: Brain-derived neurotrophic factor; FGF-2: Fibroblast growth factor 2; GDNF: Glial cell line derived neurotrophic factor; IGF: Insulin-link growth factor; IL-1ß: Interleukin-1ß; NGF: Neural growth factor; PBS: Phosphate-buffered saline; PNL: Partial sciatic nerve ligation.
Asunto(s)
Terapia por Ejercicio , Regeneración Nerviosa , Neuropatía Ciática/patología , Neuropatía Ciática/terapia , Natación , Animales , Modelos Animales de Enfermedad , Masculino , Ratones Endogámicos BALB C , Síndromes de Compresión Nerviosa/patología , Síndromes de Compresión Nerviosa/terapia , Degeneración Nerviosa/patología , Degeneración Nerviosa/terapia , Neuralgia/patología , Neuralgia/terapia , Distribución Aleatoria , Nervio Ciático/patologíaRESUMEN
ABSTRACT Objective: To evaluate the effects of right sciatic nerve compression and cryotherapy on muscle tissue. Methods: We used 42 male Wistar rats, subdivided in the following Groups Control, Injury 3, Injury 8 and Injury 15 submitted to nerve compression and euthanized in the 3rd, 8th and 15th day after surgery. The Cryotherapy Injury 3 was entailed treatment with cryotherapy by immersion of the animal in recipient for 20 minutes during 1 day, then animals were euthanized at the 3rd day after surgery, and the Cryotherapy Injury 8 and the Cryotherapy Injury 15 was treated for 6 days, and euthanized at the 8th and 15th day after surgery. Functional evaluation was performed by the grasping strength of the right pelvic limb. The right tibialis anterior muscles were evaluated for mass, smaller diameter and cross-sectional area. In the Cryotherapy Injury 8 and the Cryotherapy Injury 15 groups, the hydroxyproline was dosed in the right soles. Results: In the compression there was a significant difference in the Injury Groups compared with the Control Group (p<0.05). In the smaller diameter, the compression in Control Group was higher than Injury 8 (p=0.0094), Injury 15 (p=0.002) and Cryotherapy Injury 15 (p<0.001) groups. The comparison between groups with euthanasia in the same post-operative period, a significant difference (p=0.0363) was seen in day 8th after surgery, and this result in Cryotherapy Injury Group was greater than Injury Group. In the fiber area, Control Group was also higher than the Injury 8 (p=0.0018), the Injury 15 (p<0.001) and the Cryotherapy Injury 15 (p<0.001). In hydroxyproline, no significant difference was seen between groups. Conclusion: Nerve damage resulted in decreased muscle strength and trophism, the cryotherapy delayed hypotrophy, but this effect did not persist after cessation of treatment.
RESUMO Objetivo: Avaliar os efeitos da compressão nervosa do isquiático direito e da crioterapia no tecido muscular. Métodos: Foram utilizados 42 ratos Wistar machos, subdivididos nos Grupos Controle, Lesão 3, Lesão 8 e Lesão 15, submetidos a compressão nervosa e eutanasiados, respectivamente, no 3°, 8° e 15° dias pós-operatório; Lesão Crioterapia 3, tratado com crioterapia, por imersão durante 20 minutos, por 1 dia, e eutanasiados no 3° dia pós-operatório; e Lesão Crioterapia 8 e Lesão Crioterapia 15, tratados durante 6 dias e eutanasiados no 8° e 15° dias pós-operatório. A avaliação funcional foi realizada pela força de preensão do membro pélvico direito. Os músculos tibiais anteriores direitos foram avaliados quanto a massa, menor diâmetro e área de secção transversa. Em Lesão Crioterapia 8 e Lesão Crioterapia 15, foi dosada a hidroxiprolina nos sóleos direitos. Resultados: Na preensão, houve diferença significativa nos Grupos Lesão quando comparados ao Grupo Controle (p<0,05). No menor diâmetro, o Grupo Controle foi maior que Lesão 8 (p=0,0094), Lesão 15 (p = 0,002) e Lesão Crioterapia 15 (p<0,001). Na comparação entre os grupos com eutanásia no mesmo pós-operatório, houve diferença significativa (p=0,0363) no 8° pós-operatório, sendo Lesão Crioterapia maior que Lesão. Na área das fibras, o Grupo Controle também foi maior que Lesão 8 (p=0,0018), Lesão 15 (p<0,001) e Lesão Crioterapia 15 (p<0,001). Na hidroxiprolina, não houve diferença significativa entre os grupos. Conclusão: A lesão nervosa resultou na diminuição da força e em trofismo muscular, e a crioterapia retardou a hipotrofia, porém este efeito não se manteve após o tratamento cessar.
Asunto(s)
Animales , Masculino , Nervio Ciático/patología , Crioterapia/métodos , Neuropatía Ciática/patología , Neuropatía Ciática/terapia , Síndromes de Compresión Nerviosa/patología , Síndromes de Compresión Nerviosa/terapia , Valores de Referencia , Nervio Ciático/cirugía , Nervio Ciático/fisiopatología , Factores de Tiempo , Distribución Aleatoria , Reproducibilidad de los Resultados , Resultado del Tratamiento , Ratas Wistar , Debilidad Muscular/fisiopatología , Neuropatía Ciática/fisiopatología , Modelos Animales de Enfermedad , Hipertrofia/fisiopatología , Síndromes de Compresión Nerviosa/fisiopatologíaRESUMEN
STUDY DESIGN: Temporal immunohistochemistry analysis of spinal cord tissue from a rat model of cervical radiculopathy. OBJECTIVE: The goal was to measure spinal endothelial and astrocytic vimentin expression after a painful nerve root compression to define spinal cellular expression of vimentin in the context of pain. SUMMARY OF BACKGROUND DATA: The intermediate filament, vimentin, is expressed in a variety of cell types in the spinal cord and is modulated in response to neural pathologies. Early after nerve root compression spinal astrocytes become activated and blood-spinal cord barrier (BSCB) breakdown occurs in parallel with development of pain-related behaviors; these spinal responses remain activated as does the presence of pain. In addition to vimentin, glial fibrillary acidic protein (GFAP) expression is a hallmark of astrocyte activation. In contrast, vascular endothelial cells down-regulate vimentin expression in parallel with vascular breakdown. It is not known whether spinal astrocytes and endothelial cells modulate their expression of vimentin in response to a painful neural injury. METHODS: Mechanical hyperalgesia was measured and spinal cord tissue was harvested at days 1 and 7 after a unilateral nerve root compression in rats. Vimentin was coimmunolabeled with GFAP to label astrocytes and von Willebrand factor (VWF) for endothelial cells in the spinal cord on the side of injury. RESULTS: Spinal astrocytic vimentin increases by day 7 after nerve root compression, corresponding to when mechanical hyperalgesia is maintained. Spinal endothelial vimentin increases as early as day 1 after a painful compression and is even more robust at day 7. CONCLUSION: The delayed elevation in spinal astrocytic vimentin corresponding to sustained mechanical hyperalgesia supports its having a relationship with pain maintenance. Further, since BSCB integrity has been shown to be reestablished by day 7 after a painful compression, endothelial expressed vimentin may help to fortify spinal vasculature contributing to BSCB stability. LEVEL OF EVIDENCE: N/A.
Asunto(s)
Astrocitos/metabolismo , Endotelio Vascular/metabolismo , Dolor/metabolismo , Radiculopatía/metabolismo , Raíces Nerviosas Espinales/metabolismo , Vimentina/metabolismo , Animales , Astrocitos/patología , Vértebras Cervicales , Endotelio Vascular/patología , Proteína Ácida Fibrilar de la Glía/metabolismo , Hiperalgesia/metabolismo , Hiperalgesia/patología , Masculino , Síndromes de Compresión Nerviosa/metabolismo , Síndromes de Compresión Nerviosa/patología , Dolor/patología , Radiculopatía/patología , Ratas , Ratas Sprague-Dawley , Raíces Nerviosas Espinales/patologíaRESUMEN
OBJECTIVES: We, herein, analyzed the effect of swimming on nociception threshold and peripheral nerve regeneration in lean and obese rats submitted to median nerve compression. METHODS: To induce obesity, newborn male Wistar rats received injections of monosodium glutamate (MSG), whereas the control (CTL) group received saline. The animals were separated into 6 groups; control and obese (CTL and MSG), control and obese with lesion (CTL LES and MSG LES), and control and obese with lesion submitted to physical exercise (CTL LES PE and MSG LES PE). RESULTS: Median nerve compression reduced nociception threshold in CTL LES and MSG LES rats. Swimming effectively altered nociception only in CTL LES PE animals. Lean and obese animals displayed histological differences, when compared to sedentary animals, and exercise improved axon regeneration in both groups. The brain-derived neurotrophic factor and GAP 43 protein expression was greater in animals submitted to nervous compression without alteration by exercise. DISCUSSION: In conclusion, swimming, a conservative treatment for peripheral nerve lesions, was not able to improve the nociception threshold in obese rats.
Asunto(s)
Síndromes de Compresión Nerviosa/fisiopatología , Síndromes de Compresión Nerviosa/rehabilitación , Nocicepción/fisiología , Obesidad/complicaciones , Umbral del Dolor/fisiología , Natación , Análisis de Varianza , Animales , Animales Recién Nacidos , Índice de Masa Corporal , Factor Neurotrófico Derivado del Encéfalo/metabolismo , Modelos Animales de Enfermedad , Proteína GAP-43/metabolismo , Regulación de la Expresión Génica/efectos de los fármacos , Regulación de la Expresión Génica/fisiología , Masculino , Nervio Mediano/fisiopatología , Síndromes de Compresión Nerviosa/patología , Obesidad/inducido químicamente , Dimensión del Dolor , Condicionamiento Físico Animal , Ratas , Ratas Wistar , Glutamato de Sodio/farmacologíaRESUMEN
AIMS: To evaluate the ability of multifocal transient pattern electroretinography (mfPERG) to detect neural loss and assess the relationship between mfPERG and visual-field (VF) loss in eyes with chiasmal compression. METHODS: 23 eyes from 23 patients with temporal VF defects and band atrophy of the optic nerve and 21 controls underwent standard automated perimetry and mfPERG using a stimulus pattern of 19 rectangles, each consisting of 12 squares. The response was determined for the central rectangle, for the nasal and temporal hemifields (eight rectangles each) and for each quadrant (three rectangles) in both patients and controls. Comparisons were made using variance analysis. Correlations between VF and mfPERG measurements were verified by linear regression analysis. RESULTS: Mean ± SD mfPERG amplitudes from the temporal hemifield (0.50 ± 0.17 and 0.62 ± 0.32) and temporal quadrants (superior 0.42 ± 0.21 and 0.52 ± 0.35, inferior 0.51 ± 0.23 and 0.74 ± 0.40) were significantly lower in eyes with band atrophy than in controls (0.78 ± 0.24, 0.89 ± 0.28, 0.73 ± 0.26, 0.96 ± 0.36, 0.79 ± 0.26 and 0.91 ± 0.31, respectively). No significant difference was observed in nasal hemifield measurements. Significant correlations (0.36-0.73) were found between VF relative sensitivity and mfPERG amplitude in different VF sectors. CONCLUSIONS: mfPERG amplitude measurements clearly differentiate eyes with temporal VF defect from controls. The good correlation between mfPERG amplitudes and the severity of VF defect suggests that mfPERG may be used as an indicator of ganglion cell dysfunction.
Asunto(s)
Electrorretinografía/métodos , Hemianopsia/patología , Síndromes de Compresión Nerviosa/complicaciones , Quiasma Óptico/patología , Células Ganglionares de la Retina/patología , Adulto , Anciano , Atrofia/etiología , Atrofia/patología , Atrofia/fisiopatología , Alineadores Dentales , Femenino , Hemianopsia/etiología , Hemianopsia/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Síndromes de Compresión Nerviosa/patología , Células Ganglionares de la Retina/fisiología , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Pruebas del Campo Visual/métodos , Campos Visuales/fisiologíaRESUMEN
PURPOSE: To describe the anatomical characteristics and patterns of neurovascular compression in patients suffering classic trigeminal neuralgia (CTN), using high-resolution magnetic resonance imaging (MRI). MATERIALS AND METHODS: The analysis of the anatomy of the trigeminal nerve, brain stem and the vascular structures related to this nerve was made in 100 consecutive patients treated with a Gamma Knife radiosurgery for CTN between December 1999 and September 2004. MRI studies (T1, T1 enhanced and T2-SPIR) with axial, coronal and sagital simultaneous visualization were dynamically assessed using the software GammaPlan™. Three-dimensional reconstructions were also developed in some representative cases. RESULTS: In 93 patients (93%), there were one or several vascular structures in contact, either, with the trigeminal nerve, or close to its origin in the pons. The superior cerebellar artery was involved in 71 cases (76%). Other vessels identified were the antero-inferior cerebellar artery, the basilar artery, the vertebral artery, and some venous structures. Vascular compression was found anywhere along the trigeminal nerve. The mean distance between the nerve compression and the origin of the nerve in the brainstem was 3.76±2.9mm (range 0-9.8mm). In 39 patients (42%), the vascular compression was located proximally and in 42 (45%) the compression was located distally. Nerve dislocation or distortion by the vessel was observed in 30 cases (32%). CONCLUSIONS: The findings of this study are similar to those reported in surgical and autopsy series. This non-invasive MRI-based approach could be useful for diagnostic and therapeutic decisions in CTN, and it could help to understand its pathogenesis.
Asunto(s)
Trastornos Cerebrovasculares/etiología , Trastornos Cerebrovasculares/patología , Imagen por Resonancia Magnética/métodos , Síndromes de Compresión Nerviosa/etiología , Síndromes de Compresión Nerviosa/patología , Neuralgia del Trigémino/complicaciones , Neuralgia del Trigémino/patología , Adulto , Anciano , Constricción Patológica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Adulto JovenRESUMEN
In the Dissection Team of the Second Chair of Anatomy at the School of Medicine of the University of Buenos Aires, Argentina, during the routine dissection of 78 cadavers (corresponding to 156 supraclavicular fossae),10% formalin fixed, we found the supraclavicularis proprius muscle over the lower part of the left supraclavicular fossa in an adult Caucasian male cadaver. We described this rare muscular anomaly, the likelihood of finding this muscle, and its participation in supraclavicular nerve entrapment syndrome.
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Clavícula/anatomía & histología , Músculo Esquelético/anomalías , Región Branquial/anatomía & histología , Disección , Humanos , Masculino , Síndromes de Compresión Nerviosa/patologíaRESUMEN
El recorrido del nervio radial a través del codo constituye, para este elemento nervioso, un camino con riesgo de lesiones intrínsecas o extrínsecas. Cambios de la morfología de las estructuras osteomusculares que constituyen el desfiladero del nervio radial, tanto patológicos como traumáticos, pueden determinar el atrapamiento y compresión del mismo, determinando el daño del nervio y/o la inflamación localizada a nivel de las estructuras circundantes. Mediante la disección de 30 preparados, formolizados al 10 por ciento, y el análisis subsecuente de la disposición de las estructuras musculares e inserción de las mismas, se determinaron los posibles puntos de riesgo anatómico que pudiesen alterar al nervio radial o a sus ramos en la canal bicipital lateral o en su ingreso y distribución en el parte proximal del antebrazo (relación con el músculo supinador y los músculos extensores radial largo y corto). Definimos 4 zonas de posible atrapamiento y compresión del nervio radial y sus ramos: 1. Septo intermuscular lateral. 2. Músculo extensor radial corto. 3. Músculo supinator, a nivel de la Arcada de Frohse. 4. Músculo supinator, a la salida de la masa muscular, en el dorso del antebrazo. La compresión del nervio radial a nivel del codo es una de las neuropatías del miembro superior, más frecuentes. El objetivo de este trabajo fue analizar las implicancias anatómicas del recorrido del nervio radial en su pasaje desde el brazo al antebrazo, especialmente las relaciones con las estructuras osteomusculares, cuyas alteraciones pueden ser las responsables de patologías compresivas del nervio radial que puedan llevar a dolor, parestesias, con o sin pérdida sensorial y/o impotencia funcional.
The radial nerve route through elbow constitutes, for this nervous element, a way with risk of intrinsic or extrinsic injuries. Morphologic changes of the structures that constitute the denle of the radial nerve, pathological as much traumatic, can determine it atrapment and compression, determining the damage of the nerve and/or the inflammation located at level of the surrounding structures. 30 forearm-elbow, preserved with formol to 10 percent, were dissected, and the subsequent analysis of the disposition of the muscular structures and insertion of the same ones, will determine the possible points of anatomical risk that they will affect the radial nerve or its branches in the brachial track or in the proximal forearm (relation with the supinator muscle and extensor carpi radialis longus and brevis muscles).We defined 4 zones of atrapment and compression of the radial nerve and its branches: 1. External intermuscular setum; 2. Extensor carpi radialis brevis muscle; 3. Supinator muscle , atlevelof theFrohse's Arch;4. Supinator muscle, when coming out of the muscular mass, in the back of the forearm. The compression of the radial nerve at level of the elbow is one of the frequent neuropathies of the superior member. It is for that reason that the objective of this work consists of analyzing the anatomical aspects of the route of the radial nerve in its passage from the arm to the forearm, specially relations with morphological structures, whose alterations determines pathologies of the radial nerve which can take to pain, parestesies, with lost sensorial and functional impotence.
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Humanos , Articulación del Codo/inervación , Articulación del Codo/patología , Nervio Radial/patología , Neuropatía Radial/patología , Riesgo , Síndromes de Compresión Nerviosa/patologíaRESUMEN
OBJECTIVE: To study the influence of the anatomy of neurovascular compression (NVC) on pain outcome in patients with classic trigeminal neuralgia treated by radiosurgery. METHODS: Analysis of the anatomy of the trigeminal nerve, brainstem, and vessels was performed in 89 consecutive patients treated by Leksell gamma knife (Elekta Instruments, Stockholm, Sweden) for classic trigeminal neuralgia. One-millimeter axial magnetic resonance imaging slices (T1-weighted, T1-weighted enhanced, and T2-weighted selected partial inversion recovery) with coronal, sagittal, and three-dimensional reconstructions were viewed. The end point for outcome was total pain remission and no medication. The follow-up period ranged between 6 and 42 months. RESULTS: In 82 patients (92%), a vascular structure in contact with the nerve was observed. In four patients, the NVC was produced by a large vessel (basilar or vertebral artery) and in 78 by a smaller vessel. The superior cerebellar artery was the cause of the NVC in 64 patients (78%). The NVC was proximal (<3 mm to the brainstem) in 34 patients (41%) and distal in 43 patients (52%). Nerve dislocation was present in 29 patients (33%), and nerve atrophy was present in 21 (24%) patients. Visualization of NVC on magnetic resonance imaging scans was not associated with outcome. The two variables associated with poor outcome were a large vessel contacting the nerve with brainstem deformation and proximal NVC. Nerve atrophy and nerve dislocation were not associated with outcome. CONCLUSION: The visualization of NVC, nerve atrophy, and nerve dislocation on magnetic resonance imaging scans was not associated with pain outcome. A large vessel compressing the nerve and deforming the brainstem and proximal NVC were associated with a lesser pain control.
Asunto(s)
Síndromes de Compresión Nerviosa/cirugía , Dolor/cirugía , Radiocirugia , Neuralgia del Trigémino/patología , Neuralgia del Trigémino/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Vasos Sanguíneos/patología , Tronco Encefálico/patología , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Síndromes de Compresión Nerviosa/etiología , Síndromes de Compresión Nerviosa/patología , Resultado del Tratamiento , Nervio Trigémino/patologíaRESUMEN
We have analyzed the ultrastructural and histopathological changes that occur during experimental chronic nerve entrapment, as well as the immunohistochemical expression of chondroitin sulfate proteoglycan (CSPG). Adult hamsters (n = 30) were anesthetized and received a cuff around the right sciatic nerve. Animals survived for varying times (5 to 15 weeks) being thereafter perfused transcardially with fixative solutions either for immunohistochemical or electron microscopic procedures. Experimental nerves were dissected based upon the site of compression (proximal, entrapment and distal). CSPG overexpression was detected in the compressed nerve segment and associated with an increase in perineurial and endoneurial cells. Ultrastructural changes and data from semithin sections were analyzed both in control and compressed nerves. We have observed endoneurial edema, perineurial and endoneurial thickening, and whorled cell-sparse pathological structures (Renaut bodies) in the compressed nerves. Morphometrical analyses of myelinated axons at the compression sites revealed: (a) a reduction both in axon sectional area (up to 30%) and in myelin sectional area (up to 80%); (b) an increase in number of small axons (up to 60%) comparatively to the control group. Distal segment of compressed nerves presented: (a) a reduction in axon sectional area (up to 60%) and in myelin sectional area (up to 90%); (b) a decrease in axon number (up to 40%) comparatively to the control data. In conclusion, we have shown that nerve entrapment is associated with a local intraneural increase in CSPG expression, segmental demyelination, perineurial and endoneurial fibrosis, and other histopathological findings.
Asunto(s)
Axones/patología , Matriz Extracelular/patología , Síndromes de Compresión Nerviosa/metabolismo , Síndromes de Compresión Nerviosa/patología , Nervio Ciático/patología , Animales , Axones/ultraestructura , Proteoglicanos Tipo Condroitín Sulfato/metabolismo , Enfermedad Crónica , Cricetinae , Modelos Animales de Enfermedad , Matriz Extracelular/metabolismo , Matriz Extracelular/ultraestructura , Inmunohistoquímica/métodos , Indoles , Microscopía Electrónica de Transmisión/métodos , Fibras Nerviosas Mielínicas/patología , Fibras Nerviosas Mielínicas/ultraestructura , Nervio Ciático/metabolismo , Factores de TiempoRESUMEN
Erdheim-Chester disease (ECD) is a rare form of histiocytosis of unknown origin characterized by tissue infiltration by lipid-laden histiocytes. Typically, the diaphyseal and metaphyseal portions of the tubular bones are affected, leading to a characteristic radiographic pattern of bone sclerosis. Orbital involvement is not infrequent and is manifested by exophthalmos and periorbital xanthomatous lesions, with associated visual problems. This case report documents imaging and pathologic findings in a patient with ECD with extensive orbital involvement.
Asunto(s)
Enfermedad de Erdheim-Chester/diagnóstico , Procesamiento de Imagen Asistido por Computador , Imagen por Resonancia Magnética , Enfermedades Orbitales/diagnóstico , Huesos/patología , Diagnóstico Diferencial , Enfermedad de Erdheim-Chester/patología , Exoftalmia/etiología , Exoftalmia/patología , Resultado Fatal , Humanos , Fallo Renal Crónico/patología , Masculino , Persona de Mediana Edad , Síndromes de Compresión Nerviosa/diagnóstico , Síndromes de Compresión Nerviosa/patología , Nervio Óptico/patología , Enfermedades del Nervio Óptico/diagnóstico , Enfermedades del Nervio Óptico/patología , Órbita/patología , Enfermedades Orbitales/patología , Osteosclerosis/diagnóstico , Osteosclerosis/patología , Fibrosis Retroperitoneal/patología , Baja Visión/etiología , Baja Visión/patología , Xantomatosis/etiología , Xantomatosis/patologíaRESUMEN
Entrapment neuropathy is a group of clinical disorders involving compression of a peripheral nerve and interference with nerve function mostly through traction injury. We have investigated the chronic compression of peripheral nerves as an experimental procedure for detecting changes in ultrastructural nerve morphology. Adult hamsters (Mesocricetus auratus, N = 30) were anesthetized with a 25 percent pentobarbital solution and received a cuff around the right sciatic nerve. Left sciatic nerves were not operated (control group). Animals survived for varying times (up to 15 weeks), after which they were sacrificed and both sciatic nerves were immediately fixed with a paraformaldehyde solution. Experimental nerves were divided into segments based upon their distance from the site of compression (proximal, entrapment and distal). Semithin and ultrathin sections were obtained and examined by light and electron microscopy. Ultrastructural changes were qualitatively described and data from semithin sections were morphometrically analyzed both in control and in compressed nerves. We observed endoneurial edema along with both perineurial and endoneurial thickening and also the existence of whorled cell-sparse structures (Renaut bodies) in the subperineurial space of compressed sciatic nerves. Morphometric analyses of myelinated axons at the compression sites displayed a remarkable increase in the number of small axons (up to 60 percent) in comparison with the control axonal number. The distal segment of compressed nerves presented a distinct decrease in axon number (up to 40 percent) comparatively to the control group. The present experimental model of nerve entrapment in adult hamsters was shown to promote consistent histopathologic alterations analogous to those found in chronic compressive neuropathies
Asunto(s)
Animales , Cricetinae , Axones , Síndromes de Compresión Nerviosa/patología , Nervio Ciático , Enfermedad Crónica , Modelos Animales de Enfermedad , Regeneración NerviosaRESUMEN
Entrapment neuropathy is a group of clinical disorders involving compression of a peripheral nerve and interference with nerve function mostly through traction injury. We have investigated the chronic compression of peripheral nerves as an experimental procedure for detecting changes in ultrastructural nerve morphology. Adult hamsters (Mesocricetus auratus, N = 30) were anesthetized with a 25% pentobarbital solution and received a cuff around the right sciatic nerve. Left sciatic nerves were not operated (control group). Animals survived for varying times (up to 15 weeks), after which they were sacrificed and both sciatic nerves were immediately fixed with a paraformaldehyde solution. Experimental nerves were divided into segments based upon their distance from the site of compression (proximal, entrapment and distal). Semithin and ultrathin sections were obtained and examined by light and electron microscopy. Ultrastructural changes were qualitatively described and data from semithin sections were morphometrically analyzed both in control and in compressed nerves. We observed endoneurial edema along with both perineurial and endoneurial thickening and also the existence of whorled cell-sparse structures (Renaut bodies) in the subperineurial space of compressed sciatic nerves. Morphometric analyses of myelinated axons at the compression sites displayed a remarkable increase in the number of small axons (up to 60%) in comparison with the control axonal number. The distal segment of compressed nerves presented a distinct decrease in axon number (up to 40%) comparatively to the control group. The present experimental model of nerve entrapment in adult hamsters was shown to promote consistent histopathologic alterations analogous to those found in chronic compressive neuropathies.
Asunto(s)
Axones/ultraestructura , Síndromes de Compresión Nerviosa/patología , Nervio Ciático/ultraestructura , Animales , Enfermedad Crónica , Cricetinae , Modelos Animales de Enfermedad , Regeneración NerviosaRESUMEN
A detailed anatomic study was carried out on the lateral femoral cutaneous nerve to better understand the etiology and treatment of lateral femoral cutaneous neuralgia. As it passed from the pelvis into the thigh, the lateral femoral cutaneous nerve ran through an "aponeuroticofascial tunnel," beginning at the iliopubic tract and ending at the inguinal ligament; as it passed through the tunnel, an enlargement in its side-to-side diameter was observed, suggesting that the fascial structures proximal to the inguinal ligament may be implicated in the genesis of lateral femoral cutaneous neuralgia. The finding of pseudoneuromas at this location, distant from the inguinal ligament, supports this hypothesis. The anterior superior iliac spine is located approximately 0.7 cm from the lateral femoral cutaneous nerve and serves as the bony landmark for nerve localization. Within the first 3 cm of leaving the pelvis, the lateral femoral cutaneous nerve was observed deep to the fascia lata; therefore, surgical dissection within the subcutaneous fascia may be conducted with relative impunity near the anterior superior iliac spine just inferior to the inguinal ligament. In 36% of cases there was no posterior branch of the nerve, which is correlated to lateral femoral cutaneous neuralgia symptoms often being limited to the anterior branch region. An accessory nerve was found in 30% of cases.
Asunto(s)
Nervio Femoral/patología , Neuropatía Femoral/patología , Síndromes de Compresión Nerviosa/patología , Neuralgia/patología , Nervios Periféricos/patología , Piel/inervación , Adulto , Anciano , Cadáver , Femenino , Neuropatía Femoral/etiología , Humanos , Masculino , Persona de Mediana Edad , Síndromes de Compresión Nerviosa/etiología , Neuralgia/etiología , Parestesia/patologíaRESUMEN
OBJECTIVE AND IMPORTANCE: To highlight arterial hypertension as an additional factor favoring surgical indication in neurovascular compression syndromes such as trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia. CLINICAL PRESENTATION: A 52-year-old woman with trigeminal neuralgia concomitant with systemic arterial hypertension, submitted initially to unsatisfactory conservative treatment, presents tortuousness and enlargement of the vertebral artery (VA) topography on magnetic resonance imaging (MRI). A microsurgical neurovascular decompression of the trigeminal nerve and the medulla was performed, revealing that the compression was due to the superior cerebellar artery instead of the VA. Both the neuralgia and the hypertension were controlled with no need of medication during a 1-year follow-up. CONCLUSION: Surgical indication in neurovascular compression disorders should be reinforced in the presence of concomitant arterial hypertension and a compatible MRI examination.
Asunto(s)
Hipertensión/complicaciones , Síndromes de Compresión Nerviosa/etiología , Síndromes de Compresión Nerviosa/cirugía , Neuralgia del Trigémino/etiología , Neuralgia del Trigémino/cirugía , Cerebelo/irrigación sanguínea , Femenino , Humanos , Hipertensión/patología , Hipertensión/fisiopatología , Imagen por Resonancia Magnética , Persona de Mediana Edad , Síndromes de Compresión Nerviosa/patología , Presorreceptores/fisiología , Núcleo Solitario/fisiología , Neuralgia del Trigémino/patología , Arteria Vertebral/patologíaRESUMEN
OBJECTIVE AND IMPORTANCE: Intravascular papillary endothelial hyperplasia (Masson's vegetant hemangioendothelioma) is a rare condition affecting the neuraxis. In the literature, only one case of this lesion involving the vertebral canal with spinal cord compression has been reported. We present a case of cauda equina compression due to this abnormality. CLINICAL PRESENTATION: A 17-year-old boy was admitted at our hospital with pain, numbness, paresis of the left lower extremity, and bladder dysfunction of approximately 1 month's duration. Computed tomography and magnetic resonance imaging of the spine revealed a tumor within the spinal canal at the T12-L1 level. INTERVENTION: The patient underwent a T12-L1 laminectomy. An epidural red nodular tumor was visualized and totally resected. The findings of the pathological examination were compatible with intravascular papillary endothelial hyperplasia. At follow-up examination 1 month after the operation, the patient had complete resolution of the pain, and the motor deficit and bladder dysfunction had improved significantly. CONCLUSION: This rare benign vascular lesion may be clinically and histopathologically mistaken for an angiosarcoma. Because the intravascular papillary endothelial hyperplasia can be cured by complete surgical resection, it is important to distinguish between these two lesions to avoid inappropriate aggressive treatment.
Asunto(s)
Cauda Equina/cirugía , Neoplasias Epidurales/cirugía , Hemangioendotelioma/cirugía , Síndromes de Compresión Nerviosa/cirugía , Adolescente , Cauda Equina/patología , Diagnóstico Diferencial , Endotelio Vascular/patología , Neoplasias Epidurales/diagnóstico , Neoplasias Epidurales/patología , Hemangioendotelioma/diagnóstico , Hemangioendotelioma/patología , Humanos , Hiperplasia , Laminectomía , Vértebras Lumbares/patología , Vértebras Lumbares/cirugía , Imagen por Resonancia Magnética , Masculino , Síndromes de Compresión Nerviosa/diagnóstico , Síndromes de Compresión Nerviosa/patología , Vértebras Torácicas/patología , Vértebras Torácicas/cirugía , Tomografía Computarizada por Rayos XRESUMEN
The authors report two female patients with chronic sensitive and motor findings in lower limbs caused by compression of distal branches of sciatic nerve by lipoma. Similar cases were not described on literature. Nerve conduction studies allowed to localize the exact site of compression. At surgery, lipomas compressing the deep peroneal nerve (case 1) and the posterior tibial nerve (case 2) were observed. Histologic studies of tumors confirmed the diagnoses.