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1.
Medicine (Baltimore) ; 97(49): e13455, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30544430

RESUMO

RATIONALE: Compressive radial neuropathy by a synovial cyst in the radial tunnel during pregnancy is a rare occurrence. The management of radial nerve compression caused by a synovial cyst in a pregnant patient is a surgical dilemma owing to the fetal and maternal risks of treatment. PATIENT CONCERNS AND DIAGNOSIS: A 37-year-old pregnant woman presented with progressive forearm pain at the gestational age of 12 weeks. A cyst was identified via musculoskeletal ultrasound and magnetic resonance imaging examinations in the radiocapitellar joint causing radial compressive neuropathy. INTERVENTIONS: After regional nerve block and surgical removal of the cyst, the patient's forearm pain was alleviated without neurological deficits. OUTCOME: symptoms from nerve compression were improved after surgical treatment LESSONS:: This report illustrates the case of a pregnant woman presenting a compressive neuropathy by an enlarged cyst possibly due to the unbalance of growth factors during pregnancy. With proper diagnosis and timely surgical intervention, such patients can achieve good neurologic recovery without maternal or fetal complications.


Assuntos
Síndromes de Compressão Nervosa/cirurgia , Complicações na Gravidez/cirurgia , Neuropatia Radial/cirurgia , Cisto Sinovial/cirurgia , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Síndromes de Compressão Nervosa/diagnóstico por imagem , Síndromes de Compressão Nervosa/etiologia , Síndromes de Compressão Nervosa/patologia , Gravidez , Complicações na Gravidez/diagnóstico por imagem , Complicações na Gravidez/patologia , Neuropatia Radial/diagnóstico por imagem , Neuropatia Radial/etiologia , Neuropatia Radial/patologia , Cisto Sinovial/complicações , Cisto Sinovial/diagnóstico por imagem , Cisto Sinovial/patologia
2.
Einstein (Sao Paulo) ; 16(3): eAO4206, 2018 Sep 17.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30231143

RESUMO

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.


Assuntos
Crioterapia/métodos , Síndromes de Compressão Nervosa/patologia , Síndromes de Compressão Nervosa/terapia , Nervo Isquiático/patologia , Neuropatia Ciática/patologia , Neuropatia Ciática/terapia , Animais , Modelos Animais de Doenças , Hipertrofia/fisiopatologia , Masculino , Debilidade Muscular/fisiopatologia , Síndromes de Compressão Nervosa/fisiopatologia , Distribuição Aleatória , Ratos Wistar , Valores de Referência , Reprodutibilidade dos Testes , Nervo Isquiático/fisiopatologia , Nervo Isquiático/cirurgia , Neuropatia Ciática/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
3.
World Neurosurg ; 120: 159-162, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30176400

RESUMO

BACKGROUND: Fibrous dysplasia (FD) is most often a slowly progressive benign disease in which the normal bone structure is replaced by fibrous and osteoid tissue. CASE DESCRIPTION: A 16-year-old adolescent, known with FD in the sphenoid bone, suffered an acute decreased visual acuity with papilledema on the left eye. The radiologic images were best compatible with cystic degeneration of the known FD with optic nerve compression in the optic canal. Decompression of the optic nerve was performed through an endoscopic exploration of the left sphenoid sinus. The visual acuity recovered completely. CONCLUSIONS: In FD with cystic changes, leading to acute signs of optic nerve compression, early aggressive surgical decompression is strongly recommended. Cystic degeneration of the FD, although rare, should be considered.


Assuntos
Cistos Ósseos/cirurgia , Displasia Fibrosa Craniofacial/cirurgia , Ossos Faciais/cirurgia , Crânio/cirurgia , Adolescente , Fatores Etários , Cistos Ósseos/diagnóstico por imagem , Cistos Ósseos/patologia , Displasia Fibrosa Craniofacial/diagnóstico por imagem , Displasia Fibrosa Craniofacial/patologia , Ossos Faciais/diagnóstico por imagem , Ossos Faciais/patologia , Feminino , Hormônios Esteroides Gonadais/fisiologia , Humanos , Imagem por Ressonância Magnética , Síndromes de Compressão Nervosa/diagnóstico por imagem , Síndromes de Compressão Nervosa/patologia , Síndromes de Compressão Nervosa/cirurgia , Doenças do Nervo Óptico/diagnóstico por imagem , Doenças do Nervo Óptico/patologia , Doenças do Nervo Óptico/cirurgia , Prevenção Secundária , Crânio/patologia , Seio Esfenoidal/diagnóstico por imagem , Seio Esfenoidal/patologia , Seio Esfenoidal/cirurgia , Tomografia Computadorizada por Raios X , Acuidade Visual/fisiologia
4.
J Craniofac Surg ; 29(7): e677-e679, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30106809

RESUMO

Lingual nerve (LN) is one among the 3 branches of posterior division of mandibular nerve. It might get entrapped in the infratemporal fossa by lateral pterygoid muscle, pterygospinous ligament, or lateral pterygoid plate. Its entrapment in the submandibular region has not been reported yet. A unique entrapment of LN in the fused submandibular and sublingual salivary glands in a cadaver was reported. The deep parts of the submandibular and sublingual salivary glands were completely fused with each other. The LN passed through the center of the fused part. Histologically both submandibular and sublingual salivary glands had both mucous and serous acini. Though this entrapment might not cause any functional problems, it might get injured during various surgical procedures of the submandibular region.


Assuntos
Nervo Lingual/patologia , Síndromes de Compressão Nervosa/patologia , Glândula Sublingual/anormalidades , Glândula Submandibular/anormalidades , Idoso , Cadáver , Humanos
5.
Neurol Res ; 40(11): 955-962, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30091393

RESUMO

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.


Assuntos
Terapia por Exercício , Regeneração Nervosa , Neuropatia Ciática/patologia , Neuropatia Ciática/terapia , Natação , Animais , Modelos Animais de Doenças , Masculino , Camundongos Endogâmicos BALB C , Síndromes de Compressão Nervosa/patologia , Síndromes de Compressão Nervosa/terapia , Degeneração Neural/patologia , Degeneração Neural/terapia , Neuralgia/patologia , Neuralgia/terapia , Distribuição Aleatória , Nervo Isquiático/patologia
6.
Folia Morphol (Warsz) ; 77(2): 403-405, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29064541

RESUMO

Variations of the forearm musculature are vastly described in the literature. The palmaris longus muscle is one of the most variable structures of the human body. It usually arises from the medial epicondyle of the humerus and inserts itself into the palmar aponeurosis. Anatomy textbooks and recent papers state that this muscle may act as a weak wrist flexor. The present work aims to report an anatomical variation where the palmaris longus muscle was abnormally hypertrophied and was completely fleshy throughout the whole forearm. Anatomical variations of the palmaris longus may induce symptoms of neurovascular bundle compression, especially of the median nerve. The palmaris longus muscle may be used in tendon graft or muscle graft, due to its lack of apparent function. Furthermore, it is one of the anatomical landmarks for local anaesthesia procedures. (Folia Morphol 2018; 77, 2: 403-405).


Assuntos
Antebraço/patologia , Nervo Mediano/patologia , Músculo Esquelético/patologia , Síndromes de Compressão Nervosa/patologia , Humanos
7.
World Neurosurg ; 109: e546-e553, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29038079

RESUMO

BACKGROUND: Fibrous dysplasia (FD) of the skull base can manifest with optic nerve compression. As most patients initially do not experience vision loss, controversy exists whether to proceed with prophylactic surgical decompression or elect for conservative observation. Optical coherence tomography (OCT), a physiologic imaging modality widely used to assess the condition of the retinal nerve fiber layer (RNFL), has been useful in monitoring compressive tumors on the optic nerve. This study evaluated potential use of OCT in management of patients with fibrous dysplasia and optic nerve involvement. METHODS: Six patients with suspected optic nerve compression who underwent OCT imaging as part of a neuro-ophthalmic examination were reviewed over a 2-year period. Patient records were evaluated for visual examination measures, most notably the presence of optic neuropathy, and radiographic measures on computed tomography. Measures were compared by age-adjusted RNFL thickness (above or below fifth percentile) on OCT imaging. RESULTS: Two patients were found to have mild optic neuropathy in 1 eye each. Three of 12 eyes fell below the age-adjusted fifth percentile of RNFL thickness. Presence of optic neuropathy was associated with abnormal age-adjusted RNFL thickness but not with optic nerve compression (P = 0.45). CONCLUSIONS: Abnormal RNFL thickness as measured by OCT better predicted the presence of optic neuropathy than computed tomography alone. OCT may be a valuable imaging modality to monitor patients with fibrous dysplasia for development of optic neuropathy during periods of conservative watchful waiting.


Assuntos
Displasia Fibrosa Óssea/diagnóstico por imagem , Síndromes de Compressão Nervosa/diagnóstico por imagem , Doenças do Nervo Óptico/diagnóstico por imagem , Nervo Óptico/diagnóstico por imagem , Retina/diagnóstico por imagem , Base do Crânio/diagnóstico por imagem , Adulto , Idoso , Tratamento Conservador , Descompressão Cirúrgica , Feminino , Displasia Fibrosa Óssea/complicações , Humanos , Imagem Tridimensional , Masculino , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/etiologia , Síndromes de Compressão Nervosa/patologia , Síndromes de Compressão Nervosa/terapia , Fibras Nervosas/patologia , Nervo Óptico/patologia , Doenças do Nervo Óptico/etiologia , Doenças do Nervo Óptico/patologia , Doenças do Nervo Óptico/terapia , Retina/patologia , Tomografia de Coerência Óptica , Tomografia Computadorizada por Raios X , Transtornos da Visão/etiologia , Conduta Expectante
8.
J Tissue Eng Regen Med ; 12(3): e1441-e1449, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-28857477

RESUMO

Different damage factors are known to trigger cell death in the optic nerves. Use of mesenchymal stem cells is a possible treatments option for traumatic optic nerve injury due to their ability to secrete protective cytokines and recovery factors. In this study, we investigated the neuroprotective effects of human placenta-derived mesenchymal stem cells (hPMSCs) using an established optic nerve compression model and model of R28 cells that were exposed to hypoxia. Forty percent of axon death was seen in induced in vivo optic nerve injury model (p < .05), and 70% of R28 cells exposed to cobalt chloride (CoCl2 ), leading to hypoxia, underwent apoptosis (p < .05). After intravenous injection of hPMSCs into tail vein, there was 25% improvement of axon survival in vivo (p < .05). R28 cells incubated with hPMSCs after exposure to hypoxic condition resulted in 50% increased cell survival compared with R28 cells without hPMSC exposure (p < .05), suggesting the active release of multiple factors related to cell survival. In addition, we found that Nf-κb protein mediates neuroprotection pathway via up-regulation of target proteins regulated by hPMSCs. Therefore, we assert that Nf-κb was one of the mediator proteins in a recovery pathway induced by hPMSCs. In conclusion, these indicate that transactivation of Nf-κb protein has a critical role in recovery mechanism by hPMSCs. We suggest that hPMSCs have abilities to recover neuronal damages by up-regulating the expression of genes associated with axon survival and can a better understanding of the possible role of hPMSCs in the treatment modalities of optic nerve injury.


Assuntos
Axônios/fisiologia , Transplante de Células-Tronco Mesenquimais , Células-Tronco Mesenquimais/citologia , NF-kappa B/metabolismo , Síndromes de Compressão Nervosa/terapia , Nervo Óptico/patologia , Placenta/citologia , Transdução de Sinais , Animais , Apoptose , Linhagem Celular , Sobrevivência Celular , Citocinas/metabolismo , Modelos Animais de Doenças , Feminino , Humanos , Masculino , Síndromes de Compressão Nervosa/patologia , Regeneração Nervosa , Gravidez , Ratos Sprague-Dawley
9.
J Bone Joint Surg Am ; 99(24): e132, 2017 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-29257018

RESUMO

BACKGROUND: Late surgery for chronic nerve compression injuries usually improves sensation but rarely reverses motor atrophy. We hypothesized that a persistent glial scar after chronic nerve compression injury might account for poor motor recovery and that degradation of the glial scar as an adjunct to surgical decompression would improve functional recovery. METHODS: A previously described model of chronic nerve compression injury was created in C57BL/6 mice and Sprague-Dawley rats, and the nerves were harvested early or late after electrophysiological confirmation of the injury. Western blot, polymerase chain reaction, and quantitative immunohistochemical analyses were performed to determine levels of chondroitin sulfate proteoglycans and extracellular matrix molecules. Subsets of mice were treated either with surgical decompression alone or with decompression coupled with intraepineurial injection of a low dose (0.1 µgµL) or a high dose (0.2 µg/µL) of chondroitinase ABC at 6 weeks after injury. RESULTS: Aggrecan showed the greatest change in mRNA and protein levels at the early and late time points following creation of the chronic nerve compression injury. Quantitative immunohistochemical analysis revealed early aggrecan upregulation localized primarily to the endoneurium and late upregulation localized to the perineurium and epineurium (p < 0.0105). Quantitative immunohistochemical analysis for collagen IV, laminin-α2, and fibronectin also showed early upregulation with perineurial scarring. Quantitative immunohistochemical analysis and Western blot analysis for aggrecan demonstrated a marked increase in the endoneurium at the early time points and upregulation of expression in the epineurium and perineurium at the late time points. Decompression along with intraepineurial injection of high-dose chondroitinase ABC at 6 weeks after creation of the compression injury resulted in marked attenuation of decorin and aggrecan expression with functional improvement in nerve conduction velocity. CONCLUSIONS: Significant upregulation of chondroitin sulfate proteoglycans and other extracellular matrix components contributes to the pathogenesis of compression neuropathies in murine models. The administration of chondroitinase ABC degrades these chondroitin sulfate proteoglycans and improves functional recovery after chronic nerve compression injury; thus, it can be considered as a possible therapeutic adjunct.


Assuntos
Condroitina ABC Liase/farmacologia , Cicatriz/prevenção & controle , Descompressão Cirúrgica/métodos , Síndromes de Compressão Nervosa/tratamento farmacológico , Traumatismos dos Nervos Periféricos/tratamento farmacológico , Traumatismos dos Nervos Periféricos/patologia , Agrecanas/farmacologia , Análise de Variância , Animais , Western Blotting , Doença Crônica , Modelos Animais de Doenças , Injeções Intralesionais , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Síndromes de Compressão Nervosa/patologia , Síndromes de Compressão Nervosa/cirurgia , Condução Nervosa/efeitos dos fármacos , Traumatismos dos Nervos Periféricos/cirurgia , RNA Mensageiro/efeitos dos fármacos , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley , Reação em Cadeia da Polimerase em Tempo Real/métodos , Recuperação de Função Fisiológica/fisiologia , Sensibilidade e Especificidade
10.
Hernia ; 21(5): 715-722, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28819736

RESUMO

PURPOSE: Enlargement of the ilioinguinal nerve at the external inguinal ring is observed in 34% of patients undergoing primary open inguinal herniorrhaphy; in 88% of patients it occurs at the fascial edge where the hernia mushrooms with abdominal pressure. Compression neuropathy occurs near many anatomical nerve constriction sites and is associated with enlargement of the peripheral nerve accompanied by sensory changes. METHODS: In this prospective study, Carolina Comfort Scale (CCS) questionnaire data was collected for 35 primary hernia repairs. Each patient underwent primary inguinal herniorrhaphy that included ilioinguinal neurectomy. All nerves were sampled proximal to the external inguinal ring. Any nerves with grossly increased overall diameter to any degree distal to the external ring were additionally sampled in the thickened portions. A neuropathologist performed histologic evaluation of the H&E-stained cross sections. RESULTS: Paired comparison of proximal and distal nerves revealed a greater overall diameter and greater measured nerve-specific diameter in distal nerve segments. Nerves with increased overall diameter were also found to have a statistically significant positive correlation with four of eight pain measures. Additionally, increased nerve-specific diameter correlates with increased pain on four of eight pain values, but age effect on nerve diameter blunts this finding. CONCLUSIONS: Increased preoperative CCS pain values in primary open inguinal hernia are significantly correlated with gross enlargement of the overall diameter and nerve-specific diameter of the ilioinguinal nerve beyond the external inguinal ring. This is consistent with a compression neuropathy.


Assuntos
Hérnia Inguinal/complicações , Síndromes de Compressão Nervosa/patologia , Neuralgia/patologia , Nervos Periféricos/patologia , Adulto , Pesos e Medidas Corporais , Feminino , Hérnia Inguinal/cirurgia , Herniorrafia , Humanos , Masculino , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/etiologia , Síndromes de Compressão Nervosa/cirurgia , Neuralgia/etiologia , Neuralgia/cirurgia , Medição da Dor , Dor Pós-Operatória/etiologia , Nervos Periféricos/cirurgia , Estudos Prospectivos
11.
Biomed Res Int ; 2017: 4659761, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28691025

RESUMO

Suprascapular nerve entrapment syndrome (SNES) is a neuropathy caused by compression of the nerve along its course. The most common compression sites include the suprascapular notch and the spinoglenoid notch. The aim of this article was to review the anatomical factors influencing the occurrence of SNES in the light of the newest reports. Potential predisposing morphological factors include a V-shaped, narrow, or "deep" suprascapular notch; a band-shaped, bifurcated, or completely ossified superior transverse scapular ligament (STSL); particular arrangements of the suprascapular nerve and vessels at the suprascapular notch. A very recent report indicates structures at the suprascapular notch region that may protect from SNES, such as the suprascapular notch veins (SNV). The role of the anterior coracoscapular ligament (ACSL) is still not clear. While some studies indicate that it may predispose for SNES, the newest study proposes a protective function. Knowledge of these variations is essential for arthroscopic and other surgical procedures of this area in order to avoid iatrogenic injury of the suprascapular nerve or unexpected bleeding from the suprascapular vessels running alongside the STSL.


Assuntos
Síndromes de Compressão Nervosa/patologia , Escápula/inervação , Escápula/patologia , Suscetibilidade a Doenças , Humanos , Ligamentos Articulares/patologia , Fatores de Risco
12.
Spinal Cord ; 55(10): 886-890, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28534496

RESUMO

STUDY DESIGN: A systematic review. OBJECTIVES: Conus medullaris syndrome (CMS) and cauda equina syndrome (CES) are well-known neurological entities. It is assumed that these syndromes are different regarding neurological and functional prognosis. However, literature concerning spinal trauma is ambiguous about the exact definition of the syndromes. METHODS: A MEDLINE, EMBASE and Cochrane literature search was performed. We included original articles in which clinical descriptions of CMS and/or CES were mentioned in patients following trauma to the thoracolumbar spine. RESULTS: Out of the 1046 articles, we identified 14 original articles concerning patients with a traumatic CMS and/or CES. Based on this review and anatomical data from cadaveric and radiological studies, CMS and CES could be more precisely defined. CONCLUSION: CMS may result from injury of vertebrae Th12-L2, and it involves damage to neural structures from spinal cord segment Th12 to nerve root S5. CES may result from an injury of vertebrae L3-L5, and it involves damage to nerve roots L3-S5. This differentiation between CMS and CES is necessary to examine the hypothesis that CES patients tend to have a better functional outcome.


Assuntos
Polirradiculopatia , Compressão da Medula Espinal , Terminologia como Assunto , Humanos , Síndromes de Compressão Nervosa/diagnóstico por imagem , Síndromes de Compressão Nervosa/patologia , Síndromes de Compressão Nervosa/fisiopatologia , Polirradiculopatia/diagnóstico por imagem , Polirradiculopatia/patologia , Polirradiculopatia/fisiopatologia , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/patologia , Compressão da Medula Espinal/fisiopatologia
14.
World Neurosurg ; 104: 575-580, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28532907

RESUMO

OBJECTIVE: To prospectively evaluate the morphological and structural changes in the trigeminal nerve in patients with trigeminal neuralgia (TN) compared with healthy controls. METHODS: We conducted a prospective case-control study of 60 consecutive patients diagnosed with TN and 30 sex-and age-matched healthy controls. All subjects underwent high-resolution 3-dimensional magnetic resonance imaging (MRI). The volume and length of the cisternal segment of the trigeminal nerve and the angle between the trigeminal nerve and the anterior surface of the pons (trigeminal pontine angle) were measured and compared. RESULTS: The mean volume of the affected trigeminal nerve was significantly reduced compared with that of the nonaffected side (65.8 ± 21.1 mm3 vs. 77.9 ± 19.3 mm3; P = 0.001) and controls (65.8 ± 21.1 mm3 vs. 74.7 ± 16.5 mm3; P = 0.003). The mean trigeminal pontine angle was 42.4 ± 8.7° on the affected side, 47.6 ± 9.2° on the nonaffected side, and 46.0 ± 7.2° in the controls. The trigeminal pontine angle on the affected side was significantly smaller than that on the nonaffected side (P = 0.005) and in controls (P = 0.01). There the was no statistically significant difference in the mean length of the cisternal segment of trigeminal nerve between the affected and nonaffected sides (P = 0.46). CONCLUSIONS: TN is associated with atrophy and a small trigeminal pontine angle in the affected nerve. Nerve atrophy may be a late consequence of chronic physical stress and is likely involved in the pathogenesis of TN. A small trigeminal pontine angle may increase the risk of neurovascular conflict, and thus more likely to result in the genesis of TN.


Assuntos
Imagem Tridimensional , Imagem por Ressonância Magnética , Síndromes de Compressão Nervosa/diagnóstico por imagem , Síndromes de Compressão Nervosa/patologia , Ponte/diagnóstico por imagem , Ponte/cirurgia , Nervo Trigêmeo/diagnóstico por imagem , Nervo Trigêmeo/patologia , Neuralgia do Trigêmeo/diagnóstico por imagem , Neuralgia do Trigêmeo/patologia , Adulto , Idoso , Atrofia , Estudos de Casos e Controles , Constrição Patológica/diagnóstico por imagem , Constrição Patológica/patologia , Constrição Patológica/cirurgia , Feminino , Seguimentos , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/cirurgia , Estudos Prospectivos , Valores de Referência , Fatores de Risco , Nervo Trigêmeo/cirurgia , Neuralgia do Trigêmeo/cirurgia , Adulto Jovem
15.
J Neurosci Methods ; 284: 47-56, 2017 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-28445708

RESUMO

BACKGROUND: Cellular responses to nerve injury play a central role in the pathogenesis of neuropathic pain. However, the analysis of site specific cellular responses to nerve injury and neuropathic pain is limited to immunohistochemistry staining with numerous limitations. NEW METHODS: We proposed to apply flow cytometry to overcome some of the limitations and developed two protocols for isolation of cells from small specimens of the sciatic nerve and dorsal root ganglion (DRG) in mice. RESULTS AND COMPARASION WITH EXISTING: methods We found that both the non-enzymatic and enzymatic approaches were highly effective in harvesting a sufficient number of cells for flow cytometry analysis in normal and pathological conditions. The total number of cells in the injury site of the sciatic and its DRGs increased significantly 14days after chronic constriction injury (CCI) of the sciatic nerve, compared to sham surgery control or the contralateral control. The enzymatic approach yielded a significantly higher total number of cells and CD45 negative cells, suggesting that this approach allows for harvest of more resident cells, compared to the non-enzymatic method. The percentage of CD45+/CD11b+ cells was significantly increased in the sciatic nerve but not in the DRG. These results were consistent with both protocols. CONCLUSIONS: We thus offer two simple and effective protocols that allow for application of flow cytometry to the investigation of cellular and molecular mechanisms of neuropathic pain.


Assuntos
Citometria de Fluxo/métodos , Síndromes de Compressão Nervosa/imunologia , Síndromes de Compressão Nervosa/patologia , Neuralgia/imunologia , Neuralgia/patologia , Neuropatia Ciática/imunologia , Neuropatia Ciática/patologia , Animais , Feminino , Gânglios Espinais/imunologia , Gânglios Espinais/lesões , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Nervo Isquiático/imunologia , Nervo Isquiático/patologia
16.
Am J Surg ; 213(5): 975-982, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28388973

RESUMO

PURPOSE: The purpose of this study is to describe the known soft tissue neuro-histology factors associated with compression neuropathy in relation to the incidence of preoperative pain in primary inguinal hernia. Enlargement of the ilioinguinal nerve occurs in 63% of patients with primary inguinal hernia; compression neuropathy has similar gross features. METHODS: Patients completed pain questionnaires pertaining to preoperative pain and the quality of pain experienced. During routine inguinal hernia repair, nerve segments were sampled for histologic evaluation. RESULTS: Twenty-two thickened nerve segments (63% of total) with proximal and distal specimens were resected for examination and comparison. We quantified various histologic indicators including nerve diameter, fascicle count, myxoid content within the epineurium, perineurium and endoneurium. Increased preoperative patient pain scores correlate with increased nerve diameter, increased fascicle count and increased myxoid material both within the perineurium and endoneurium. CONCLUSION: These findings support the concept that preoperative hernia pain is associated with compression neuropathy.


Assuntos
Hérnia Inguinal/complicações , Canal Inguinal/inervação , Canal Inguinal/patologia , Síndromes de Compressão Nervosa/etiologia , Neuralgia/etiologia , Hérnia Inguinal/patologia , Hérnia Inguinal/cirurgia , Herniorrafia , Humanos , Síndromes de Compressão Nervosa/diagnóstico , Síndromes de Compressão Nervosa/patologia , Neuralgia/diagnóstico , Neuralgia/patologia , Medição da Dor , Período Pré-Operatório , Estudos Prospectivos
17.
Neurol Res ; 39(4): 285-291, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28290778

RESUMO

OBJECTIVE: Recently, neural microcirculation and regeneration were regarded as critical factors in diabetic peripheral neuropathy (DPN) improvement. In the present study, we explored the cytological and molecular mechanisms how peripheral nerve decompression impaired nerve injury. METHODS: Forty-five male SD rats were established as the DPN model. HE staining was used to observe the morphology and distribution of microvessels. Transmission electron microscopy was applied to observe the morphology and distribution of Schwann cells. Immunohistochemical staining was performed to measure nerve growth factor (NGF), tyrosine kinase receptor A (TrkA) and growth-associated protein 43 (GAP-43) in the distal sciatic nerve. RESULTS: Distribution of microvessels and Schwann cells decreased in the DPN group (p < 0.05). NGF, TrkA and GAP-43 also decreased significantly in the DPN group (p < 0.05). NGF, TrkA, GAP-43 and distribution of microvessels and Schwann cells increased in the decompressed group (p < 0.05). DISCUSSION: In DPN rats, after nerves are compressed, microcirculation disturbance and hypoxia ischemia will happen, which cause decreased expression of NGF, TrkA and GAP-43. Finally, the self-healing function of compressed nerves is impacted. Conversely, nerve decompression can improve neural microcirculation and regeneration and change the former pathological process.


Assuntos
Neuropatias Diabéticas/fisiopatologia , Neuropatias Diabéticas/terapia , Microcirculação/fisiologia , Síndromes de Compressão Nervosa/fisiopatologia , Síndromes de Compressão Nervosa/terapia , Regeneração Nervosa/fisiologia , Animais , Diabetes Mellitus Experimental/patologia , Diabetes Mellitus Experimental/fisiopatologia , Neuropatias Diabéticas/patologia , Modelos Animais de Doenças , Proteína GAP-43/metabolismo , Imuno-Histoquímica , Masculino , Microscopia Eletrônica de Transmissão , Microvasos/patologia , Microvasos/fisiologia , Síndromes de Compressão Nervosa/patologia , Fator de Crescimento Neural/metabolismo , Distribuição Aleatória , Ratos Sprague-Dawley , Receptor trkA/metabolismo , Células de Schwann/metabolismo , Células de Schwann/patologia , Nervo Isquiático/irrigação sanguínea , Nervo Isquiático/patologia , Nervo Isquiático/fisiopatologia
18.
Spine (Phila Pa 1976) ; 42(19): 1434-1439, 2017 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-28169954

RESUMO

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.


Assuntos
Astrócitos/metabolismo , Endotélio Vascular/metabolismo , Dor/metabolismo , Radiculopatia/metabolismo , Raízes Nervosas Espinhais/metabolismo , Vimentina/metabolismo , Animais , Astrócitos/patologia , Vértebras Cervicais , Endotélio Vascular/patologia , Proteína Glial Fibrilar Ácida/metabolismo , Hiperalgesia/metabolismo , Hiperalgesia/patologia , Masculino , Síndromes de Compressão Nervosa/metabolismo , Síndromes de Compressão Nervosa/patologia , Dor/patologia , Radiculopatia/patologia , Ratos , Ratos Sprague-Dawley , Raízes Nervosas Espinhais/patologia
19.
No Shinkei Geka ; 45(2): 117-125, 2017 Feb.
Artigo em Japonês | MEDLINE | ID: mdl-28202828

RESUMO

The optimal method for diagnosing cochleovestibular neurovascular compression syndrome(CNVC)remains controversial, and the aim of this study is to develop a standard diagnostic instrument for the condition. The clinical features of 53 sides of 50 patients with a combination of vertigo, tinnitus, and/or hearing loss were retrospectively evaluated. The following five clinical features were evaluated and given a score of 1 or 0:1)a long history of recurrent vertigo, tinnitus, or hearing loss;2)neurological findings related to positional vertigo, nystagmus, tinnitus, or hearing loss;3)neuro-otological findings involving tinnitus, audiometry, or vestibular testing;4)auditory brainstem response(ABR)evaluation with the detection of a low 25-75% II wave amplitude on the contralateral side and delayed interpeak latency in the I-III or I-V waves(usually low II wave amplitude combined with double peaks and a wide-based form)during ABR evaluation using 80 and 90dB clicks;and 5)the detection of vascular contact with the eighth cranial nerve on magnetic resonance imaging-constructive interference in steady state or air computed tomography imaging. Finally, the sum of these scores was evaluated. For cases in which more than one of the features of the items 1), 2), or 3) were present, the score was evaluated based on the most representative of the items. RESULTS: The patients were divided into those with scores of 4-5 and those with scores of 2-3. All the patients with scores of 4-5 exhibited CNVC, while those with scores of 2-3 had other diseases. Therefore, CNVC should be suspected in patients with scores of 4-5, but can be ruled out in those with scores of 2-3.


Assuntos
Potenciais Evocados Auditivos do Tronco Encefálico/fisiologia , Síndromes de Compressão Nervosa/diagnóstico , Zumbido/diagnóstico , Vertigem/diagnóstico , Adulto , Idoso , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/patologia , Estudos Retrospectivos , Zumbido/patologia , Vertigem/patologia
20.
World Neurosurg ; 98: 870.e1-870.e3, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28003172

RESUMO

A 65-year-old female presented with progressive unilateral vision loss leading to blindness and features of central diabetes insipidus (DI) for 3 months' duration. Imaging showed a well-circumscribed, lobulated, rim-enhancing suprasellar lesion with inhomogeneous diffusion restriction. Through a pterional trans-sylvian approach, subtotal resection was performed and histopathology revealed features of an epidermoid cyst. At 5 months' follow-up, she had improvement of her diabetes insipidus but no visual improvement. This paper presents a case of suprasellar epidermoid with atypical imaging findings.


Assuntos
Cistos do Sistema Nervoso Central/patologia , Cisto Epidérmico/patologia , Idoso , Cegueira/etiologia , Cegueira/patologia , Cegueira/cirurgia , Cistos do Sistema Nervoso Central/cirurgia , Craniotomia/métodos , Diabetes Insípido Neurogênico/etiologia , Diabetes Insípido Neurogênico/patologia , Diabetes Insípido Neurogênico/cirurgia , Cisto Epidérmico/cirurgia , Feminino , Humanos , Imagem por Ressonância Magnética , Síndromes de Compressão Nervosa/etiologia , Síndromes de Compressão Nervosa/patologia , Síndromes de Compressão Nervosa/cirurgia , Doenças do Nervo Óptico/etiologia , Doenças do Nervo Óptico/patologia , Doenças do Nervo Óptico/cirurgia , Resultado do Tratamento
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