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1.
Neurobiol Dis ; 176: 105952, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36493976

RESUMO

The glial cell of the peripheral nervous system (PNS), the Schwann cell (SC), counts among the most multifaceted cells of the body. During development, SCs secure neuronal survival and participate in axonal path finding. Simultaneously, they orchestrate the architectural set up of the developing nerves, including the blood vessels and the endo-, peri- and epineurial layers. Perinatally, in rodents, SCs radially sort and subsequently myelinate individual axons larger than 1 µm in diameter, while small calibre axons become organised in non-myelinating Remak bundles. SCs have a vital role in maintaining axonal health throughout life and several specialized SC types perform essential functions at specific locations, such as terminal SC at the neuromuscular junction (NMJ) or SC within cutaneous sensory end organs. In addition, neural crest derived satellite glia maintain a tight communication with the soma of sensory, sympathetic, and parasympathetic neurons and neural crest derivatives are furthermore an indispensable part of the enteric nervous system. The remarkable plasticity of SCs becomes evident in the context of a nerve injury, where SC transdifferentiate into intriguing repair cells, which orchestrate a regenerative response that promotes nerve repair. Indeed, the multiple adaptations of SCs are captivating, but remain often ill-resolved on the molecular level. Here, we summarize and discuss the knowns and unknowns of the vast array of functions that this single cell type can cover in peripheral nervous system development, maintenance, and repair.


Assuntos
Traumatismos dos Nervos Periféricos , Células de Schwann , Humanos , Células de Schwann/metabolismo , Nervos Periféricos/metabolismo , Axônios/metabolismo , Neurônios/metabolismo , Sistema Nervoso Periférico/metabolismo , Regeneração Nervosa/fisiologia , Traumatismos dos Nervos Periféricos/metabolismo
2.
Artigo em Inglês | MEDLINE | ID: mdl-36446613

RESUMO

BACKGROUND AND OBJECTIVES: To clinically characterize post-immune checkpoint inhibitor (ICI) Hu antibody (Ab) neurologic disorders, we analyzed Hu-Ab-positive patients with neurologic immune-related adverse events (n-irAEs) and compared them with patients with other n-irAEs, ICI-naive patients with Hu-Ab paraneoplastic neurologic syndromes (PNSs) identified in the same study center, and those with Hu-Ab n-irAEs reported elsewhere. METHODS: Patients whose samples were sent to the French reference center for a suspicion of n-irAE (2015-2021) were identified; those with a final diagnosis of n-irAE and Hu-Ab were included. Control groups included patients with a final diagnosis of n-irAE occurring during the same period as the patients included (2018-2021) but without Hu-Ab, and ICI-naive patients with Hu-Ab PNS diagnosed during the same period; a systematic review was performed to identify previous reports. RESULTS: Eleven patients with Hu-Ab and n-irAEs were included (median age, 66 years, range 44-76 years; 73% men). Ten patients had small cell lung cancer, and 1 had lung adenocarcinoma. The median follow-up from onset was 3 months (range 0.5-18 months). Compared with those with other n-irAEs (n = 63), Hu-Ab-positive patients had more frequently co-occurring involvement of both central and peripheral nervous systems (36% vs 8%, p = 0.02) and limbic (54% vs 14%, p < 0.01), brainstem (27% vs 5%, p = 0.02), and dorsal root ganglia (45% vs 5%, p < 0.01) involvement. The proportion of patients with severe disability (modified Rankin Scale score >3) at diagnosis was higher among Hu-Ab n-irAEs (91% vs 52%, p = 0.02). Patients with Hu-Ab had also poorer outcome (100% vs 28%, p < 0.01) and higher mortality (91% vs 46%, p < 0.01). There was no significant difference in terms of clinical features between Hu-Ab n-irAEs and ICI-naive Hu-Ab PNS (n = 92), but there was a poorer outcome (56/78, 71%, p < 0.01) and higher mortality (26%, p < 0.01) among the former. No significant difference was found between the patients reported herein and those in the literature. DISCUSSION: The presence of Hu-Ab identifies a subgroup of n-irAEs that consistently reproduce the phenotypes of Hu-Ab-related PNS, supporting the hypothesis of ICI triggering or unmasking PNS. As these patients show high disability and mortality, further studies are required to investigate the underlying immunopathogenic mechanisms and to improve the outcome of Hu-Ab n-irAEs.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Neoplasias Pulmonares , Humanos , Masculino , Feminino , Inibidores de Checkpoint Imunológico/efeitos adversos , Sistema Nervoso Periférico , Anticorpos Antinucleares
3.
Sci Rep ; 12(1): 20810, 2022 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-36460669

RESUMO

Neurons are connected by complex branching processes-axons and dendrites-that process information for organisms to respond to their environment. Classifying neurons according to differences in structure or function is a fundamental part of neuroscience. Here, by constructing biophysical theory and testing against empirical measures of branching structure, we develop a general model that establishes a correspondence between neuron structure and function as mediated by principles such as time or power minimization for information processing as well as spatial constraints for forming connections. We test our predictions for radius scale factors against those extracted from neuronal images, measured for species that range from insects to whales, including data from light and electron microscopy studies. Notably, our findings reveal that the branching of axons and peripheral nervous system neurons is mainly determined by time minimization, while dendritic branching is determined by power minimization. Our model also predicts a quarter-power scaling relationship between conduction time delay and body size.


Assuntos
Axônios , Neurônios , Animais , Fenômenos Físicos , Sistema Nervoso Periférico , Cetáceos , Dendritos
4.
Front Immunol ; 13: 1063928, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36466889

RESUMO

The central nervous system is the most important nervous system in vertebrates, which is responsible for transmitting information to the peripheral nervous system and controlling the body's activities. It mainly consists of the brain and spinal cord, which contains rich of neurons, the precision of the neural structures susceptible to damage from the outside world and from the internal factors of inflammation infection, leading to a series of central nervous system diseases, such as traumatic brain injury, nerve inflammation, etc., these diseases may cause irreversible damage on the central nervous or lead to subsequent chronic lesions. After disease or injury, the immune system of the central nervous system will play a role, releasing cytokines to recruit immune cells to enter, and the immune cells will differentiate according to the location and degree of the lesion, and become specific immune cells with different functions, recognize and phagocytose inflammatory factors, and repair the damaged neural structure. However, if the response of these immune cells is not suppressed, the overexpression of some genes can cause further damage to the central nervous system. There is a need to understand the molecular mechanisms by which these immune cells work, and this information may lead to immunotherapies that target certain diseases and avoid over-activation of immune cells. In this review, we summarized several immune cells that mainly play a role in the central nervous system and their roles, and also explained the response process of the immune system in the process of some common neurological diseases, which may provide new insights into the central nervous system.


Assuntos
Doenças do Sistema Nervoso Central , Animais , Sistema Nervoso Central , Sistema Imunitário , Sistema Nervoso Periférico , Inflamação
5.
J Med Life ; 15(11): 1442-1448, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36567843

RESUMO

Overlapping central nervous system (CNS) and peripheral nervous system (PNS) demyelination is a rare clinical entity, more frequently seen in patients with chronic inflammatory demyelinating polyneuropathy (CIDP) and multiple sclerosis (MS). This case report showcases a patient with atypical CIDP and CNS demyelination lesions. Demographic data, disease course, treatment responsiveness, neurological examination, laboratory tests, nerve conduction studies (NCS), and brain and spinal cord MRI were registered. The case highlights the difficulty of diagnosis establishment and treatment selection, given the atypical course of the disease and limited answers to the indicated therapies. The data from our report suggest that specific and widely available immunological targets are necessary for diagnosing combined central and peripheral demyelination cases appropriately. The association of different immunotherapeutic agents may be necessary to induce and maintain disease remission.


Assuntos
Esclerose Múltipla , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica , Humanos , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/diagnóstico por imagem , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/patologia , Sistema Nervoso Central , Sistema Nervoso Periférico , Encéfalo/patologia
6.
Int J Mol Sci ; 23(23)2022 Nov 23.
Artigo em Inglês | MEDLINE | ID: mdl-36498887

RESUMO

(1) The co-occurrence of AQP4 and myelin oligodendrocyte glycoprotein (MOG) antibodies in patients with demyelinating disorders is extremely rare. In addition, a concomitant involvement of the peripheral nervous system (PNS) has been described either in association with AQP4 antibodies-positive neuromyelitis optica spectrum disorder (NMOSD), or MOG-associated disease. We report on a case of NMOSD with co-occurrence of AQP4 and MOG antibodies and concomitant central and peripheral nervous system involvement. We also reviewed available cases of AQP4-MOG double-positive patients. (2) Brain and spine MRI, cerebrospinal fluid studies, and electrophysiological test were performed. Serum AQP4 and MOG positivity was assessed with live cell-based assay. (3) A 62-year-old woman presented with recurrent optic neuritis, myelitis, and radiculitis, tested positive for AQP4 and MOG antibodies, and was treated successfully with rituximab. (4) Although few cases of AQP4-MOG double-positive patients were already described mostly affecting females with a concomitant spinal cord and optical nerve involvement, we describe the first case of double-positive NMOSD with the peculiar involvement of both central and peripheral nervous system.


Assuntos
Neuromielite Óptica , Feminino , Humanos , Neuromielite Óptica/diagnóstico por imagem , Glicoproteína Mielina-Oligodendrócito , Aquaporina 4 , Autoanticorpos , Imunoglobulina G , Sistema Nervoso Periférico
7.
Rom J Morphol Embryol ; 63(2): 335-347, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36374139

RESUMO

In this paper, we developed the hypothesis concerning the reasons to assimilate endoneurial fibroblast-like dendritic phenotype [shortly termed endoneurial dendritic cells (EDCs)] to the endoneurial telocytes (TCs). We reviewed the literature concerning EDCs status and report our observations on ultrastructure and some immune electron microscopic aspects of the cutaneous peripheral nerves. Our data demonstrate that EDCs long time considered as fibroblasts or fibroblast-like, with an ovoidal nucleus and one or more moniliform cell extensions [telopodes (Tps)], which perform homocellular junctions, also able to shed extracellular microvesicles can be assimilated to TC phenotype. Sometimes, small profiles of basement membrane accompany to some extent Tps. Altogether data resulted from scientific literature and our results strength the conclusion EDCs are really TCs inside of the peripheral nervous system. The inner three-dimensional (3D) network of endoneurial TCs by their homo- and heterocellular communications appears as a genuine cell-to-cell communication system inside of each peripheral nerve.


Assuntos
Telócitos , Comunicação Celular , Fibroblastos , Sistema Nervoso Periférico , Nervos Periféricos
8.
Curr Opin Cell Biol ; 79: 102133, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36347131

RESUMO

Neuron types are the building blocks of the nervous system, and therefore, of functional circuits. Understanding the origin of neuronal diversity has always been an essential question in neuroscience and developmental biology. While knowledge on the molecular control of their diversification has largely increased during the last decades, it is now possible to reveal the dynamic mechanisms and the actual stepwise molecular changes occurring at single-cell level with the advent of single-cell omics technologies and analysis with high temporal resolution. Here, we focus on recent advances in the field and in technical and analytical tools that enable detailed insights into the emergence of neuron types in the central and peripheral nervous systems.


Assuntos
Neurônios , Sistema Nervoso Periférico
9.
Int J Mol Sci ; 23(21)2022 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-36361821

RESUMO

Chronic neuropathic pain (CNP) affects around 10% of the general population and has a significant social, emotional, and economic impact. Current diagnosis techniques rely mainly on patient-reported outcomes and symptoms, which leads to significant diagnostic heterogeneity and subsequent challenges in management and assessment of outcomes. As such, it is necessary to review the approach to a pathology that occurs so frequently, with such burdensome and complex implications. Recent research has shown that imaging methods can detect subtle neuroplastic changes in the central and peripheral nervous system, which can be correlated with neuropathic symptoms and may serve as potential markers. The aim of this paper is to review available imaging methods used for diagnosing and assessing therapeutic efficacy in CNP for both the preclinical and clinical setting. Of course, further research is required to standardize and improve detection accuracy, but available data indicate that imaging is a valuable tool that can impact the management of CNP.


Assuntos
Neuralgia , Humanos , Neuralgia/diagnóstico por imagem , Neuralgia/terapia , Sistema Nervoso Periférico , Biomarcadores , Diagnóstico por Imagem
11.
Biochim Biophys Acta Rev Cancer ; 1877(6): 188828, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36283598

RESUMO

Recent studies have shown that peripheral nerves play an important role in the progression of breast cancer. Breast cancer cells (BCCs) promote local peripheral nerve growth and branching by secreting neuroactive molecules, including neurotrophins and axon guidance molecules (AGMs). Sympathetic nerves promote breast cancer progression, while parasympathetic and sensory nerves mainly have anti-tumor effects in the progression of breast cancer. Specifically, peripheral nerves can influence the progression of breast cancer by secreting neurotransmitters not only directly binding to the corresponding receptors of BCCs, but also indirectly acting on immune cells to modulate anti-tumor immunity. In this review, we summarize the crosstalk between breast cancer and peripheral nerves and the roles of important neuroactive molecules in the progression of breast cancer. In addition, we summarize indicators, including nerve fiber density and perineural invasion (PNI), that may help determine the prognosis of breast cancer based on current research results, as well as potential therapeutic approaches, such as ß-blockers and retroviral-mediated genetic neuroengineering techniques, that may enhance the prognosis of breast cancer. In addition, we propose suggestions for future research priorities based on a current lack of knowledge in this area.


Assuntos
Neoplasias da Mama , Humanos , Feminino , Invasividade Neoplásica/patologia , Orientação de Axônios , Sistema Nervoso Periférico/patologia
12.
Rinsho Ketsueki ; 63(9): 991-998, 2022.
Artigo em Japonês | MEDLINE | ID: mdl-36198563

RESUMO

The nervous system is distributed throughout all body organs and unconsciously maintains homeostasis. The peripheral nervous system, which comprises autonomic and sensory nerves, is distributed in the bone marrow, which controls hematopoiesis, and the surrounding bone tissue, which is also closely associated with hematopoiesis regulation. Recent advances in research techniques have revealed that the peripheral nervous system affects normal hematopoiesis, hematopoiesis under stress, and the regulation of hematopoietic aging. The peripheral nervous system also affects the development and progression of malignant tumors, including hematopoietic tumors and normal tissue, making the peripheral nerve regulation a potential new therapeutic target.


Assuntos
Neoplasias , Nicho de Células-Tronco , Células da Medula Óssea , Hematopoese/fisiologia , Células-Tronco Hematopoéticas , Humanos , Sistema Nervoso Periférico
13.
Artigo em Russo | MEDLINE | ID: mdl-36168683

RESUMO

Based on the available literature data, the article discusses the prevalence of various forms of damage of the peripheral nervous system in COVID-19 and in the post-COVID period. Information about the clinical features and the course of individual cranial neuropathies, chronic dysimmune neuropathies, Guillain-Barré syndrome, drug-induced neuropathies, fine fiber neuropathy, myasthenia gravis and polyneuropathy of critical conditions was systemized in the context of coronavirus infection. SARS-CoV-2 can trigger various stages of pathogenesis, including neuroimmune ones, which cause long-term consequences of COVID-19, including those associated with the damage of the peripheral nervous system. Awareness of COVID-19-associated pathological conditions will allow assessment of the possible risks of damage of the peripheral nervous system, recognize them at early stages and develop more effective approaches for treatment.


Assuntos
COVID-19 , Síndrome de Guillain-Barré , Miastenia Gravis , COVID-19/complicações , Síndrome de Guillain-Barré/complicações , Síndrome de Guillain-Barré/etiologia , Humanos , Miastenia Gravis/complicações , Sistema Nervoso Periférico , SARS-CoV-2
15.
Dev Biol ; 490: 37-49, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35820658

RESUMO

The vertebrate peripheral nervous system (PNS) is an intricate network that conveys sensory and motor information throughout the body. During development, extracellular cues direct the migration of axons and glia through peripheral tissues. Currently, the suite of molecules that govern PNS axon-glial patterning is incompletely understood. To elucidate factors that are critical for peripheral nerve development, we characterized the novel zebrafish mutant, stl159, that exhibits abnormalities in PNS patterning. In these mutants, motor and sensory nerves that develop adjacent to axial muscle fail to extend normally, and neuromasts in the posterior lateral line system, as well as neural crest-derived melanocytes, are incorrectly positioned. The stl159 genetic lesion lies in the basic helix-loop-helix (bHLH) transcription factor tcf15, which has been previously implicated in proper development of axial muscles. We find that targeted loss of tcf15 via CRISPR-Cas9 genome editing results in the PNS patterning abnormalities observed in stl159 mutants. Because tcf15 is expressed in developing muscle prior to nerve extension, rather than in neurons or glia, we predict that tcf15 non-cell-autonomously promotes peripheral nerve patterning in zebrafish through regulation of extracellular patterning cues. Our work underscores the importance of muscle-derived factors in PNS development.


Assuntos
Nervos Periféricos , Peixe-Zebra , Animais , Axônios/fisiologia , Fatores de Transcrição Hélice-Alça-Hélice Básicos , Músculos , Sistema Nervoso Periférico , Peixe-Zebra/genética
16.
Glia ; 70(12): 2237-2259, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-35785432

RESUMO

Myelin is essential to nervous system function, playing roles in saltatory conduction and trophic support. Oligodendrocytes (OLs) and Schwann cells (SCs) form myelin in the central and peripheral nervous systems respectively and follow different developmental paths. OLs are neural stem-cell derived and follow an intrinsic developmental program resulting in a largely irreversible differentiation state. During embryonic development, OL precursor cells (OPCs) are produced in distinct waves originating from different locations in the central nervous system, with a subset developing into myelinating OLs. OPCs remain evenly distributed throughout life, providing a population of responsive, multifunctional cells with the capacity to remyelinate after injury. SCs derive from the neural crest, are highly dependent on extrinsic signals, and have plastic differentiation states. SC precursors (SCPs) are produced in early embryonic nerve structures and differentiate into multipotent immature SCs (iSCs), which initiate radial sorting and differentiate into myelinating and non-myelinating SCs. Differentiated SCs retain the capacity to radically change phenotypes in response to external signals, including becoming repair SCs, which drive peripheral regeneration. While several transcription factors and myelin components are common between OLs and SCs, their differentiation mechanisms are highly distinct, owing to their unique lineages and their respective environments. In addition, both OLs and SCs respond to neuronal activity and regulate nervous system output in reciprocal manners, possibly through different pathways. Here, we outline their basic developmental programs, mechanisms regulating their differentiation, and recent advances in the field.


Assuntos
Bainha de Mielina , Células de Schwann , Feminino , Humanos , Bainha de Mielina/metabolismo , Neuroglia , Sistema Nervoso Periférico/fisiologia , Gravidez , Células de Schwann/metabolismo , Fatores de Transcrição/metabolismo
17.
Cell Rep ; 40(3): 111130, 2022 07 19.
Artigo em Inglês | MEDLINE | ID: mdl-35858549

RESUMO

Peripheral nervous system (PNS) injuries initiate transcriptional changes in glial cells and sensory neurons that promote axonal regeneration. While the factors that initiate the transcriptional changes in glial cells are well characterized, the full range of stimuli that initiate the response of sensory neurons remain elusive. Here, using a genetic model of glial cell ablation, we find that glial cell loss results in transient PNS demyelination without overt axonal loss. By profiling sensory ganglia at single-cell resolution, we show that glial cell loss induces a transcriptional injury response preferentially in proprioceptive and Aß RA-LTMR neurons. The transcriptional response of sensory neurons to mechanical injury has been assumed to be a cell-autonomous response. By identifying a similar response in non-injured, demyelinated neurons, our study suggests that this represents a non-cell-autonomous transcriptional response of sensory neurons to glial cell loss and demyelination.


Assuntos
Doenças Desmielinizantes , Neuroglia , Humanos , Neuroglia/fisiologia , Sistema Nervoso Periférico , Células Receptoras Sensoriais
18.
Histochem Cell Biol ; 158(5): 497-511, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-35854144

RESUMO

We previously reported that the membrane skeletal protein 4.1G in the peripheral nervous system transports membrane palmitoylated protein 6 (MPP6), which interacts with the synaptic scaffolding protein Lin7 and cell adhesion molecule 4 (CADM4) in Schwann cells that form myelin. In the present study, we investigated the localization of and proteins related to MPP2, a highly homologous family protein of MPP6, in the cerebellum of the mouse central nervous system, in which neurons are well organized. Immunostaining for MPP2 was observed at cerebellar glomeruli (CG) in the granular layer after postnatal day 14. Using the high-resolution Airyscan mode of a confocal laser-scanning microscope, MPP2 was detected as a dot pattern and colocalized with CADM1 and Lin7, recognized as small ring/line patterns, as well as with calcium/calmodulin-dependent serine protein kinase (CASK), NMDA glutamate receptor 1 (GluN1), and M-cadherin, recognized as dot patterns, indicating the localization of MPP2 in the excitatory postsynaptic region and adherens junctions of granule cells. An immunoprecipitation analysis revealed that MPP2 formed a molecular complex with CADM1, CASK, M-cadherin, and Lin7. Furthermore, the Lin7 staining pattern showed small rings surrounding mossy fibers in wild-type CG, while it changed to the dot/spot pattern inside small rings detected with CADM1 staining in MPP2-deficient CG. These results indicate that MPP2 influences the distribution of Lin7 to synaptic cell membranes at postsynaptic regions in granule cells at CG, at which electric signals enter the cerebellum.


Assuntos
Cerebelo , Proteínas de Membrana , Animais , Camundongos , Membrana Celular/química , Cerebelo/química , Guanilato Quinases , Proteínas de Membrana/metabolismo , Sistema Nervoso Periférico/metabolismo
19.
J Vis Exp ; (184)2022 06 27.
Artigo em Inglês | MEDLINE | ID: mdl-35815978

RESUMO

During vertebrate development, neural crest cells (NCCs) migrate extensively and differentiate into various cell types that contribute to structures like the craniofacial skeleton and the peripheral nervous system. While it is critical to understand NCC migration in the context of a 3D embryo, isolating migratory cells in 2D culture facilitates visualization and functional characterization, complementing embryonic studies. The present protocol demonstrates a method for isolating chick cranial neural folds to generate primary NCC cultures. Migratory NCCs emerge from neural fold explants plated onto a fibronectin-coated substrate. This results in dispersed, adherent NCC populations that can be assessed by staining and quantitative morphological analyses. This simplified culture approach is highly adaptable and can be combined with other techniques. For example, NCC emigration and migratory behaviors can be evaluated by time-lapse imaging or functionally queried by including inhibitors or experimental manipulations of gene expression (e.g., DNA, morpholino, or CRISPR electroporation). Because of its versatility, this method provides a powerful system for investigating cranial NCC development.


Assuntos
Embrião de Mamíferos , Crista Neural , Movimento Celular/fisiologia , Sistema Nervoso Periférico
20.
Mult Scler Relat Disord ; 65: 103997, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35816954

RESUMO

INTRODUCTION: Multiple cranial neuropathies (MCN) is an entity frequently seen in clinical practice but there is a lack of studies published about this entity, with most of them based on case reports and small case series. OBJECTIVE: The aim of this study is to describe the clinical involvement of different cranial nerves, the location within the central or peripheral nervous system and the diagnosis in a group of patients with MCN managed in one hospital in Bogotá-Colombia. METHODOLOGY: A case series study was conducted using the electronic clinical records of a teaching hospital in Bogota-Colombia. Clinical data were collected from patients aged ≥18 with a clinical diagnosis of MCN between 2015 and July 2021. RESULTS: The cranial nerves most commonly affected were III and VII, with the most prevalent combinations being III-IV, III-VI, and V-VII. Among etiologies, the most frequently found were autoimmune, vascular and neoplastic and most common locations included peripheral nerves, neuromuscular junction, cavernous sinus and lateral medulla. CONCLUSIONS: The differential diagnosis of MCN is broad, but clinical clues may aid in identifying the underlying etiology. According to our results, MG was the most frequent etiology, so it should be considered in any patient with a clinical diagnosis of MCN associated with fatigability.


Assuntos
Seio Cavernoso , Doenças dos Nervos Cranianos , Seio Cavernoso/inervação , Colômbia , Doenças dos Nervos Cranianos/diagnóstico , Doenças dos Nervos Cranianos/etiologia , Nervos Cranianos/irrigação sanguínea , Humanos , Sistema Nervoso Periférico
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