Diseases Of The Nerve Roots

(Radiculopathy)

Nerve root disease lead to segmental radicular deficits (z. B. dermatombezogene pain or paresthesias, weakness of innervated from the root muscles). The diagnosis may require imaging, an electro diagnostic testing and systemic examination for underlying diseases. Although the treatment depends on the cause, but includes in relieving symptoms NSAIDs, other analgesics and corticosteroids.

(See also summary of disorders of the peripheral nervous system.)

Nerve root disease lead to segmental radicular deficits (z. B. dermatombezogene pain or paresthesias, weakness of innervated from the root muscles). The diagnosis may require imaging, an electro diagnostic testing and systemic examination for underlying diseases. Although the treatment depends on the cause, but includes in relieving symptoms NSAIDs, other analgesics and corticosteroids. (See also summary of disorders of the peripheral nervous system.) Diseases of the nerve roots (radiculopathy) are triggered by acute or chronic pressure on a nerve root within near or adjacent to the spinal column (spinal nerve). Spinal nerve Etiology The most common cause is a herniated disc bony changes caused by rheumatoid arthritis or osteoarthritis, v. a. in the cervical and lumbar areas, can also compress individual nerve roots. Less common causes carcinomatous meningitis flick shaped multisegmental root lesions. Rarely, spinal lesions (eg. As epidural abscesses and tumors, spinal meningiomas, neurofibromas) can take the form of radicular symptoms instead of the more common symptoms of dysfunction of the spinal cord. Diabetes mellitus can cause ischemia of the nerve root, thereby causing a painful thoracic or related to the extremities radiculopathy. Infectious diseases, such as due to mycobacteria (eg. As tuberculosis), fungi (eg. B. histoplasmosis) or spirochetes (such as Lyme disease, syphilis), sometimes affecting the nerve roots. A herpes zoster infection usually causes a painful radiculopathy with dermatome sensory deficits and a characteristic rash, but it may also cause motor radiculopathy with segmental paresis and reflex loss. Cytomegalovirus-induced radiculoneuritis is a complication of AIDS. Symptoms and complaints radiculopathy tend to lead to characteristic radicular symptoms of pain and segmental neurological deficits, depending on the spinal height of the root affected (see Table: Symptoms often radiculopathy, according to the level of the spinal segment). The innervated by the affected motor root muscles are paretic and atrophy; they can also be limp paralyzed, with fasciculations. The involvement of a sensory root causes sensory loss in a dermatome distribution pattern. The corresponding tendon reflexes may be reduced or absent. Electric shock-like pain may radiate to the affected nerve root along in the innervation of the nerve root. Symptoms often radiculopathy, according to the level of the spinal segment Spinal height symptoms C6 pain at the trapezius edge and the shoulder top, often radiating to the thumb, with paresthesia and sensory impairment in the same regions weakness of the biceps Reduced biceps brachii- and brachioradialis reflex C7 pain in shoulder blade and armpit, Reduced radiating to the middle finger weakness of the triceps reflex of the triceps T (j ach segment) band-shaped Dysthesien around the chest L5 pain in the buttocks, rear lateral thigh, calf and foot drop foot with weakness of the front and rear tibia and fibula muscle sensory loss over the tibia and the posterior foot S1 pain at the back of the leg and buttocks along weakness of the medial gastrocnemius muscle with reduced plantar flexion failure of the Achilles reflex See Sensory loss over the lateral calf and foot pain can be exacerbated by movements on the Subarac hnoidalraum pressure on the nerve root transmitted (z. B. spinal movements, coughing, sneezing, running the Valsalva maneuver). Lesions of the cauda equina, affecting several lumbar and sacral roots, causing radicular symptoms in both legs and sphincters and sexual function can affect. Findings, indicating a spinal cord compression, are the following: A sensitive level (abrupt change in the sensitivity below a horizontal line through the spine) Sagging para- or tetraparesis reflex abnormalities below the compression point Early onset hyporeflexia, later followed by hyperreflexia sphincter dysfunction diagnosis Neuroimaging Sometimes electrodiagnostic testing radicular symptoms require an MRI or CT scan of the affected area. Myelography is required only when an MRI is contraindicated inconclusive (z. B. because of an implanted pacemaker or other metal parts) and a CT. The area to be displayed depends on the symptoms; if the amount is unclear, a localization of the root should be affected by electromagnetic diagnostic testing, however, the cause can not be identified by this. When the imaging reveals no anatomical abnormalities, a CSF analysis is performed to test for infectious or inflammatory causes, and fasting plasma glucose is determined to exclude diabetes mellitus. Treatment Treatment of cause and drs pain is treated, the specific causes. Acute pain requires adequate analgesics (eg. As acetaminophen, NSAIDs, sometimes opioids). NSAIDs are particularly useful in diseases associated with inflammation. Muscle relaxants, sedatives and topical treatments often provide added value. If the symptoms are not relieved by non-opioid analgesics, corticosteroids may be administered systemically or epidural injection; However, the analgesia is moderate and transient. Methylprednisolone, which is slipped over 6 d may be given: Beginning with 24 mg / d p.o., dose reduction of 4 mg / d. The treatment of chronic pain can be difficult; Acetaminophen and NSAIDs are often only partially effective, and their chronic use carries substantial risks. Opioids are associated with a high risk of dependence. Tricyclic antidepressants and anticonvulsants can, as well as physiotherapy and psychotherapy can be effective. In a few patients alternative medical therapy strategies (eg. As transdermal electrical nerve stimulation, spinal manipulation, acupuncture, medicinal herbs therapy) can be tried in case of failure of all other treatments. Conclusion Drag a radiculopathy considered in patients with segmental deficits as dermatonbezogene sensory abnormalities (eg. As pain, paresthesias) and / or motor abnormalities (eg. As weakness, atrophy, fasciculations, hyporeflexia) at the level of nerve root. Take in patients with a sensory level of bilateral flaccid weakness and / or sphincter dysfunction to a Rückenmarkksompression. Insert the clinical findings a radiculopathy close, perform an MRI or CT. Put in acute pain analgesics and sometimes corticosteroids, and consider other medications and other treatments and painkillers for chronic pain.

Health Life Media Team

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