Physical Medicine & Rehabilitation/ELECTRODIAGNOSTIC MEDICINE AND CLINICAL NEUROMUSCULAR PHYSIOLOGY (20) 썸네일형 리스트형 M/35 Right 2,3,4th fingers tingling sense (1YA) M/35 Right 2,3,4th fingers tingling sense (1YA) With cystic mass(1cm) just anterior to 2nd metacarpal bone Sensory NCS Nerve / Sites Rec. Site Peak Lat Amp.2-3 ms µV R MEDIAN - Digit II1. Wrist II 6.20 5.4 R MEDIAN - III1. Wrist II 7.40 9.3 L MEDIAN - Digit II1. Wrist II 3.70 43.3 R ULNAR - DIGITAL (V)1. Wrist II 3.45 31.5 R MEDIAN - DIgit IV1. Median 7.55 5.3 2. Ulnar 3.15 21.3 Nerve / Sites La.. Three broad categories of focal nerve injury Three broad categories of focal nerve injury 1. Minimal neural insult - Focal AP propagation failure secondary to short period of ischemia - slowing of nerve conduction is possible if neural blockade is incomplete with sparing of the relatively slower conduction fibers. i.e., preferential blockade of fastest-conducting fibers 2. Intermediate neural injury - failure or slowing of AP propagation s.. Entrapment neuropathy Pathologicallly, entrapment neuropathy characterized by ❶ paranodal demyelination in the early stages ❷ complete segmental demyelination in the full-blown stage ❸ complete degeneration of fibers in the later stage -> wallerian degeneration in the nerve distal to the entrapment is natural consequence Monomelic amyotrophy Monomelic amyotrophy는 편측의 상지나 하지 혹은 다른측에 비하여 한쪽사지의 원위부에 현저한 침범을 보이는 전각세포 병변으로, 양성적인 예후를 가지는 운동 신경원성 질환의 드문 형태이다. 병의 진행은 2-3년간 서서히 지속되다가 정지되는 경우가 대부분 첫증상: 통증을 수반하지 않는 근위축 및 근쇠약 (상지 원위부에 국한) 대개 편측증상, but 근위부 침범, 하지 침범, 양측 상지 침범의 경우도 보고 Tremor, cold paresis P/R(-) EMG CMAP 운동신경의 axonal damage가 심한 경우 amplitude감소, onset latency 감소, F-wave 지연 및 미세한 속도지연소견이 나타날 수 있다고 함 Needle EMG상 근위축이 있는 근육에서는 ASA관찰 P.. F-wave F-wave. F response: Stimulation (dot) is followed by the source of depolarization (arrows). Initially depolarization travels in both directions: fi rst directly to the muscle fi ber producing the M response, and retrograde up to the axon and to the neuron, where it is repropogated in a small percentage of neurons back down the axons to produce the delayed F response. H-reflex H-reflex. The H response is obtained by stimulation of the afferent sensory fiber (top) resulting in orthodromic conduction to the spinal cord. In the spinal cord, there is synaptic stimulation of the alpha motor neuron, this results in the evoked H response in the muscle. A rudimentary M response is produced when a few motor axons are directly stimulated. Post-ganglionic injury Post-ganglionic injury: results in Wallerian degeneration of both motor and sensory axons. There is physical separation of the axon from the cell bodies in the DRG and the ventral portion of the spinal cord. CMAP and SNAP responses are diminished or absent. Pre-ganglionic injury: produces the same injury to the motor fi bers but allows the peripheral sensory fi bers to remain in contact with the.. The Motor Unit The Motor Unit This motor unit is the basic functional element of the neuromuscular system. It consists of the following components: • Anterior horn cell (motor nerve cell body) • Motor nerve axons • Peripheral nerve • Neuromuscular junction • Muscle fibers 이전 1 2 3 다음
