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PubMedDate not supplied

Experimental traction injuries of ventral spinal nerve roots. A scanning electron microscopic study.

The aims of this experimental scanning electron microscopic study were to identify the levels at which cervical ventral nerve roots, or the rootlets by which they are attached to the spinal cord, rupture under traction and to document the resulting damage. This information would provide the basis of a rationale for repairing rootlet avulsions which may follow brachial plexus traction injuries in man and which cause severe impairment of upper limb function. Traction was applied to C4 to T1 ventral roots until rupture occurred, in 10 freshly fixed and three living anaesthetized Wistar albino rats and in one human post-mortem specimen. Rupture occurred at the rootlet-cord junction in 80% of cases. Most individual myelinated fibres broke at the central-peripheral nervous system (CNS-PNS) transitional node which, in the cervical region, lies at the bottom of an endoneurial invagination surrounding each fibre and extending deep to the cord surface. Fibre rupture at more distal levels occurred internodally, and a length of axon commonly protruded well beyond the level of sheath rupture. Some sheaths broke cleanly across but the torn surfaces of others tapered, perhaps because of rupture at Schmidt-Lanterman incisures. The cellular and connective tissue rootlet sheaths ruptured where they were continuous with the pia mater. Ruptured fixed and unfixed tissues were ultrastructurally similar. It is clear from the findings of this study that regeneration would take place entirely in a PNS environment. The endoneurial invaginations would ensure that sprouts emerging from transitional nodes would be guided distally into rootlets surgically apposed to the torn transitional zone.

Animals↗
PubMedDate not supplied

[Clinical techniques for use in neurological physical examinations. I. General organisation, cranial and peripheral spinal nerves].

AIMS: The purpose of this work is to focus on the main practical aspects of the techniques used for the physical examination of the nervous system and to present an approach for the practice of this study in adult patients. DEVELOPMENT: We recommend clinicians to carry out a brief but consistent and effective exploration in a systematic, flexible and orderly manner to check for alterations in the functioning of the nervous system. Should any anomalies be detected, then a more detailed and thorough neurological exploration must be performed selectively. The techniques and data from this examination are organised into five broad categories: mental status, cranial nerves, motor function, reflex function and sensory function. The practical aspects of the main techniques used in the physical exploration are reviewed and we also describe the technique to be employed for palpating the main peripheral nerves. CONCLUSIONS: The study offers a detailed description of the chief clinical techniques used in the physical exploration of the cranial nerves and for the palpation of the peripheral nerves; we also present an approach to performing the neurological examination. Furthermore, we highlight the importance of physically examining the nervous system in contemporary medicine and the need to continually perfect the way these techniques are performed in order to achieve an efficient clinical practice.

Cranial Nerves↗
PubMed1996

[Inflammatory diseases of the spinal cord and spinal nerve roots in the MRI].

PURPOSE: To evaluate characteristic and reliable MRI patterns of different inflammatory lesions of the spinal cord and the nerve roots in immunologically compromised and immunologically competent patients in order to be able to establish a correct diagnosis based on MRI findings. MATERIAL AND METHODS: The MRI examinations of 52 patients (27 men, 25 women, mean age 38.5 years, range 14-75 years) with proven inflammatory lesions (39 patients) or tumorous/postactinic lesions of the spinal cord (6 patients) and vascular malformations of the spinal cord (7 patients) were retrospectively analyzed. All examinations were performed on a 1.5 T MR unit, using bi- or triplanar T1-w pre- and postcontrast as well as T2-w SE sequences. Additionally, a review of the common medical literature concerning inflammatory lesions of the spinal cord was included. RESULTS: Clinical and radiological examinations allow a subdivision of inflammations of the spinal cord and the nerve roots into (meningoradiculo) myelitis and meningoradiculo (myelitis) in immunologically suppressed or competent patients. The MRI patterns of these two inflammatory subtypes vary: meningoradiculitis presents with an enhancement of the nerve roots and the leptomeninges; myelitis itself is characterized by single or multiple, diffuse or multifocal, with or without nodular, patchy or diffusely enhancing intramedullary lesions, with or without thickening of the cord and leptomeningeal inflammation. This differentiation helps to determine the underlying etiology in some of the patients. The immunologically suppressed patient suffers from viral infections (especially herpes simplex, varicella-zoster virus, cytomegalovirus), bacterinal infections (tuberculosis), but rarely from parasitic infections. The immunologically competent patient suffers from bacterial (borreliosis), but rarely viral infections, sarcoidosis and demyelinating diseases. Idiopathic myelitis is also common. CONCLUSIONS: Secondary ischemic and demyelinating processes result in a complex morphology of inflammatory lesions on MRI, and therefore the whole spectrum of demyelinating, ischemic and inflammatory lesions has to be included in the differential diagnosis. Even tumors may imitate inflammatory myelitis and radiculitis. Most commonly, meningoradiculitis can be separated from myelitis. A reliable diagnosis of a specific inflammatory lesion is difficult and is mostly achieved in patients with multiple sclerosis and in patients with HIV-associated cytomegalovirus infection.

AIDS-Related Opportunistic Infections↗
PubMed1993

GAP 43-like immunoreactivity in normal adult rat sciatic nerve, spinal cord, and motoneurons: axonal transport and effect of spinal cord transection.

Using immunofluorescence and cytofluorimetric scanning techniques in the rat, the fast anterograde and retrograde axonal transport of growth-associated protein-43-like immunoreactivity in normal sciatic nerves, and after spinal cord transection in the lower thoracic region, were investigated. Spinal roots and motor endplates in the peroneal muscles were also studied. For comparison, anti-synaptophysin (p38) was used. In intact adult animals, the amounts of immunoreactive growth-associated protein-43 increased linearly, both proximally and distally to the crush site, between 1 and 24 h after crushing the sciatic nerve. The accumulations were present in thick as well as in thin axons. Distal accumulations in the sciatic nerve were about 40-60% of the proximal amounts, indicating a recycling of organelles with growth-associated protein-43-like immunoreactivity. During the week after spinal cord transection, no clear changes were observed; the anterograde transport of growth-associated protein-43-like immunoreactivity showed a tendency to decrease at day 1 and then a tendency to increase, reaching 120% of control at seven days (not significant). Transported p38-like immunoreactivity showed similar but smaller changes. In the lumbar spinal cord gray matter many nerve terminals with growth-associated protein-43-like immunoreactivity were seen in intact animals. After spinal transection, these terminals gradually decreased, suggesting that they belonged to descending pathways. However, p38-positive terminals were not obviously decreased. After crushing ventral and dorsal roots, accumulations of pf growth-associated protein-43-like immunoreactivity were present in thick axons in the ventral roots and in thin to medium-sized axons in the dorsal roots. In peroneal muscles, growth-associated protein-43-like immunoreactivity was present in some (but not all) motor endplates in all groups. These results indicate that: (i) growth-associated protein-43 is normally present in nerve terminals of many descending projections of the spinal cord; (ii) growth-associated protein-43-like immunoreactivity is expressed and bidirectionally transported in neurons (motor as well as sensory) of normal sciatic nerves; (iii) growth-associated protein-43-like immunoreactivity is present in some adult motor endplates; and (iv) inhibited supraspinal input causes minor, if any, alterations--paralleled by p38--in axonal transport of growth-associated protein-43-like immunoreactivity.

Animals↗
PubMed1992

[Regression of motor symptoms after intervertebral disk displacement-induced spinal nerve root lesion. Clinical study].

Ever since the causal relationship between backache, radicular pain and intravertebral disc herniation was established [25], there have been different opinions about the degree of recovery of motor lesions of the nerve root caused by disc herniation. Of 123 patients with a severe motor deficit of the L5 nerve root, 95 patients were available for a follow up examination 4 to 8 years after the operation. The statistical evaluation showed that the degree of recovery of the root lesion was mainly dependent on the age of the patient and the time interval until operation. Even a prior herniation of the disc without much compression of the nerve root can cause chronic damage to the nerve through traction at the trilamellar nerve root fixation. So even in the case of only a small disc hernia with a corresponding nerve root lesion, we would recommend immediate operative therapy.

Adult↗
PubMed1991

[Lumbar spinal nerve root compression syndrome as an atypical initial manifestation of a rare vascular disease].

A 55 year old male Turkish patient developed L3/L4 root compression caused by a retroperitoneal hematoma after covered perforation of the infrarenal aorta. The aneurysm was resected and a tube interposition made. For more than 20 years the patient has suffered from oral and scrotal ulcers. These signs led to the diagnosis of Behçet's disease. A review of the literature revealed 200 arterial complications (aneurysms and occlusions) in 105 patients with Behçet's disease, only 19 of them had aneurysms of the infrarenal aorta.

Aortic Rupture↗
PubMed1993

Vasogenic edema induced by compression injury to the spinal nerve root. Distribution of intravenously injected protein tracers and gadolinium-enhanced magnetic resonance imaging.

The function of the blood-nerve barrier appears quite unique in the nerve root. Protein tracers that were injected into the subarachnoid space passed through the nerve root sheath and entered into the capillary lumen in the endoneurial space but tracers that were injected intravenously did not appear in the endoneurial space. Marked extravasation of protein tracers in the nerve root was induced at the compressed part by strong compression (60 gram force, 30 gram force) and capillaries in the nerve root showed opening of the tight junction accompanied by an increase in vesicular transport under the electron microscope. This situation was reflected as high intensity on Gadolinium-enhanced magnetic resonance imaging. In twenty-one of fifty patients with lumbar disc herniation, the affected nerve root was strongly enhanced by Gadolinium-diethylene-triaminepentaacetic acid, indicating that the blood-nerve barrier in the affected nerve root was broken and intraradicular edema was produced in these cases.

Adult↗