多发性单神经病讲解.docx

多发性单神经病讲解.docx

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多发性单神经病讲解

multiplemononeuropathy

1.NeurolNeuroimmunolNeuroinflamm.2015Nov12;3

（1）:

e180.doi:

10.1212/NXI.0000000000000180.eCollection2016.

Vasculiticneuropathyfollowingexposuretominocycline.

BarattaJM

（1）,DyckPJ

（1）,BrandP

（1）,ThaisetthawatkulP

（1）,DyckPJ

（1）,

EngelstadJK

（1）,GoodmanB

（1）,KaramC

（1）.

Authorinformation:

（1）DepartmentsofPhysicalMedicine&Rehabilitation（J.M.B.）andNeurology

（C.K.）,TheUniversityofNorthCarolina,ChapelHill;theDepartmentof

Neurology（P.J.B.D.,P.B.,P.J.D.,J.K.E.）,MayoClinic,Rochester,MN;the

DepartmentofNeurologicalSciences（P.T.）,UniversityofNebraskaMedical

Center,Omaha;andtheDepartmentofNeurology（B.G.）,MayoClinic,Scottsdale,

AZ.

OBJECTIVE:

Toreport3patientswithminocycline-inducedautoimmunityresulting

inperipheralnervevasculitis.

METHODS:

Wereport3patientswho,duringminocyclinetreatmentforacne

vulgaris,developedsubacuteonsetofpainandweaknesscausedbyvasculitisin

singleandmultiplemononeuropathypatterns.

RESULTS:

Eachpatientunderwenteitheranerveormusclebiopsythatconfirmed

vasculitis.Onepatientadditionallydevelopedsystemicsymptoms（including

fever,fatigue,andnightsweats）andanotherhadaposteriorcirculationstroke.

Symptomsdevelopedwitheitherearlyorprolongeduseofminocycline.Despite

withdrawalofminocycline,patientsneededlong-termimmunotherapytogain

neurologicimprovement.

CONCLUSIONS:

Ourfindingssuggestthatthetypicalneuropathyassociatedwith

minocyclineuseispainfulsingleormultiplemononeuropathyduetoperipheral

nervevasculitis,whichmayalsobeaccompaniedbypresumedCNSvasculitis

（presentingasstroke）.

PMCID:

PMC4645168

PMID:

26601119[PubMed]

2.JAMANeurol.2015Dec1;72（12）:

1510-8.doi:

10.1001/jamaneurol.2015.2347.

TheImportanceofRareSubtypesinDiagnosisandTreatmentofPeripheral

Neuropathy:

AReview.

CallaghanBC

（1）,PriceRS

（2）,ChenKS（3）,FeldmanEL

（1）.

Authorinformation:

（1）DepartmentofNeurology,UniversityofMichigan,AnnArbor.

（2）Departmentof

Neurology,UniversityofPennsylvania,Philadelphia.（3）Departmentof

Neurosurgery,UniversityofMichigan,AnnArbor.

IMPORTANCE:

Peripheralneuropathyisaprevalentconditionthatusuallywarrants

athoroughhistoryandexaminationbuthaslimiteddiagnosticevaluation.

However,rarelocalizationsofperipheralneuropathyoftenrequiremoreextensive

diagnostictestinganddifferenttreatments.

OBJECTIVE:

Todescriberarelocalizationsofperipheralneuropathy,includingthe

appropriatediagnosticevaluationandavailabletreatments.

EVIDENCEREVIEW:

ReferenceswereidentifiedfromPubMedsearchesconductedonMay

29,2015,withanemphasisonsystematicreviewsandrandomizedclinicaltrials.

Articleswerealsoidentifiedthroughtheuseoftheauthors'ownfiles.Search

termsincludedcommonrareneuropathylocalizationsandtheircauses,aswellas

epidemiology,pathophysiology,diagnosis,andtreatment.

FINDINGS:

Diffuse,nonlength-dependentneuropathies,multiplemononeuropathies,

polyradiculopathies,plexopathies,andradiculoplexusneuropathiesarerare

peripheralneuropathylocalizationsthatoftenrequireextensivediagnostic

testing.Atypicalneuropathyfeatures,suchasacute/subacuteonset,asymmetry,

and/ormotorpredominantsigns,arefrequentlypresent.Themostcommondiffuse,

nonlength-dependentneuropathiesareGuillain-Barrésyndrome,chronic

inflammatorydemyelinatingpolyneuropathy,multifocalmotorneuropathy,and

amyotrophiclateralsclerosis.Effectivedisease-modifyingtherapiesexistfor

manydiffuse,nonlength-dependentneuropathiesincludingGuillain-Barrésyndrome,

chronicinflammatorydemyelinatingpolyneuropathy,multifocalmotorneuropathy,

andsomeparaprotein-associateddemyelinatingneuropathies.Vasculiticneuropathy

（multiplemononeuropathy）alsohasefficacioustreatmentoptions,butdefinitive

evidenceofatreatmenteffectforIgManti-MAGneuropathyanddiabetic

amyotrophy（radiculoplexusneuropathy）islacking.

CONCLUSIONSANDRELEVANCE:

Recognitionofrarelocalizationsofperipheral

neuropathyisessentialgiventheimplicationsfordiagnostictestingand

treatment.Electrodiagnosticstudiesareanimportantearlystepinthe

diagnosticevaluationandprovideinformationonthelocalizationand

pathophysiologyofnerveinjury.

PMID:

26437251[PubMed-inprocess]

3.AnnRehabilMed.2015Oct;39（5）:

833-7.doi:

10.5535/arm.2015.39.5.833.Epub2015

Oct26.

MultipleLowerExtremityMononeuropathiesbySegmentalSchwannomatosis:

ACase

Report.

KwonNY

（1）,OhHM

（1）,KoYJ

（1）.

Authorinformation:

（1）DepartmentofRehabilitationMedicine,CollegeofMedicine,TheCatholic

UniversityofKorea,Seoul,Korea.

Schwannomaisanencapsulatednervesheathtumorthatisdistinctfrom

neurofibromatosis.Itisdefinedastheoccurrenceofmultipleschwannomas

withoutanybilateralvestibularschwannomas.A46-year-oldmanwithmultiple

schwannomasinvolvingperipheralnervesoftheipsilaterallowerextremity

presentedwithneurologicsymptoms.Electrodiagnosticstudiesrevealedmultiple

mononeuropathiesinvolvingtheleftsciatic,commonperoneal,tibial,femoraland

superiorglutealnerves.Histologicfindingsconfirmedthediagnosisof

schwannoma.Wereportedthisrarecaseofsegmentalschwannomatosisthat

presentedwithneurologicsymptomsincludingmotorweakness,whichwasconfirmed

asmultiplemononeuropathiesbyelectrodiagnosticstudies.

PMCID:

PMC4654091

PMID:

26605183[PubMed]

4.MuscleNerve.2015Jul;52

（1）:

151-2.doi:

10.1002/mus.24617.

Brachioplasty-associatedmultiplemononeuropathies.

ThawaniSP

（1）,BieriP

（2）,HerskovitzS

（2）.

Authorinformation:

（1）PeripheralNeuropathyCenter,TheNeurologicalInstituteofNewYork,Columbia

UniversityMedicalCenter,NewYork,NewYork,USA.

（2）AlbertEinsteinCollegeof

Medicine,MontefioreMedicalCenter,Bronx,NewYork,NewYork,USA.

PMID:

25703458[PubMed-indexedforMEDLINE]

5.Neuron.2015Jun3;86（5）:

1215-27.doi:

10.1016/j.neuron.2015.05.005.Epub2015

May21.

RobustAxonalRegenerationOccursintheInjuredCAST/EiMouseCNS.

OmuraT

（1）,OmuraK

（1）,TedeschiA

（1）,RivaP

（1）,PainterMW

（1）,RojasL

（1）,

MartinJ

（1）,LisiV

（2）,HuebnerEA

（1）,LatremoliereA

（1）,YinY

（1）,Barrett

LB

（1）,SinghB

（1）,LeeS

（1）,CrismanT（3）,GaoF（3）,LiS（4）,KapurK

（1）,

GeschwindDH（3）,KosikKS

（2）,CoppolaG（3）,HeZ

（1）,CarmichaelST（4）,Benowitz

LI

（1）,CostiganM（5）,WoolfCJ（6）.

Authorinformation:

（1）F.M.KirbyNeurobiologyCenter,BostonChildren'sHospitalandHarvardMedical

School,Boston,MA02115,USA.

（2）NeuroscienceResearchInstitute,Departmentof

Molecular,Cellular,andDevelopmentalBiology,UniversityofCalifornia,Santa

Barbara,SantaBarbara,CA93106,USA.（3）DepartmentsofPsychiatryand

Neurology,SemelInstituteforNeuroscienceandHumanBehavior,DavidGeffen

SchoolofMedicine,UniversityofCalifornia,LosAngeles,LosAngeles,CA90095,

USA.（4）DepartmentofNeurology,DavidGeffenSchoolofMedicine,andMultiple

MyelomaResearchConsortium,SemelInstituteforNeuroscienceandHumanBehavior,

UniversityofCalifornia,LosAngeles,LosAngeles,CA90095,USA.（5）F.M.Kirby

NeurobiologyCenter,BostonChildren'sHospitalandHarvardMedicalSchool,

Boston,MA02115,USA;AnaesthesiaDepartment,BostonChildren'sHospitaland

HarvardMedicalSchool,Boston,MA02115,USA.Electronicaddress:

michael.costigan@childrens.harvard.edu.（6）F.M.KirbyNeurobiologyCenter,Boston

Children'sHospitalandHarvardMedicalSchool,Boston,MA02115,USA.Electronic

address:

clifford.woolf@childrens.harvard.edu.

AxonregenerationintheCNSrequiresreactivatinginjuredneurons'intrinsic

growthstateandenablinggrowthinaninhibitoryenvironment.Usinganinbred

mouseneuronalphenotypicscreen,wefindthatCAST/Eimouseadultdorsalroot

ganglionneuronsextendaxonsmoreonCNSmyelinthantheothereightstrains

tested,especiallywhenpre-injured.Injury-primedCAST/Eineuronsalso

regeneratemarkedlyinthespinalcordandopticnervemorethanthosefrom

C57BL/6miceandshowgreatersproutingfollowingischemicstroke.Heritability

estimatesindicatethatextendedgrowthinCAST/Eineuronsonmyelinis

geneticallydetermined,andtwowhole-genomeexpressionscreensyieldtheActivin

transcriptInhbaasmostcorrelatedwiththisability.InhibitionofActivin

signalinginCAST/EimicediminishestheirCNSregenerativecapacity,whereasits

activationinC57BL/6animalsboostsregeneration.Thisscreendemonstratesthat

mammalianCNSregenerationcanoccurandrevealsamolecularpathwaythat

contributestothisability.

Copyright©2015ElsevierInc.Allrightsreserved.

PMCID:

PMC4458182[Availableon2016-06-03]

PMID:

26004914[PubMed-indexedforMEDLINE]

6.NeurosciLett.2015Jun2;596:

3-13.doi:

10.1016/j.neulet.2015.02.038.Epub2015

Feb19.

Advancesindiagnosticsandoutcomemeasuresinperipheralneuropathies.

MerkiesIS

（1）,FaberCG

（2）,LauriaG（3）.

Authorinformation:

（1）DepartmentofNeurology,SpaarneHospital,Hoofddorp,TheNetherlands;

DepartmentofNeurology,MaastrichtUniversityMedicalCenter,Maastricht,The

Netherlands.

（2）DepartmentofNeurology,MaastrichtUniversityMedicalCenter,

Maastricht,TheNetherlands.（3）3rdNeurologyUnit,IRCCSFoundation"Carlo

Besta"NeurologicalInstitute,Milan,Italy.Electronicaddress:

glauria@istituto-besta.it.

Peripheralneuropathiesareagroupofacquiredandhereditarydisorders

presentingwithdifferentdistributionandnervefiberclassinvolvement.The

overallprevalenceis2.4%,increasingto8%intheelderlypopulation.However,

thefrequencymayvarydependingontheunderlyingpathogenesisandassociation

withsystem