Funktion und Struktur peripherer Nerven aus neuropädiatrischer Sicht: Wie klinische, neurophysiologische und Ultraschalluntersuchungen ergänzende diagnostische Informationen liefern

Zusammenfassung

In der vorliegenden Übersicht wird dargestellt, wie sich klinisch neurophysiologische Methoden (Nervenleitgeschwindigkeit und Elektromyografie) und Ultraschalluntersuchungen (US) von peripheren Nerven bei der Abklärung von hereditären senso-motorischen Neuropathien (HMSN), der Friedreichschen Ataxie, erworbenen Neuropathien (am Beispiel von Diabetes mellitus) und traumatischen Nervenläsionen bei Kindern ergänzen können. Bei allen Formen der HMSN 1 kommt es zu einer Verlangsamung der Nervenleitgeschwindigkeit. Die Ultraschalluntersuchung zeigt nur bei HMSN1A eine deutlich vergrösserte Nervenquerschnittsfläche. Beim M. Friedreich können meist keine sensiblen Potentiale ausgelöst werden und die US-Resultate sind variabel. Bei traumatischen Nervenläsionen kann vor allem mithilfe der US-Untersuchung entschieden werden, ob eine operative Nervenrevision indiziert ist. Die erworbenen Neuropathien werden am Beispiel der diabetischen Neuropathie dargestellt. Die US- und die ENG Resultate sind oft abnorm, auch wenn klinisch keine Neuropathie-Symptome nachweisbar sind.

Abstract

The present overview illustrates how clinical neurophysiological methods (nerve conduction velocity and electromyography) and ultrasonography of peripheral nerves in the investigation of hereditary sensory motor neuropathies, Friedreich ataxia, acquired neuropathies (eg. Diabetes mellitus) and traumatic nerve lesions of children deliver complementary diagnostic informations. The nerve conduction velocity (ncv) of all patients with CMT 1 is slowed and the ultrasonography of the peripheral nerves reveals an increased cross sectional area. No sensory potentials are detectable in the ncv registration of the majority of Friedreich ataxia patiens whereas the ultrasonographic results are variable. The diabetic neuropathy is represented as an example of acquired neuopathies. In many cases the ncv or ultrasonographic results are abnormal even if there are no clinical signs of a neuropathy. The combined neurophysiological and ultrasonographic investigation is essential in traumatic nerve lesions for the decision to perform a surgical revision of injured nerv.

Schlüsselwörter

Nervenleitgeschwindigket - Nerven Ultrasonografie - angeborene und erworbene Neuropathien - traumatische Nervenlasionen

Key words

Nerve conduction velocitiy - Ultrasonography of peripheral nerves - congenital and acquired neuropathies - traumatic nerve lesions

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