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DOI: 10.1055/a-1506-8603
Funktion und Struktur peripherer Nerven aus neuropädiatrischer Sicht: Wie klinische, neurophysiologische und Ultraschalluntersuchungen ergänzende diagnostische Informationen liefern
Function and Structure of Peripheral Nerves from Neuropediatric View: How Clinical, Neurophysiologic and Ultrasonographic Investigations Deliver Complementary Diagnostic Informations![](https://www.thieme-connect.de/media/klinneuro/202104/lookinside/thumbnails/15068603_10-1055-a-1506-8603-1.jpg)
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 NervenlasionenKey words
Nerve conduction velocitiy - Ultrasonography of peripheral nerves - congenital and acquired neuropathies - traumatic nerve lesionsPublikationsverlauf
Artikel online veröffentlicht:
03. August 2021
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Literatur
- 1 Jenny C, Lütschg J, Broser P. Change in cross sectional area of the median nerve with age in neonates, infants and children analyzed by high resolution ultrasound imaging European journal of pediatric neurology 2020; 29: 137-143
- 2 Walker FO, Cartwright MS, Wiesler ER, Caress J. Ultrasound of nerve and muscle. Clin Neurophysiol 2004; 115: 495-507 DOI: 10.1016/j.clinph.2003.10.022. PMID: 15036045
- 3 Holzgreve RE, Wagner E, Singer A. Daly Ch. Imaging of the peripheral nerve: Concepts and Future Direction of Magnetic Resonance Neurography and Ultrasound. J. Hand Surg Am 2019; 44: 1066-1079
- 4 Brown JM, Yablon CM, Mora Y. et al. US of the peripheral nerves of the upper extremity: a landmark Radio Graphics 2016; 36: 452-463
- 5 Alexander N, Broser P. Counter movement jump characteristics in patients with Charcot-Marie-Tooth 1a disease. Gait & Posture, in Review.
- 6 Fabrizi GM, Tamburin S, Cavallaro T. et al. The spectrum of Charcot-Marie-Tooth disease due to myelin protein zero: An electrodiagnostic, nerve – ultrasound and histological study.
- 7 Zanette G, Tamburin S, Taioli F. et al. Nerve size correlates with clinical severity in Charcot-Marie-Tooth disease 1A. Muscle Nerve 2019; 60: 744-788
- 8 Noto Y, Shiga K, Tsuji Y. et al. Nerve ultrasound depicts peripheral nerve enlargement in patients with genetically distinct Charcot-Marie-Tooth disease. J Neurol Neurosurg Psychiatry 2015; 86: 378-384
- 9 Grimm A, Vittore D, Schubert V. et al. Ultrasound pattern sum score, homogeneity score and regional nerve enlargement for differentiation of emyelinating inflammatory and hereditary neuropathies. Clinical Neurophysiology 2015; 127: 2618-2624
- 10 Hobbelink SMR, Brockley CR, Kennedy RA. et al. Dejerine-Sottas disease in childhood – Genetic and sonographic heterogeneity. Brain and Behavior 2018; 8: e00919
- 11 Pazaglia C, Minciotti I, Coraci D. et al. Ultrasound assessment of sural nerves in Charcot Marie Tooth 1A neuropathy. Clinical Neurophysiology 2013; 124: 1695-1699
- 12 Schreiber S, Vielhaber S, Schelle T. Neurosonographie, eine neurologische Perspektive auf chirurgisch relevante Krankheitsbilder der peripheren Nerven Zentralbl. Chir 2020; 145: 541-548
- 13 Padua L, Di Pasquale A, Liotta G. et al. Ultrasound as an useful tool in the diagnosis and management of traumatic nerve lesions. Clinical Neurophysiology 2013; 124: 1237-1243
- 14 Goedee SH, Brekelmaus GJF, Van der Berg LH, Visser LH. Distincive pattern of sonographic nerve enlargement in Charcot-Marie-Tooth disease type 1A and hereditary neuropathy with pressure palsy. Clinical Neurophysiology 2015; 126: 1413-1420
- 15 Luis de Aquino Neves E, Fernando Kok. Clinical and neurophysiological investigation of a large family with dominant Charcot-Marie-Tooth type 2 disease with pyramidal signs. Arq Neuropsiquiatr 2011; 69: 424-430
- 16 Padua L, Coracci DE, Lucchetta M. et al. Different nerve ultrasound patterns in Charcot-Marie- Tooth types and hereditary neuropathy with liability to pressure palsies. Muscle Nerve 2018; 57: E18-E23
- 17 Mulroy E, Pelosi L, Leadbetter R. et al. Peripheral nerve ultrasound in Friedreich ataxia. Muscle Nerve 2018; 57: 852-856
- 18 Manara R, Gasparotti R, Briani Ch.. Unexspectet nerve imaging findings in Friedreich ataxia. Clinical Neurophysiology 2015; 126: 1058-1061
- 19 Chen J, Wang Ch-L, Wu S. et al. The feasibility of using high resolution ultrasonography to assess ulnar nerve in patients with diabetes mellitus. J Ultrason 2017; 17: 160-166
- 20 Singh KP, Gupta K, Katania N. et al. High resolution ultrasonography of the sural nerve in diabetic peripheral neuropathy. J Ultrason 2020; 20: e83-e 89
- 21 Borire AA, Issar T, Kwai NC. et al. Correlation between markers of peripheral nerve function and structure in type 1 diabetes. Diabetes Metab Res Rev 2018; 34: 1-8
- 22 Walter-Höliner I, Seik Barbarini D, Lütschg J. et al. High Prevalence and in cadence of Diabetic Peripheral Neuropathy in Children and Adolescents with Type 1 Diabetes mellitus: Results from a five-year prospective Cohort study. Pediatric Neurology 2018; 80: 51-60