儿童和青少年桡神经病变的电生理特征。

Electrophysiologic Features of Radial Neuropathy in Childhood and Adolescence.

机构信息

Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Neurology, Lahey Clinic, Burlington, Massachusetts; Department of Neurology, Emory University School of Medicine, Atlanta, Georgia.

Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.

出版信息

Pediatr Neurol. 2018 Apr;81:14-18. doi: 10.1016/j.pediatrneurol.2018.01.003. Epub 2018 Jan 31.

DOI:10.1016/j.pediatrneurol.2018.01.003

PMID:29506771

Abstract

BACKGROUND

We analyzed the clinical and electrophysiologic patterns of nerve injury in pediatric patients with radial neuropathy.

METHODS

This is a retrospective analysis of 19 children and adolescents with radial neuropathy.

RESULTS

The mean subject age was 12 years (range one month to 19 years), 56% were female, and 53% had traumatic etiologies. Weakness in the finger and wrist extensors was the prevailing complaint (82%). Predominant localization was at the posterior interosseous nerve (37%), followed by the radial nerve below the spiral groove (32%), the radial nerve at the spiral groove (26%), and the radial nerve above the spiral groove (5%). Extensor indicis proprius compound muscle action potential amplitude was reduced in 86% of cases when tested, with a median axon loss estimate of 78%. The radial sensory nerve action potential amplitude was reduced in 53% of all cases, and in 83% of cases affecting the main radial trunk with a median axon loss estimate of 100%. For neuropathy affecting the main radial trunk, there was a high correlation of extensor indicis proprius median axon loss estimate and radial sensory nerve action potential median axon loss estimate (r = 0.72, P = 0.02). Neurogenic changes were seen in the extensor indicis proprius, extensor digitorum communis, extensor carpi radialis, and brachioradialis in 88%, 94%, 60%, and 44% of cases, respectively. Pathophysiology was demyelinating in 10%, axonal in 58%, and mixed in 32%.

CONCLUSIONS

In contrast to adults, where localization at the spiral groove predominates, radial neuropathy in children and adolescents is commonly localized at the posterior interosseous nerve or at the distal main radial trunk. Pediatric radial neuropathy is frequently of traumatic etiology and axonal pathophysiology.

摘要

背景

我们分析了儿童桡神经病变患者的临床和电生理神经损伤模式。

方法

这是对 19 例桡神经病变儿童和青少年的回顾性分析。

结果

平均受检者年龄为 12 岁（1 个月至 19 岁），女性占 56%，创伤性病因占 53%。手指和腕部伸肌无力是最常见的主诉（82%）。主要定位在骨间后神经（37%），其次是螺旋沟以下桡神经（32%）、螺旋沟桡神经（26%）和螺旋沟以上桡神经（5%）。当测试时，86%的病例伸指示骨肌复合肌肉动作电位幅度降低，轴索丢失估计中位数为 78%。所有病例桡神经感觉神经动作电位幅度降低，83%的病例影响主要桡神经干，轴索丢失估计中位数为 100%。对于影响主要桡神经干的神经病变，伸指示骨肌轴索丢失估计与桡神经感觉神经动作电位轴索丢失估计有很高的相关性（r=0.72，P=0.02）。在 88%、94%、60%和 44%的病例中，分别有 88%、94%、60%和 44%的病例出现伸指示骨肌、伸指总肌、桡侧伸腕肌和肱桡肌的神经源性改变。脱髓鞘病理生理改变占 10%，轴索占 58%，混合占 32%。