Rubin Devon I
Electromyography Laboratory, Mayo Clinic, Jacksonville, FL, USA.
Clin Neurophysiol Pract. 2020 Aug 13;5:173-193. doi: 10.1016/j.cnp.2020.07.005. eCollection 2020.
Diseases of the brachial and lumbosacral plexus are uncommon and complex. The diagnosis of plexopathies is often challenging for the clinician, both in terms of localizing a patient's symptoms to the plexus as well as determining the etiology. The non-specific clinical features and similar presentations to other root, nerve, and non-neurologic disorders emphasize the importance of a high clinical index of suspicion for a plexopathy and comprehensive clinical evaluation. Various diagnostic tests, including electrodiagnostic (EDX) studies, neuroimaging (including ultrasound, MRI, or PET), serologic studies, and genetic testing, may be used to confirm a plexopathy and assist in identifying the underlying etiology. EDX testing plays an important role in confirming a plexopathy defining the localization, pathophysiology, chronicity, severity, and prognosis. Given the complexity of the plexus anatomy, multiple common and uncommon NCS and an extensive needle examination is often required, and a comprehensive, individualized approach to each patient is necessary. Treatment of plexopathies often focuses on symptomatic management although, depending on the etiology, specific targeted treatments may improve outcome. This article reviews the clinical features, EDX approaches, and evaluation and treatment of brachial and lumbosacral plexopathies.
臂丛和腰骶丛疾病并不常见且复杂。对于临床医生而言，丛病的诊断往往具有挑战性，这体现在将患者症状定位到丛以及确定病因两方面。其非特异性临床特征以及与其他神经根、神经和非神经系统疾病的相似表现，凸显了对丛病保持高度临床怀疑指数和进行全面临床评估的重要性。各种诊断测试，包括电诊断（EDX）研究、神经影像学检查（包括超声、MRI或PET）、血清学研究以及基因检测，均可用于确诊丛病并协助确定潜在病因。EDX检测在确诊丛病、明确定位、病理生理、慢性程度、严重程度及预后方面发挥着重要作用。鉴于丛解剖结构的复杂性，通常需要进行多项常见和不常见的神经传导速度（NCS）检查以及广泛的针极肌电图检查，并且针对每位患者采取全面、个性化的方法很有必要。丛病的治疗通常侧重于对症处理，不过，根据病因不同，特定的靶向治疗可能会改善治疗效果。本文综述了臂丛和腰骶丛疾病的临床特征、EDX检查方法以及评估和治疗。
