Articles: spinal-nerves.
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Review
Herpetic neuralgia. Use of combination therapy for pain relief in acute and chronic herpes zoster.
Herpes zoster (shingles) is a localized infection that begins in the dorsal root ganglla of the cranial or spinal nerves and spreads as a rash over the corresponding dermatome. It usually is caused by reactivation of latent varicella-zoster virus remaining from childhood chicken pox. ⋯ Management of zoster-related pain should begin as soon as possible after the onset of symptoms. Combination therapy--including antiviral, antidepressant, corticosteroid, opioid, and topical agents--provides the most effective analgesia.
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Radiol. Clin. North Am. · Nov 2000
ReviewAnatomy of the extradural compartments of the lumbar spinal canal. Peridural membrane and circumneural sheath.
The development of newer and more accurate methods of identifying the structures within the spinal canal has given a much better understanding of the soft tissue structures that lie between the dura and the surrounding bone of the vertebral canal. One anatomic structure of special importance, but seldom spoken of, is the peridural membrane. Although it was mentioned in the writings of Fick14 as early as 1904, it was Dommissee12,13 who first described it accurately and who named it the peridural membrane. ⋯ At this same point the dural sleeve becomes adherent to the nerve and henceforth is called the epineurium. For this 1- to 2- cm segment of spinal nerve from the dura to just beyond the ganglion we propose the name dural root sleeve. After all, it is a sleeve, it is made of dura, and it covers two nerve roots.
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Mayo Clinic proceedings · Sep 2000
ReviewPotential neurotoxicity of spinal anesthesia with lidocaine.
Spinal (intrathecal) anesthesia has evolved into a safe, widely accepted method of anesthesia with many advantages. However, the past decade has seen a large number of case reports and incidence studies that implicate the local anesthetic (LA) lidocaine as being more neurotoxic than other commonly used LAs such as bupivacaine and tetracaine, based on patterns of clinical use current at the time of those reports. Available studies suggest a risk of persistent lumbosacral neuropathy after spinal lidocaine by single injection in about 1 in 1300 procedures and a risk as high as about 1 in 200 after continuous spinal anesthesia with lidocaine. ⋯ Although the pain typically resolves within 1 week without lasting sequelae, it can be severe in up to one third of patients with the syndrome. In addition to clinical studies, both whole animal and in vitro studies have shown that lidocaine can be neurotoxic at clinically available concentrations and that lidocaine is more neurotoxic than equipotent concentrations of other commonly used LAs. The mechanism of this neurotoxicity may involve changes in cytoplasmic calcium homeostasis and mitochondrial membrane potential.
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Focal upper extremity neuropathies are common in neonates. The brachial plexus is the most common site involved. Brachial plexus injuries may involve different structures, thus producing different clinical presentations: complete brachial plexus palsy, Duchenne-Erb palsy, upper-middle trunk brachial plexus palsy, Klumpke palsy, fascicular brachial plexus palsy, and bilateral brachial plexus palsy. ⋯ The differential diagnosis of brachial plexus palsy includes pseudoparesis, amyoplasia congenita, congenita varicella syndrome, and neurological lesions at other neuroanatomical levels. The cause and the degree of injury dictate the prognosis. The prognosis of obstetric brachial plexus injury is usually good.