Značaj kombinovane primene elektrofizioloških ispitivanja i ispitivanja magnetne rezonance brahijalnog pleksusa za potvrdu dijagnoze multifokalne motorne neuropatije

  • Ivana Basta Neurology Clinic, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Ana Nikolić Neurology Clinic, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Slobodan Apostolski Outpatient Neurological Clinic, Belgrade, Serbia
  • Slobodan Lavrnić Magnetic Resonance Imaging Center, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Tatjana Stošić-Opinćal Magnetic Resonance Imaging Center, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Sandra Banjalić Magnetic Resonance Imaging Center, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Slađana Knežević-Apostolski Outpatient Neurological Clinic, Belgrade, Serbia
  • Tihomir V. Ilić Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
  • Ivan Marjanović Neurology Clinic, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Milena Milićev Neurology Clinic, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Dragana Lavrnić Neurology Clinic, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
DOI: https://doi.org/10.2298/3611
Ključne reči: peripheral nervous system diseases||, ||živci, periferni, bolesti, diagnostic techniques and procedures||, ||dijagnostičke tehnike i procedure, brachial plexus||, ||plexus brachialis, magnetic resonance imaging||, ||magnetna rezonanca, snimanje, electrophysiology||, ||elektrofiziologija,

Sažetak


Uvod/Cilj. Multifokalna motorna neuropatija (MMN) je imunski posredovano oboljenje perifenih nerava koje karakteriše sporo napredovanje asimetričnih slabosti mišića ekstremiteta, bez poremećaja senzibiliteta. Cilj rada bio je da se ispita značaj kombinovane primene magnetne stimulacije u cervikalnom nivou i magnetne rezonance (MR) brahijalnog pleksusa u potvrdi proksimalnih blokova provođenja kod obolelih od MMN. Takođe, želeli smo da utvrdimo da li postoje znaci oštećenja nervnih korenova koji grade nerve koji inervišu klinički slabe mišiće, kod kojih konvencionalnim ispitivanjem provodljivosti perifernih nerava nije registrovano postojanje blokova provođenja (BP). Metode. U studiju je bilo uključeno devet bolesnika sa klinički i elektrofiziološki potvrđenom dijagnozom MMN. Svim bolesnicima urađen je MR vratnog dela kičme i brahijalnog pleksusa u T1 i turbo spin-eho T1 sekvenci, aksijalnoj turbo spin-eho T2 sekvenci i koronarnoj turbo spin-eho T2 sekvenci sa saturacijom masti, pomoću aparata Simens Avanto jačine 1.5 T. Rezultati. Kod svih bolesnika registrovana je izražena asimetrična distalna slabost mišića inervisanih radijalnim, ulnarnim, medijalnim i peronealnim nervima, sa najupečatljivijom kliničkom prezentacijom viseće šake i prstiju. Analizom cerebrospinalnog likvora zabeležena je blaga proteinorahija kod većine obolelih. U serumu šest bolesnika nađena su poliklonska anti-GM1 antitela. Elektromioneurografija (EMG) pokazala je znake neurogene lezije, predominantno u distalnoj muskulaturi inervisanoj radijalnim nervom. Kod svih bolesnika registrovan je parcijalni BP van uobičajenih mesta kompresije radijalnog, ulnarnog, medijalnog i peronealnog nerva, a MR pregledom detektovane su zone pojačanog intenziteta signala u najmanje jednom cervikalnom korenu, trunkusu ili fascikulusu brahijalnog pleksusa. Kod tri bolesnika kod kojih standardnim elektroneurografskim pregledom nije registrovano postojanje BP primenom magnetne stimulacije u cervikalnom nivou sugerisani su proksimalni BP, što je bilo u korelaciji sa MR promenama odgovarajućih cervikalnih korenova. Zaključak. Rezultati ispitivanja pokazuju korelaciju između mišićne slabosti, produženog vremena provođenja kroz motorne korenove i promena na MR brahijalnog pleksusa, što je od posebnog značaja za nerve koji inervišu klinički slabe mišiće, a kod kojih primenom konvencionalne elektroneurografije nije moguće detektovati BP.

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Objavljeno
2015/04/23
Broj časopisa
Vol. 71 Br. 8 (2014)
Rubrika
Originalni članak