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MUDr. Helena Sobolov Nemocnice Trinec Polyneuropatie doln ch koncetin

Difusn? nebo v?cecetn?syst?mov? posti?en? perifern?ch nervu. Obecn? charakteristika. Etiologie . Heredit?rn?Metabolick?Nutricn? poruchyToxick?Z?netliv?Autoimunn?Paraneoplastick?Kryptogenn?. Subjektivn? pr?znaky. Pozitivn? - bolesti p?len? mr

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MUDr. Helena Sobolov Nemocnice Trinec Polyneuropatie doln ch koncetin

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    1. Polyneuropatie dolnch koncetin Polyneuropatie dolnch koncetin

    3. Etiologie Hereditrn Metabolick Nutricn poruchy Toxick Znetliv Autoimunn Paraneoplastick Kryptogenn

    4. Subjektivn prznaky Pozitivn - bolesti plen mravencen Negativn - snen citlivost pocit chladu svalov slabost zven navnost DKK

    5. Objektivn nlez Snen reflexy Hypestezie Porucha propriocepce Pallhypestezie Svalov slabost Svalov atrofie Anhidrosa nebo hyperhidrosa

    6. Terapie Lcba prciny polyneuropatie Symptomatick lcba analgetika tricyklick antidepresiva antikonvulziva myorelaxans Baclofen Podpurn terapie vasodilatacn terapie

    7. EMG laborator

    8. EMG vyetrovan nervy N. peroneus N. tibialis N. plantaris medialis

    9. EMG nlezy Axonln nzk amplituda CMAP nzk amplituda SNAP Demyelinizacn zpomalen rychlosti veden prodlouen latence blok veden casov disperze

    10. Vyetrovan soubor

    11. Vek pacientu Prumern vek 59,90 Prumern vek muu 57,45 Prumern vek en 61,56

    12. Vekov rozvrstven

    13. Nejcastej pote pacientu Bolesti 85 44% Parestezie 76 39% Slabost 53 27% Hypestezie 17 9% Krece 16 8% Pocit chladu 11 6% Neklidn DKK 5 3%

    14. Dal pote Nejistota pri chuzi Tres dolnch koncetin Hubnut dolnch koncetin Celkov slabost Klaudikacn pote Tuhost dolnch koncetin navnost dolnch koncetin

    15. Kombinace subjektivnch prznaku

    16. Zjiten prciny pot Diabetes mellitus 85 Hepatopatie, etylismus 14 Nemoci ttn lzy 12 Ischemick choroba DKK 10 Boreliosa 6 Myelom, leukemie 3

    17. Dal prciny pot Renln onemocnen 3 Polyradikuloneuritida GB 2 Radioterapie 2 Chemoterapie 2 Terapie statiny 2 Susp. hereditrn etiologie 1 Waldenstrom. makroglobulinemie 1

    18. Normln EMG nlez Celkem 24 pacientu 12,44 % Mui 6 25% eny 18 75% Prumern vek 46 let DM - 5, hepatopatie - 3 Bolesti 12, parestezie 7, slabost 5 Neurol. nlez normln 14 hyporeflexie 10

    19. Diabetes mellitus 85

    20. Subjektivn pote u DM Bolesti 40 47% Parestezie 34 40% Slabosti 23 27% Hypestezie 8 9% Bez pot 8 9% Pocit chladu 5 6% Nejistota pri chuzi 4 5% Krece DKK 4 5% Klaudikace 2 2% Neklid v DKK 1 1%

    21. Objektivn neurologick nlez Hyporeflexie 71 84% Hypestezie 26 31% Normln nlez 11 13% Svalov slabost 7 8% Porucha vibracnho cit 6 7% Dysestezie 2 2% Ataktick chuze 1 1%

    22. EMG nlez u pacientu s DM senzit. demyel. axon sm. kmen. norm. --------------------------------------------------------- DM na diete 10 1 5 4 2 0 DM na PAD 30 3 12 16 5 3 DM na inz. 24 3 9 14 11 1 Zchyt DM 3 2 0 0 0 1 --------------------------------------------------------- Celkem 85 67 9 26 34 18 5

    23. EMG nlez u pacientu s DM

    24. Hepatopatie, etylismus Celkem 14 pacientu 3 pacienti - normln nlez 3 pacienti - senzitivn polyneuropatie 6 pacientu - axon. motorick a senzitivn 2 pacienti - axonlne demyelinizacn a senzitivn

    25. Zvery: Nejcastejmi prznaky polyneuropatie jsou bolest, parestezie, svalov slabost Nejcastej klinick nlez: hyporeflexie Nejcastej EMG nlez: Senzitivn postien Prevne distln postien

    26. Zvery: Diabetick polyneuropatie Nejcasteji senzitivn postien a smen axonlne demyelinizacn Te onemocnen nekoreluje s t polyneuropatie Alkoholick polyneuropathie Senzitivn a axonln motorick postien

    27. Zvery: Z EMG nlezu nelze stanovit etiologii polyneuropatie (podobn EMG nlezy u vech onemocnen) Nutno vyetrovat senzitivn nervy - nejcitlivej metoda k prukazu polyneuropatie ( n. plantaris medialis, lateralis, n. peroneus superficialis, n. suralis)

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