Obsah 1 Z ákla dn í s tru k tu ra a fu n k c e p e rife rn íc h n e r v ů ............................................................ 13 N e u ro n ......................................................................................................................................... 14 A kční p o te n c iá l.........................................................................................................................2 6 N eurom uskuiárni s p o je n i......................................................................................................30 Svalová k o n tr a k c e .................................................................................................................. 33 D enervace a kolaterální re in e rva ce ......................................................................................36 Periferní n e r v ............................................................................................................................ 38 C harakter poškození periferních n e rvů ............................................................................... 41 2 K lin ic k á d ia g n o s tik a léze p e rife rn íc h n e r v ů .................................................................. 51 V yšetření m o to rik y .................................................................................................................. 51 V yšetření c it li v o s t i.................................................................................................................. 53 3 K lin ic k á e le k tr o m y o g r a fie ...................................................................................................63 H istorie E M G ............................................................................................................................ 63 N e u ro g ra fie ............................................................................................................................... 66 F v ln a ............................................................................................................................................ 69 Blink re fle x .................................................................................................................................. 71 H re fle x.........................................................................................................................................7 3 Jehlová E M G ............................................................................................................................ 8 6 Základní ty p y a k tiv ity ............................................................................................................... 87 Rizika a kontraindikace E M G ............................................................................................. 105 Strategie a ta ktika EMG v y š e t ř e n í ....................................................................................105 Konkrétní indikace EMG u m on on euro pa tií: ................................................................ 107 Slovník základních po jm ů užívaných v e le k tro m y o g ra fií............................................. 109 4 M o n o n e u ro p a tie a p le x o p a tie .......................................................................................... 115 N ádory kraniálních a spinálních n e r v ů ............................................................................. 117 Plexus c e r v ic a lis ....................................................................................................................118 Plexus b r a c h ia lis ....................................................................................................................123 EMG v y š e tře n í................................................................................................................ 126 Neuralgická a m y o tro fie ................................................................................................ 135 Syndrom horní hrudní a p e rtu ry ..........................................................................................137 Léze je d n o tlivých nervů pažní p le te n ě ............................................................................. 139 N. tho ra cicu s lo n g u s ................................................................................................... 139 N. dorsalis s c a p u la e .......................................................................................................14 0 N. s u b s c a p u la ris .............................................................................................................142 N. th o ra c o d o rs a lis ..........................................................................................................142 Nn. p e c to ra le s ................................................................................................................ 142 N. s u p ra sca p u la ris ..........................................................................................................142 N. a x illa ris ..........................................................................................................................143 N. m u s c u lo c u ta n e u s ................................................................................................... 145 N. ra d ia lis ..........................................................................................................................147 N. u ln a r is ..........................................................................................................................15 3 N. m e d ia n u s ................................................................................................................... 16 8
Syndrom karpálního t u n e lu ................................................................................173 Nervy hrudníku a b ř ic h a ...................................................................................................... 177 Plexus lu m bosacralis ......................................................................................................... 179 Plexus lu m b a lis ................................................................................................................179 Plexus s a c ra lis ................................................................................................................179 Postižení lum bosakrálního p le x u .............................................................................180 Léze je d n o tlivých nervů Is p le t e n ě ...................................................................................181 N. iliohypogastricus. n. ilioinguinalis. n. g e n ito fe m o ra lis ................................... 181 N. cutaneus fe m o ris la te ra lis ...................................................................................... 181 N. f e m o r a lis ................................................................................................................... 183 N. o b tu ra to riu s ................................................................................................................189 Nn. g lu t e i......................................................................................................................... 189 N. cutaneus fem oris p o sterio r a n. p u d e n d u s......................................................... 190 N. N. N. Léčba
is c h ia d ic u s ................................................................................................................194 p e r o n e u s ................................................................................................................... 199 t ib i a li s ......................................................................................................................... 2 0 6 po ruch je d n o tlivých periferních n e r v ů ........................................................... 2 1 0
5 P oru chy k ra n iá ln ích n e r v ů ................................................................................................21 8 N. I. - o lfa c to r iu s ...................................................................................................................21 8 N. II. - o p tic u s ......................................................................................................................... 22 0 N. III.. IV., VI. - okohybné n e r v y ......................................................................................... 221 O fta lm o p le g ie ............................................................................................................... 22 4 N. V. - trig e m in u s ...................................................................................................................22 8 N. VII - f a c i a l i s ......................................................................................................................23 3 Bellova obrna (akutní id iop atická fa ciá ln í p a ra lý z a )............................................ 23 4 K linický o b ra z ......................................................................................................... 23 5 D iagnostika a dife ren ciální d ia g n o s tik a .........................................................23 6 Léčba .................................................................................................................. 241 Prognóza Bellovy o b r n y ......................................................................................241 H em ifaciální spasm us (hem ispasm us lícního ne rvu)............................................ 24 2 N. VIII. - vestib ulococh le aris (s ta to a c u s tic u s )............................................................... 24 2 Poruchy postra nn íh o sm íšeného s y s té m u ......................................................................2 4 3 N. IX. - g lo sso p h a ryn g e u s ...................................................................................................2 4 3 N. X. - v a g u s ......................................................................................................................... 2 4 4 N. XI. - acce ssorius............................................................................................................... 2 4 6 N. XII. - h y p o g lo s s u s ............................................................................................................ 2 4 8 6 P o ly n e u ro p a tie .................................................................................................................. 2 5 3 Základní cha rakteristika p o ly n e u ro p a tií.........................................................................2 5 3 Klinická d ia g n o s tik a ......................................................................................................2 5 5 E le k tro d ia g n o s tik a ......................................................................................................... 2 6 4 Laboratorní a k o m p le m e n tá rn í v y š e tře n í............................................................... 2 6 8 N ervová a svalová b io p s ie ......................................................................................... 271 Zánětlivé a d ysim u n itn í p o ly n e u ro p a tie ......................................................................... 2 7 4 G uillainův-Barrého s y n d r o m ......................................................................................2 7 4 E tiopatogeneze............................................................................................................... 2 7 4 M iller-Fisherův syn d ro m ................................................................................................2 8 3
Chronická zánětlivá de m yelinizační p o lyn euro pa tie (C ID P)................................291 Distální m otorická axonální n e u ro p a tie ................................................................... 3 0 0 M u ltifo ká ln í m otorická n e u ro p a tie .............................................................................3 0 0 Elektrofyziologická kritéria pro blok vedení ......................................................... 3 0 2 Lokalizovaná pe rin euriáln í h yp ertrofická m o n o n e u ro p a tie ................................3 0 3 G lutenová s e n z itiv ita .............................................................................................................3 0 9 M on okloná ln í g a m a p a tie ................................................................................................... 3 1 0 M n o h o če tn ý m y e lo m ................................................................................................... 3 1 3 A m y lo id ó z a ...................................................................................................................... 3 1 6 K ry o g lo b u lin e m ie ......................................................................................................... 3 1 8 M on okloná ln í gam apatie neurčeného v ý z n a m u ................................................... 3 2 0 N europatie u vaskulitid a systém ových im u n o p a to lo g ických stavů......................... 3 2 4 Polyarteriitis n o d o s a ...................................................................................................... 3 2 7 Syndrom C h urg a-S trausso vé...................................................................................... 3 2 9 W egenerova g ra n u lo m a tó z a ...................................................................................... 3 2 9 M ikroskopická p o ly a n g iitid a ...................................................................................... 331 Leukocytoklastická v a s k u litid a ...................................................................................331 Lokalizovaná nesystém ová (m onosystém ová) vaskulitida periferního nervového s y s té m u .............................................................................3 3 2 Terapie ne uro patií u v a s k u litid ...................................................................................3 3 2 S ystém ový lu pu s e r y th e m a to d e s .............................................................................3 3 2 R evm atoidní a r t r it id a ................................................................................................... 3 3 3 S jogrenův s y n d r o m ...................................................................................................... 3 3 3 Progresivní systém ová skleróza (s k le ro d e rm ie ) ...................................................3 3 4 M ig rující senzitivní W artenb erg ova n e u r i t i d a ...................................................... 3 3 5 S a rk o id ó z a ...................................................................................................................... 3 3 5 N europatie u některých in fe k c í......................................................................................... 3 3 7 Lymeská b o r r e lió z a ...................................................................................................... 3 3 7 N europatie u infekce H IV / A ID S ................................................................................3 3 9 D i f t e r i e .............................................................................................................................3 4 0 Infekce vire m západonilské horečky (W est N ile v iru s)......................................... 3 4 0 N europatie u le p ry ..........................................................................................................3 4 0 N europatie v souvislosti s m align ím i p ro c e s y ................................................................341 Paraneoplastické s y n d r o m y ...................................................................................... 341 M etab olické a en do krinn í n e u r o p a t ie .............................................................................3 4 6 Diabetická n e u ro p a tie ................................................................................................... 3 4 7 Etiopatogeneze diab etické n e u ro p a tie .............................................................3 5 2 Im unitní m e c h a n is m y ......................................................................................... 3 5 4 D y s lip id e m ie ......................................................................................................... 3 5 4 Sym etrické diab etické p o lyn e u ro p a tie .............................................................3 5 6 Fokální a m u ltifo ká ln í n e u ro p a tie ...................................................................... 3 6 2 Léčba diab etické n e u r o p a tie ............................................................................ 3 6 4 N europatie a h e p a titíd a ...................................................................................................... 3 7 0 U rem ická p o ly n e u ro p a tie ...................................................................................................3 7 2 C hronická ob štru kční plien i n e m o c ...................................................................................3 7 4 N europatie u orgánových tra n s p la n ta c í......................................................................... 3 7 4 Hypotyreóza a hyp ertyreó za................................................................................................3 7 4 H y p o ty re ó z a ................................................................................................................... 3 7 4
H y p e rtyre ó za ...................................................................................................................37 4 P orfyrie......................................................................................................................................37 4 V itam ino vé a n u tričn í d e fic ie n c e ..................................................................................... 3 7 5 A lko ho lová p o ly n e u ro p a tie .........................................................................................3 7 5 D eficience vita m in u ............................................................................................... 3 7 7 N u tričn í d e fic ie n c e ......................................................................................................... 3 7 8 P olyneuropatie po g a s tro p la s tic e ............................................................................3 7 9 T oxické p o ly n e u r o p a tie ......................................................................................................3 8 0 N eurotoxické l é k y ......................................................................................................... 3 8 0 A n titu b e rk u lo tik a ............................................................................................................ 3 8 0 C y to s ta tik a ......................................................................................................................38 2 T axany................................................................................................................................38 4 O statní ne uro to xické lé k y ............................................................................................ 38 6 O statní ne uro to xické l á t k y ......................................................................................... 3 9 0 Tropická m ye lo n e u ro p a tie ...................................................................................................391 P olyneuropatie kritické h o sta v u ......................................................................................... 39 2 H ereditární p o ly n e u ro p a tie ................................................................................................39 7 C harcotova-M arieho-Toothova c h o ro b a ...................................................................39 7 C harcotova-M arieho-Toothova choroba ty p u 1 .........................................4 0 2 C harcotova-M arieho-Toothova choroba ty p u 2 .........................................4 0 6 D éjerine-Sottasův s y n d ro m .........................................................................................4 0 7 G igantická axonální n e u r o p a t ie ............................................................................... 4 0 7 H ereditární ne uro patie se sklonem k tlako vým p a ré z á m .................................. 4 0 9 H ereditární senzitivní a a u to n o m n í ne uro patie (H S A N )..................................... 4 1 0 Friedreichova a ta x ie ......................................................................................................4 1 2 H e red itární m o to rické n e u ro p a tie ............................................................................ 4 1 3 H ereditární ne uro patie spojené se spe cifickým i biochem ickým i a b n o rm ita m i............................................................................................................... 4 1 4 Refsum ova c h o r o b a ............................................................................................ 4 1 4 X-vázaná a d re n o m y e lo n e u ro p a tie .................................................................. 4 1 4 Fabryho c h o ro b a ...................................................................................................4 1 5 Tangierská c h o r o b a ............................................................................................ 4 1 5 A b e ta lip o p ro te in e m ie (B assenův-K ornzw eigtiv s y n d ro m ).................................................................. 4 1 5 M e ta ch ro m a tická le u k o d y s tro fie ......................................................................4 1 6 Fam iliární a m y lo id ó z a ......................................................................................... 4 1 6 M ito c h o n d riá ln í nem oci (m ito c h o n d rio p a tie ).........................................................4 1 7 Idio pa tické n e u ro p a tie ......................................................................................................... 4 2 0 N europatie te n kých v lá k e n ......................................................................................... 421 7 N e m o c m o to n e u ro n u - a m y o tro fic k á la te rá ln í s k le r ó z a ..................................... 4 2 4 Etiologie a p a to g e n e ze ......................................................................................................... 4 2 6 G enetické f a k t o r y ......................................................................................................... 4 2 6 K linické p r o je v y ............................................................................................................ 4 2 7 D iagnostická kritéria A L S ............................................................................................ 4 2 8 Úloha elektrofyzio log ie ( E M G ) .................................................................................. 4 3 0 K onkrétní EMG n á le zy...................................................................................................4 3 0 Lokalizované f o r m y ......................................................................................................4 3 2
Brachiální am yo tro fická d ip le g ie ................................................................................4 3 2 P ro g n ó z a ......................................................................................................................... 4 3 3 Diferenciální d iag nóza ................................................................................................... 4 3 3 L é č b a ................................................................................................................................4 3 4 P ostpoliom yelitický s y n d r o m ............................................................................................ 4 3 6 8
N e u ro p a tic k á b o le s t ..................................................................................................................... 4 3 9
Fyziologie b o le s ti................................................................................................................... 4 3 9 Patofyziologie neuro patická b o l e s t i ................................................................................4 4 4 Diagnostika a dife ren ciálně dia g n o stický p o s tu p ......................................................... 4 4 6 N europatická bolestivé s y n d r o m y ...................................................................................4 4 8 Terapie neuropatická b o le s t i............................................................................................ 4 5 0 A n tid ep resiva................................................................................................................... 451 M o d u lá to ry kalciových k a n á lů ...................................................................................4 5 3 O p io id y .............................................................................................................................4 5 6 Lokální lé č b a ................................................................................................................... 4 5 6
