Management Of Peripheral Nerve Injury
Peripheral Nerve Etiology
- Traumatic: Either closed or open injury
- Inflammatory: Leprosy, diphtheria, herpes zoster
- Lead and arsenical poisoning
- Alcoholism
- Diabetes mellitus
- Vitamin B1 deficiency
- Porphyria
- Neurofibroma and other neural tumors
- Idiopathic.
Peripheral Nerve Clinical Features
- Loss of sensory, motor, autonomous and reflx functions.
- Secondary changes in the skin and joint.
Peripheral Nerve Management
Peripheral Nerve Medicinal
- Steroids: They reduce the edema around nerve and is useful in neurapraxia. Prednisolone 5 to 10 mg is effctive.
- Nerve tonics: Vitamin B
1, B6, B12, they are supposed to facilitate nerve fier regeneration and are useful in cases of neuropraxia and axonotmesis. - In cases with acute neuralgic pain, drugs like carbamazepine or gabapentin can be prescribed. It is purely symptomatic treatment.
- Physiotherapy: Inthe form of electrical nerve stimulation (TENS) and in cases of motor nerve exercises and massage therapy can be given.
Peripheral Nerve Surgical
- Decompression: It is used if nerve compression occurs resulting into neuropraxia.
It is usually done when nerve due to bone deposition in the nerve canal; there is pressure on the nerve leading to neuropraxia. Here,enlargement of the canal boundaries is done to relieve the pressure on the nerve. - Anastomosis: It is microsurgical repair of the severed ends of the nerve. It is useful, when there is no loss of nerve tissue as in accidental clean surgical by transection of the nerve.
- Cross innervation: It is useful when there is motor nerve defiit due to a lesion in the course of the nerve.
In this repair, a nerve is grafted to connect the affcted nerve to the normal functional nerve on the other side of the body using microsurgical repair. - Nerve grafts: It is use of a nerve segment from one part of the body to reconstruct and repair an affcted nerve in some other part using microsurgical technique.
- Glasgow coma scale gives clear idea about neuronal injury.
- Autonomic disturbances with bradycardia, systolic hypertension, deep and slow respiration, Cheyne stokes ventilation.
- Cushing’s triad of raised intracranial pressure is obvious i.e. bradycardia, hypertension and respiratory irregularity.
- Features such as restlessness, irritability, headache,vomiting and progressive deterioration are common.
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