Radicular Syndrome Kuliah Blok

Radicular SyndromeDarwin AmirBgn Ilmu Penyakit Saraf Fakultas Kedokteran Universitas AndalasPeripheral Nerves and Nerve PlexusesCervical plexusBrachial plexusC1C2C3C4C4C4C4C4T1T2T3T4T5T6T7T8T9T10T11T12Lu!ar plexus"acral plexusL1L2L3L4L5"1"2"3"4"5C#1Phrenic nerve$xillar% nerve&uscul#cu'ane#us nerveTh#racic nerves(adial nerve)lnar nerve&edian nerveLa'eral *e#ral cu'ane#us nerve+eni'#*e#ral nerve,e#ral nervePudendal nerve"cia'ic nerveSee ANS lecture(adicular "%ndr#eDenition! a com"ination of c#anges usually seen wit# com$romise of a s$inal root wit#in t#e intras$inal canal% t#ese include neck or "ack $ain and& in t#e a'ected root distri"ution dermatomal $ain& $arast#esia or "ot# decreased dee$ tendon re(e)& occasionally myotomal weakness(adicular "%ndr#eArises due to com$ression or #erniation of t#e nerve roots are "ranc#ing of t#e s$inal cord t#at transmits signals t#roug#out t#e "ody at every level along t#e s$ine (adicular "%ndr#e "%p'#e*eads to $ain and ot#er signs like lack of sensation& tingling and a sense of weakness felt in t#e u$$er or lower regions of t#e "ody like t#e arms or legs Sensory+related sym$tomes are more $revalens as com$ared to motor+related sym$tomes& and muscular weakness is generally as indicator of t#e increased severity of nerve com$ression ,#e nature and kind of $ain could di'er ranging from dulling& t#ro""ing $ain and com$le) to locali-e & and even s#ar$+s#ooting and "urning sensation could "e felt(adicular "%ndr#e "%p'#esRadicular $ain!Less c##n t#an somatic $ain,#e #allmark of radiculo$at#y& any $at#ologic condition a'ecting t#e nerve rootsArises *r# 'he nerve r##'s #r d#rsal r##' -an-lia.ernia'ed dis/ is "y far t#e most common causeRadicular $ain!Lancina'in- #r elec'ric 0uali'%.oves in "ands and usually radiates down t#e lim"sAssociated sym$toms of pares'hesias are very help*ul de'erinin- 'he iden'i'% of t#e involved nerve root "etter t#an site of $ainSym$toms of weakness and o"/ective ndings of sensory loss& weakness and re(e) loss may occurRadicular $ain!1n2aa'i#n is im$ortant as a $ain mec#anism!Ph#sph#lipase $ and 34 N54 TN,& ot#er $ro+in(ammatory mediators are released !% a hernia'ed dis/,#e dura surrounding t#e ventral and dorsal nerve root is "at#ed in t#is e)udate1n2aa'i#n #r pri#r in6ur% to nerve root is necessary to cause c#pressi#n to generate continued $ain,y$es of $eri$#eral nerve in/ury!Neura$ra)ia! Segmental loss of myelin coating on nerve root0nerve1eakness& "ut n# a'r#ph%A)onotmesis! *oss of a)ons and myelin "ut at least some su$$orting structures are $reserved1eakness and muscle a'r#ph% i* severeNeurotmesis! *oss of a)ons& myelin& and com$lete disru$tion of su$$orting structures 2transection3 weakness and atro$#yDermatome 4ac# nerve root su$$lies cutaneous sensation to a s$ecic area of skin& known as a dera'#e 5verla$s somew#at& so won6t loseAll sensation& "ut will feel $arest#esia.yotomeIf radicular $ain sever could a'ect myotome 4ac# nerve root su$$lies motor innervation to certain muscles& known as a %#'#e In t#e cervical s$ine!Nerve roots e)it a!#ve t#eir named verte"ral "odyI7e7& 89 e)its "elow 8: and a"ove 89+so lateral disk #erniation #ere gets 89In t#e lum"ar s$ine!S$inal cord ends at *; or *