İnme sonrası sekel üst ekstremite parezisi olan hastalarda Karpal tünel ve Kübital tünel sendromu gelişimi
Küçük Resim Yok
Tarih
2010
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Trakya Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
İnme dünyada en sık görülen nörolojik problem olup ölüm nedenleri arasında gelişmiş ülkelerde kalp hastalığı ve kanserden sonra üçüncü, dünya genelinde ikinci sırada yer almaktadır. Erişkin populasyonunda da mortalite ve morbiditenin en sık nörolojik sebebidir. Son yıllarda risk faktörlerinin daha detaylı tanımlanması ve tedavi edilmesi, görüntüleme yöntemleri ile erken dönemde doğru tanı konulması, yeni tedavi olanaklarının kullanımı sayesinde inmeye bağlı mortalite oranlarında azalma olduğu bildirilmektedir. Böylece, yaşayan inme hastalarının oranı artmaktadır. İnmenin erken ve kronik dönemlerinde birçok farklı komplikasyonlar görülebilir. Özellikle ulnar ve median sinir tuzak nöropatileri başta olmak üzere, tuzak nöropatileri de inmenin komplikasyonlarındandır.Bu çalışmada, inme sonrası ağır üst ekstremite sekel parezisi bulunan (MRC < 3/5) hastaların üst ekstremitelerinde elektrofizyolojik olarak bilekte median sinir nöropatisi, dirsekte ulnar sinir nöropatisi gelişimi araştırıldı, semptomatik ve asemptomatik üst ekstremiteleri tuzak nöropatisi gelişimi açısından karşılaştırıldı. İnme geçirdiği tarihten itibaren en az altı ay geçmiş olan 32 hastanın yapılan elektromiyografi tetkiklerinde, semptomatik taraflarında; 12 bilekte median sinir nöropatisi, 12 dirsekte ulnar sinir nöropatisi saptandı. Buna rağmen asemptomatik taraflarında; 8 bilekte median sinir nöropatisi ve 6 dirsekte ulnar sinir nöropatisi tespit edildi. Median sinir nöropatisi hastaların 7'sinde bilateral iken, ulnar nöropati 2'sinde bilateral saptandı. İki hastada hem median sinir nöropatisi hem de ulnar sinir nöropatisi her iki üst ekstremitelerinde tespit edildi. Rehabilitasyon gören ve görmeyen semptomatik ekstremiteler kıyaslandığında rehabilitasyon gören hastaların hem semptomatik hem de asemptomatik ekstremitelerinde tuzak nöropatisi gelişimine yatkınlıklarının azaldığı saptandı.Sonuç olarak, bu çalışmada, inme sonrası sekel ağır üst ekstremite parezisi olan hastalarda kronik dönemde yüksek oranda median ve ulnar sinir nöropatisi geliştiği saptandı. Rehabilitasyonun hem semptomatik hem de asemptomatik ekstremitelerde tuzak nöropatisi gelişimini azalttığı saptandı. Ağır hemiparezisi olan hastalarda, özellikle paretik ekstremitelerinde daha fazla olmak üzere, tuzak nöropatileri daha fazla görülmekle birlikte erken ve etkin rehabilitasyon programları tuzak nöropatisi gelişiminin önüne geçebilir.
Stroke, after heart disease and cancer, is the third most common cause of death in the developed countries, and the second most common cause of mortality in the whole world. It is also the most common neurological cause of mortality and morbidity in adult population. In recent years, the mortality ratios of stroke decreased because of detailed defining and treatment of stroke risk factors, new neuroimaging techniques and treatment modalities. Thus the ratio of stroke patients who survived were increased. Various complications may be seen in early and chronic stage of stroke. Entrapment neuropathies are known as the complications of stroke, especially median and ulnar nerve entrapment neuropathies in the upper extremities.In this study, we aimed to evaluate the development of median nerve neuropathy at the wrist and ulnar nerve neuropathy at the elbow in severe stroke patients (MRC<3) at least 6 months after the event. The electrophysiological parameters of symptomatic and asymptomatic sides were compared for entrapment neuropathies. The symptomatic and asymptomatic sides of the patients were also compared with control subjects. In the symptomatic side, 12 of 32 patients had median nerve entrapment at the wrist and 12 had ulnar nerve entrapment at the elbow. In asymptomatic side, eight patients had median nerve entrapment at the wrist and 6 had ulnar nerve entrapment at the elbow. Seven patients had bilateral median nerve entrapment and only 2 patients had ulnar nerve entrapment. Two patients had both bilateral median and ulnar nerve entrapments. The patients who received rehabilitation had less vulnerability of entrapment neuropathies both in symptomatic and asymptomatic sides.As a result, median and ulnar nerve entrapment neuropathies were found common in severe stroke patients in the chronic stage after the event. However the rate of entrapment neuropathies were found decreased in stroke patients who received rehabilitation. Our results confirm that, in severe hemiparetic patients, the entrapment neuropathies may be commonly seen, especially in the paretic extremities. The early rehabilitation programs against the development of entrapment neuropathies may be beneficial in stroke patients.
Stroke, after heart disease and cancer, is the third most common cause of death in the developed countries, and the second most common cause of mortality in the whole world. It is also the most common neurological cause of mortality and morbidity in adult population. In recent years, the mortality ratios of stroke decreased because of detailed defining and treatment of stroke risk factors, new neuroimaging techniques and treatment modalities. Thus the ratio of stroke patients who survived were increased. Various complications may be seen in early and chronic stage of stroke. Entrapment neuropathies are known as the complications of stroke, especially median and ulnar nerve entrapment neuropathies in the upper extremities.In this study, we aimed to evaluate the development of median nerve neuropathy at the wrist and ulnar nerve neuropathy at the elbow in severe stroke patients (MRC<3) at least 6 months after the event. The electrophysiological parameters of symptomatic and asymptomatic sides were compared for entrapment neuropathies. The symptomatic and asymptomatic sides of the patients were also compared with control subjects. In the symptomatic side, 12 of 32 patients had median nerve entrapment at the wrist and 12 had ulnar nerve entrapment at the elbow. In asymptomatic side, eight patients had median nerve entrapment at the wrist and 6 had ulnar nerve entrapment at the elbow. Seven patients had bilateral median nerve entrapment and only 2 patients had ulnar nerve entrapment. Two patients had both bilateral median and ulnar nerve entrapments. The patients who received rehabilitation had less vulnerability of entrapment neuropathies both in symptomatic and asymptomatic sides.As a result, median and ulnar nerve entrapment neuropathies were found common in severe stroke patients in the chronic stage after the event. However the rate of entrapment neuropathies were found decreased in stroke patients who received rehabilitation. Our results confirm that, in severe hemiparetic patients, the entrapment neuropathies may be commonly seen, especially in the paretic extremities. The early rehabilitation programs against the development of entrapment neuropathies may be beneficial in stroke patients.
Açıklama
Tıpta Uzmanlık
Anahtar Kelimeler
Nöroloji, Neurology
