Radiation peripheral neuropathy
Introduction
Introduction to radioactive peripheral neuropathy Radiation therapy is the leading cause of radiation-induced peripheral neuropathy that can cause damage to the nervous system, including the brain, spinal cord, and peripheral nerves. The occurrence of radioactive peripheral neuropathy is closely related to the site of irradiation and the dose of radiation. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: glossopharyngeal nerve injury
Cause
Causes of radioactive peripheral neuropathy
(1) Causes of the disease
Radiation therapy is the leading cause of radiation-induced peripheral neuropathy. Other diseases can also be caused by improper protection or accidental exposure to waste radioactive sources.
(two) pathogenesis
The occurrence of radioactive peripheral neuropathy is related to the radiation of connective tissue around the nerve trunk or nerve plexus. It has been reported that the death of 22 months after receiving high-dose radiation therapy, the autopsy pathological observation found that there are around the brachial plexus. Obvious fibrosis, microscopic examination showed that the proximal nerves in the fibrotic area were relatively intact, the extraneural membrane of the fibrotic part was thickened, the myelin sheath was lost, the nerve fibers were replaced by fibrous connective tissue, and the distal median nerve of the fibrotic part was also extensive. Significant loss of myelin, nerve fiber atrophy, partially replaced by fibrous tissue, and another patient who received low-dose radiation therapy for 12 months, had only mild neurological symptoms in the clinic, and post-mortem autopsy found fiber only in front of the brachial plexus The nerves are almost unaffected. In addition to the slight demyelination and fibrosis of the small nerves near the forearm of the armpit, the other axons and myelin are normal. It can be seen that the dose of radiation therapy and pathology The extent of the findings of the plexus fibrosis is completely consistent with the clinical manifestations.
Prevention
Radioactive peripheral neuropathy prevention
1. Mainly the prevention and treatment of primary disease, as well as strict control of radiotherapy indications.
2. Strengthen the management of radiological protection and waste radioactive sources.
Complication
Radioactive peripheral neuropathy Complications of the glossopharyngeal nerve
Systemic damage, especially digestive dysfunction and blood system lesions are more common.
Symptom
Symptoms of Radioactive Peripheral Neuropathy Common Symptoms Blocking muscle fiber twitching lingual pharyngeal nerve injury after radiation of the brachial plexus...
Radiotherapy is the best treatment option for breast cancer, neck tumor, testicular tumor and lymphoma. It is also the most likely to cause brachial plexus and lumbosacral injury after radiation. Radiotherapy of nasopharyngeal tumor can cause glossopharyngeal nerve injury. Optic nerve and optic chiasm can occur after radiotherapy for pituitary tumors and craniopharyngioma.
Radioactive peripheral neuropathy often has a certain period of incubation period, mostly for several months to 2 years, but also for more than 10 years. The disease is usually slow onset, and a few cases can suddenly start on days or months after receiving radiotherapy. Most of the patients with plexus neuropathy first manifested as decreased finger sensation or paresthesia. Some of them may have weak hands and fingers at the same time. As the disease progresses, the affected limbs may gradually appear. A few patients have sudden onset of dyskinesia.
Physical examination showed abnormal motor sensation, and sacral reflex was weakened. The upper brachial plexus and the lower brachial plexus were often involved at the same time. In the early stage, the brachial plexus was mainly damaged. Very few patients involved the phrenic nerve and caused diaphragmatic paralysis.
Neuroelectrophysiological examination showed denervation potential, fibrillation potential and myokymic discharge, motor and sensory nerve conduction velocity were slowed down, and motor block was detected between cervical spinal cord and clavicle. Somatosensory induction The potential shows that N9 disappears.
Examine
Radioactive peripheral neuropathy
Blood tests: including blood routine, liver function, renal function, routine examination of erythrocyte sedimentation rate; rheumatism series, immunoglobulin electrophoresis and other serological tests related to autoimmunity;
Neurophysiological examination is differentiated from other peripheral neuropathy.
Diagnosis
Diagnosis and diagnosis of radioactive peripheral neuropathy
The diagnosis of this disease mainly depends on medical history and clinical manifestations.
Brachial plexus MRI can identify whether breast cancer or neck tumor recurrence is neurological or post-radiation neuropathy. Skull base MRI can identify nasopharyngeal tumor recurrence and radioactive glossopharyngeal nerve injury. King reports that tongue appears within 2.5 years after radiotherapy of nasopharyngeal tumor. In 17 patients with pharyngeal nerve spasm, MRI showed 14 cases of radiation damage, which showed extensive fibrosis along the glossopharyngeal nerve pathway, involving the pharyngeal neural tube and carotid sheath, 2 cases of tumor recurrence, and 1 case of tumor recurrence. Combined with radioactive damage.
