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传导阻滞翻译

发表时间:2018-12-6  浏览次数:24  
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原文:

Conduction block represents a focal pathologic process affecting peripheral nerve. However, although conduction block is generally used interchangeably with suspected underlying segmental demyelination, axonal pathology may also create clinically and electrophysiologically observable conduction block. For example, acute focal axonal lesions and chronic immune-mediated neuropathies such as multifocal motor neuropathy with conduction block may both be characterized by some degree of axonally mediated conduction block. Typically, once wallerian degeneration has occurred, the block in conduction is replaced by low-amplitude CMAPs at all points of stimulation along the nerve, as would be conventionally suspected in an axonal process. Therefore, the identification of conduction block not only has diagnostic and therapeutic value but also demonstrates the presence of preserved but at-risk axons caused by the disorder at hand.

Frequently, a focal process affecting the nerve may be insufficient to cause frank conduction block but may cause focal slowing (Fig. 10). This is usually attributed to focal dysmyelination. When assessed over long interstimulation distances, areas of focal slowing may be missed via an averaging effect with more plentiful segments of unaffected rapidly conducting nerve. Therefore, focal slowing is usually apparent with stimulation over shorter distances (such as a focally prolonged distal latency or with short segmental stimulation, or inching, techniques).50 Isolation of focal conduction block or slowing with short segmental stimulation is one of the most powerful localizing tools in clinical neurophysiology and, in the setting of compressive pathology, can lead directly to definitive interventional management.

 

 

译文:

传导阻滞为一种外周神经受累的局部病理学变化。虽然传导阻滞常与神经节段脱髓鞘联系在一起,但轴突病理学改变有可能导致传导阻滞。例如,急性局部轴突病变与慢性免疫介导的神经病变(如多病灶运动神经病)常存在轴突介导的传导阻滞。一旦发生Waller变性,低振幅CMAP可替代传导阻滞。因此,传导阻滞鉴定不但具有诊断、治疗价值,还可体现患者轴突受损风险情况。

通常,局部病变不会直接导致传导阻滞,但可能导致局部传导缓慢,如图10。这与局部脱髓鞘相关。当刺激距离较长时,局部信号传导缓慢区域为快速传导神经所影响,整体传导速度较快。因此,局部传导缓慢仅发生于短距离刺激中。局部传导阻滞或局部传导缓慢为临床神经病检查的重要途径之一,据此可直接进行介入管理。


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