Fig. 5. Herpetic lesion of Th1-4 spinal sensitive ganglions.
In cases of recurrent herpetic ganglioneuropathy (more than 1 time in 3 months) HIV and oncology should be excluded.
Herpetic ganglioneuropathy treatment.
Antiviral medications (acyclovir (Zovirax), 5-10 mg / kg i/v or 800 mg oral 5 times daily for 5-7 days, valacyclovir (Valtrex), 1000 mg 3 times daily for 7 days).
Human Immunoglobulin (Bioven mono, Octagam – 50,0 i/v), desensitizing agents.
Acyclovir ointment on the affected skin.
Topical creams (Lidocaine cream) can relieve the itching. Do not scratch the skin where the rash is located. This may increase the risk of secondary bacterial infection and scarring.
Vitamins B.
Postherpetic neuralgia treatment.
Antiepileptic drugs: gabapeptin 300-2400 mg daily for 3 times, pregabalin (Lyrica) 75-600 mg, daily in 3 times.
Tricyclic antidepressant amitriptyline 25 mg 3 times daily.
Local compresses (dimexidum, novocaine, lidocaine).
Laser therapy.
Ineffective conservative treatment - hormone or radiotherapy.
6. Plexopathy.
The defeat of the brachial plexus. Etiology: collarbone fracture, dislocated shoulder, compression between the clavicle and I rib or shoulder head, compression by cervical ribs, callus after fracture of the clavicle, scalene muscle contracture.
Clinic.
Upper brachial Erb-Duchenne plexopathy (damage to the upper primary trunk of the brachial plexus of the C5-C6 segment, Fig. 6) - loss of function of the proximal part of the limb - flaccid paresis of proximal muscles of hand (biceps, triceps, brachioradialis muscle), disorders of sensation at a polyneural type and pain in external surface of proximal arm part.
Lower brachial Dejerine-Klumpke plexopathy (damage to the lower primary trunk of the brachial plexus of the C8- T1 segment, Fig. 6) - loss of function of the distal part of the limb - flaccid paresis of distal muscles of hand, muscular atrophy of forearm and small muscles of hand, disorders of sensation at a polyneural type on distal arm part, Bernard-Horner syndrome (ptosis, miosis, enophthalmos) due to lesion or compression of one side of the cervical or thoracic sympathetic chain.
Fig. 6. Segmental innervation of the upper extremities.
Total brachial plexopathy (the whole plexus defeat) - flaccid paresis, muscular atrophy and disorders of sensation of the whole arm.
Lumbo-sacral plexopathy (defeat of the L5, S1-S2 segment). Causes: infections, tumors of the pelvis and abdomen. Clinic - flaccid paralysis of the foot, leg, thigh adduductors, loss of Achilles reflex, sensor and vegetaative disorders in the foot and shin.
7. Mononeuropathies of the upper extremities.
Mononeuropathy of the radial nerve (humerus fractures, compression of the nerve at surgery, using a crutch, after sleep (especially - "alcoholic"):
paresis of forearm, hand and fingers extensors – impossibility of hand extension – ”dropping hand” (Fig. 7)
absence of unbend-elbow reflex
anesthesia of extensor surface of hand and I, II 1\2 radial part III fingers.
