tailieunhanh - Thieme Mumenthaler, Neurology - part 9

Nói chung, tiêm bắp nên tránh, trừ khi thật cần thiết. Khác biệt giữa các chẩn đoán Một tiêm vào một động mạch mông có thể gây ra hội chứng Nicolau, trong đó một phần của hệ thống cơ mông trở nên bị đổi màu (màu xanh) và có thể trở thành hoại tử. | Common Peroneal Nerve 793 branches on the dorsum of the foot caused by excessively tight shoes usually mountain hiking or ski boots with resulting dysesthesia and hypesthesia. Hypesthesia of the medial portion of the distal phalanx of the great toe results from the pressure of a rigid shoe in the presence of either hallux valgus or an osteophytic change of the unguicular process. A painful syndrome of the sciatic nerve the piriformis syndrome will be described below p. . Injection Palsies Pathologic Anatomy Injections improperly placed into or in the vicinity of a nerve cause an intense foreign body reaction around the nerve leading to dense fibrosis which may penetrate between the nerve fascicles. Clinical Features Weakness develops immediately after injection in about two-thirds of patients while only one-sixth have immediate pain. In about 10 of cases the weakness develops only after an interval of hours or even days. The weakness is at its worst 2448 hours after its onset. A causalgia-like pain syndrome may develop and dominate the clinical picture. Causes Injection palsies are most often due to injections into or near the sciatic nerve less commonly the gluteal nerves . They usually cause paresis in the muscles supplied by the common peroneal nerve lateral half of the sciatic trunk and are therefore discussed in this section. The occurrence of an injection palsy is largely determined by the site of in jection rather than by the substance injected as many different substances can produce harm in this way. In general intramuscular injections should be avoided unless absolutely necessary. Differential Diagnosis An injection into a gluteal artery can cause Nicolau syndrome in which part of the gluteal musculature becomes discolored blue and may become necrotic. Prophylactic Measures Proper Injection Technique Intragluteal injections should be carried out exclusively in the upper outer quadrant of the buttock and with the needle perpendicular to the body surface .