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PATOLOGA DE

LOS NERVIOSPERIFRICOS

Dpto. de Ciruga Ortopdica y Traumatologa

Clnica Universitaria de Navarra

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TEJIDO NERVIOSO

SISTEMA NERVIOSO CENTRAL

EncfaloMdula espinal

NerviosGanglios

Receptores

SISTEMA NERVIOSO PERIFRICO

Ross MH, Reith EJ, Romrell LJ: Histology. A Text and atlas (2 edition). William & Wilkins, Baltimore, Maryland, 1989.

Axn

Mielina

Cono axnico

Mielina

SN. CENTRALSN. CENTRAL

SN: PERIFRICOSN: PERIFRICO

Celula Schwann

Oligodendrocito

Ndulo de

Unin Neuromuscular

Dendritas

Dendritas

Ranvier

GranulacionesNissl

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NERVIO PERIFRICO

ESTRUCTURAS EPITELIALES CONDUCTORASFibra nerviosa

EndoneuroPerineuro

Epineuro

SISTEMA MESENQUIMAL Y DE PROTECCIN

Amillo, S; Caadell, J: Microciruga en Ortopedia y Traumatologa. Eunsa, 1986.

Axn o cilindro-eje

Vaina de mielina (mielnicas)Clula de Schwann

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EndoneuroPerineuro

Epineuro

Nervio raqudeo

Axn motor

Axn sensitivo

Clula de Schwann

Mielina

Somaneu

rona motora

Mdula espinal

Raz anterior

Raz posterior

Ganglio sensitivo

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Mexoaxn

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Collarete citoplasmtico

Nucleo

interno

Collarete citoplasmticointerno

Collarete citoplasmticoexternoCollarete citoplasmticoextern

Citoplasma

Nucleo cel Schwann

Axn

Mielina

S-LIncisuras

Axn

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Endoneuro

Perineuro

Epineuro

Schwann

AxnMielina

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ndoneuro

Perineuro

Epineuro

Sistema Extrnseco

Sistema Intrnseco

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CLASIFICACIN LESIONES NERVIOSAS

SEDDON(1943)

NeuroapraxiaAxonotmesis

Lesiones de 1 grado: Conduccin axonal

SUNDERLAND(1951)

Neurotmesis

Seddon, H J: Three types of nerve injury. Brain,1943;66:237

Sunderland, S: A classification of peripheral nerve injuries producing loss of function. Brain,1951;74:491

Lesiones de 2 grado: Continuidad axonal

Lesiones de 3 grado: Continuidad fibra nerviosaLesiones de 4 grado: Perineuro y fascculoLesiones de 5 grado: Continuidad tronco nervioso

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2 semanas 3 semanas 3 meses Varios meses

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NEUROAPRAXIA (LESIN DE 1 GRADO)

Clnica: Parlisis motoraAlt. sensitiva y vegetativa nula

EMG: Persiste conduccin distalNo actividad voluntaria

No atrofia muscularFragmentacin vaina de mielina

Evolucin: Restitucin completaPatrn anrquico

Tratamiento: Abstencin terapetica

Seddon, H J: Three types of nerve injury. Brain,1943;66:237

Sunderland, S: A classification of peripheral nerve injuries producing loss of function. Brain,1951;74:491

AP

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AXONOTMESIS

Clnica: Parlisis motora,sensitiva y vegetativaEMG: Interrupcin de la conduccin

No actividad voluntaria

Atrofia muscular progresivaDegeneracin walleriana del axn

Evolucin: Restitucin completa (1-3 mm/da)

Segn patrn de regeneracinTratamiento: Fisioterpico

Quirrgico

Fibrilacin en reposo

Seddon, H J: Three types of nerve injury. Brain,1943;66:237

Sunderland, S: A classification of peripheral nerve injuries producing loss of function. Brain,1951;74:491

AP

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NEUROTMESIS

Clnica:Parlisis completaEMG: Interrupcin de la conduccin

No actividad voluntaria

Atrofia muscular progresiva

Seccin t interrupcin del axn

Evolucin: No restitucin espontnea

Tratamiento: Quirrgico

Fibrilacin en reposo

desmielinizacin

estructuras conjuntivas

Seddon, H J: Three types of nerve injury. Brain,1943;66:237

Sunderland, S: A classification of peripheral nerve injuries producing loss of function. Brain,1951;74:491

AP

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