Group of Functional Neurosurgery Research Institute named after. Burdenko Ramn - neurosurgery news

1. Recording

Research is carried out by appointment. You can sign up by phone. Or request a call back

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Note!

The magnet tunnel is a pipe 2 meters long with a diameter of 55 cm. Patients with dimensions exceeding the diameter of the tube cannot be examined on a closed tomograph. You are welcome to visit our facility before enrolling to ensure that size restrictions or claustrophobia will not interfere with your exploration. If you are unable to remain still for long periods of time or suffer from claustrophobia, please inform us when booking.

If you are unable to remain still for long periods of time or suffer from claustrophobia, please inform us when booking. During the recording, inform the operator of the list of studies you are interested in, last name, first name, patronymic and date of birth. Enter the date, time and location of the examination on the referral form, this will help you avoid surprises and allow you to visit the center at the time reserved for you.

2. Preparation for the study

Most MRI exams require no special preparation, meaning you can eat, drink, and take prescribed medications before and immediately after the exam. Wear comfortable clothing without metal fragments and bring a change of shoes. It is better to leave jewelry and costumes at home. Before the study, it is not recommended to use cosmetics containing metal particles and metal-containing ointments.

MRI of organs abdominal cavity and retroperitoneal space

  1. Taking the drug "Espumizan" - to eliminate increased gas formation.
  2. The study is carried out on an empty stomach: the last meal should take place no later than 6 hours before the start of the study.

MRI of the pelvic organs in women

  1. It is recommended to conduct an examination on days 7-12 menstrual cycle, it is possible to conduct research in the second phase of the cycle for endometriosis and assess the spread of previously identified tumor process. The examination is not carried out during menstruation; it is recommended to calculate in advance the day of the cycle on which the examination day will occur.
  2. For the highest quality and full description the doctor obtained the results, you must have with you all available medical documentation: postoperative extracts, data (images and conclusions) of previous MRI, ultrasound, SCT studies, a referral from the attending physician is also desirable.
  3. The day before the test, you need to exclude from the diet coarse fiber and foods that cause excessive gas formation (cabbage, fruits, carbonated drinks, brown bread, dairy products etc.).
  4. Taking the drug "Espumizan" - to eliminate increased gas formation..
  5. 30-40 minutes before the start of the study, take 1-2 No-Spa tablets.
  6. Do not urinate 2 hours before the test. Additional reception no fluid is needed - the bladder should be moderately full

MRI of the pelvic organs in men

  1. For the highest quality and complete description by the doctor of the results obtained, you must have with you all available medical documentation: postoperative statements, data (images and conclusions) of previous MRI, ultrasound, SCT studies, and a referral from the attending physician is also desirable.
  2. The day before the test, you need to exclude from your diet coarse fiber and foods that cause excessive gas formation (cabbage, fruits, carbonated drinks, brown bread, dairy products, etc.).
  3. Bowel preparation: for normal digestion - natural bowel movement on the day of the test, for constipation - the use of gentle microenemas (Microlax)
  4. The last meal is no later than 4 hours before the start of the study.
  5. 30-40 minutes before the start of the study, take 1-2 No-Spa tablets.
  6. Do not urinate 2 hours before the test. Additional fluid intake is not needed - the bladder should be moderately full.

MRI of the rectum

  1. Bowel preparation: for normal digestion - natural bowel movement on the day of the test, for constipation - the use of gentle microenemas (Microlax)
  2. An hour before the test - emptying Bladder and further avoidance of fluid intake.
  3. 50 minutes before the examination, take 2-3 No-Spa tablets
  4. You must have with you all medical documentation related to your this disease: referral from the attending physician, results of colonoscopy or sigmoidoscopy, postoperative notes, results of previous MRI or CT examinations

Preparing for an MRI-guided prostate biopsy

  1. 7 days before the biopsy, stop taking anticoagulants (aspirin, thrombo-ass, cardiomagnyl, warfarin, Plavix, Clexane, Marevan, Pradaxa, Sincumar, Fraxiparin, Fragmin
    and etc.)
  2. Ciprofloxacin 500 mg x 2 times a day. - start taking it 1 day before the biopsy and then take it for another 4 days (5 days in total).
  3. Metronidazole 250 mg x 3 times a day. - start taking it 1 day before the biopsy and then take it for another 4 days (5 days in total).
  4. The evening before the biopsy and in the morning on the day of the biopsy - a cleansing enema.
  5. 2 hours before biopsy don't urinate.

Ultrasound of the brachial plexus, that is, a complex of 4-8 cervical and 1-2 thoracic nerves, is a procedure necessary for patients having problems with the peripheral nerves of the hand. Pathological conditions often develop as a result of a previous dislocation or fracture of the shoulder. Recording what the brachial plexus looks like on an ultrasound is very important for further diagnosis.

There are several indications for prescribing ultrasound of the nerves, some of them are absolute(if all plexus structures are affected), and some are relative(this includes preventive examination). TO absolute indications for ultrasound examination nerve structures upper limb include:

  • stiffness in the hand and decreased mobility;
  • decreased tactile ability of the skin along the entire length of the arm;
  • on the pathological side there is signs of Horner's syndrome which is characterized by a disorder of the sympathetic nervous system and is accompanied by such manifestations as drooping eyelids, enophthalmos and constriction of the pupil.

Relative indications to ultrasound examination symptoms appear indicating partial damage to the brachial plexus nerves:

  1. Diseases associated with a malfunction of the nerves of the upper part of the shoulder can be accompanied by a violation of not only the sensitivity of this part of the arm, but also its motor functions.
  2. About defeat in the middle part nerve plexus Shoulders indicate similar pathologies in the fingers or hand as a whole.
  3. A malfunction of the nervous system is also indicated by motor and tactile disorders in the area of ​​the fingers (from the first to the third). This symptom indicates damage to the lower part of the nerve structures of the shoulder.
  4. An additional reason for prescribing an ultrasound may be the detection of tumors upon palpation in the clavicle area.
  5. In addition, when traumatic lesions shoulder, there is a high probability of prescribing an ultrasound of the brachial plexus to assess the state of the nervous system.

What does it show?

Ultrasound examination of the brachial plexus nerves is carried out according to diagnostic standards peripheral nerves. During the procedure, the sonologist evaluates parameters such as:

  • clarity of neural circuits;
  • volume and branching of nerves in the plexus;
  • the fiber structure of each nerve;
  • cross-sectional shape – should demonstrate predominance connective tissue in front of the bundles nerve fibers;
  • are there any tumors;
  • interaction between nerves and adjacent tissues.

How do they do it?

A patient planning to undergo a brachial plexus ultrasound does not need to undergo any special preparation. If it is necessary to carry out the procedure with an existing open injury in the collarbone area, the bandages will be removed from the patient, and the doctor will wrap the ultrasonic sensor of the device with a special film.

Important! Disinfected polyethylene will protect the patient from possible infection without affecting the results of the study.

Video

See how the brachial plexus ultrasound procedure works. From the video you can find out what the doctor is looking at and how he moves the sensor to obtain complete data on the condition of the nerves.

Pathologies and decoding

During the analysis of the data obtained, the doctor can form his opinion about preliminary diagnosis, having before your eyes an ultrasound picture of the plexus, and most often it turns out to be one of the following pathologies:

  • tumors in nerve endings(the study protocol will indicate their exact location, possible cause of appearance and relationship to adjacent tissues);
  • inflammation of the brachial plexus structures;
  • injuries to its elements;
  • neuropathy resulting from compression, that is, compression of nerves by surrounding tissues.

How much does it cost and where to do it?

The price of an ultrasound scan of the brachial plexus varies from 1000 to 2000 rubles. The difference depends, of course, on the region: in Moscow and in the provinces the cost will be significantly different. You can do it in any paid diagnostic center. The procedure is also available in free medical institutions with a referral from a doctor.

This may be a tractional effect, as a result of which intra-trunk ruptures of the brachial plexus may occur; shock impact, as a result of which the trunks of the plexus can be damaged between the collarbone and the first rib, compressed as a result of the formation of a hematoma, etc. Most looking heavy damage is separation of the roots that form the brachial plexus from spinal cord. Brachial plexus injuries are often the result of motor vehicle injuries and motorcycle falls.

Clinically, brachial plexus injury manifests itself in the form of partial or complete paralysis of the arm muscles, sensitivity disorders and pain syndrome. Spontaneous restoration of function after a brachial plexus injury is possible during the first 3-6 months after the injury against the background rehabilitation treatment. No signs of recovery of sensitivity and motor functions during this period is an indication for an examination to determine the nature and level of damage to the brachial plexus. The main examination methods include: MRI and CT myelography cervical spine spinal cord, plain x-ray chest, stimulation electromyography, ultrasound of the brachial plexus trunks and nerves. MRI and CT myelography allow visualization possible separation roots from the spinal cord. A plain chest x-ray can show unilateral paresis of the diaphragm, which will indicate damage to the phrenic nerve. Stimulation electromyography allows you to determine the approximate level of damage, assess conductivity along the nerve trunks and signs of their degeneration. Ultrasound of the plexus trunks and nerves allows us to assess the nature of their damage, the presence of ruptures and neuromas.

The choice of surgical reconstruction technique for the brachial plexus depends on the nature of its damage. In any case, the use of microsurgical techniques and intraoperative stimulation electromyography is mandatory. If there are no signs of separation of the roots from the spinal cord and there is evidence of the formation of an intra-trunk neuroma, then surgical treatment is reduced to revision of the trunks of the brachial plexus, freeing them from scars (neurolysis) and excision of the neuroma. Neuroma occurs as a result of intra-trunk rupture of nerve fibers and their subsequent multidirectional growth. Conducting nerve signals through a neuroma is impossible. Therefore, during the operation it is excised, and inserts are sewn between the fascicular bundles of the plexus trunks - nerve fiber grafts, which are most often taken from the n.suralis on the posterolateral surface of the leg. In the event that damage to the brachial plexus occurs at several levels: at the level of the primary and secondary trunks, then
Even adequate surgical reconstruction leaves little chance of recovery, since the path for the germination of nerve fibers is too long. In this case, a technique is used to neurotize peripheral nerves that have lost their function, bypassing the brachial plexus. This allows you to shorten the path of nerve fiber germination and improve recovery results. The essence of neurotization is that a donor nerve is sewn into a nerve that has lost its function. The donor nerve fibers sprout and restore the impaired function. Lareral and medial anterior nerves can be used as donor nerves. pectoral nerve, thoracodorsal nerve, intercostal nerves, spinal portion of the accessory nerve, phrenic nerve, motor branches of the cervical plexus. The main recipient nerves are the suprascapular nerve, the musculo- cutaneous nerve and axillary nerve. IN functionally highest value has restoration of the function of the musculocutaneous nerve, as it ensures flexion of the arm in elbow joint. Next in importance is the axillary nerve, which provides abduction of the arm, and the suprascapular nerve, which provides stability. shoulder joint. Restoration of function of the median and ulnar nerves seems unlikely because long way for the sprouting of nerve fibers. When the roots forming the brachial plexus are separated from the spinal cord, neurotization is the only reconstruction technique. Optimal timing for neuro surgical treatment is 6-9 months after injury. After 18 months after injury, the results of surgical treatment drop sharply due to the development of Wallerian degeneration of nerve fibers.

The ulnar nerve begins with the brachial plexus and ends near the hand. Pinching of such a nerve in the elbow joint provokes a decrease in its functions, which leads to poor mobility of the arm and fingers. This disease is called neuropathy ulnar nerve. Typically, this disease affects people who, due to their work or habit, rest their hand on a hard surface.

Considering that the most common disease of the ulnar nerve is neuropathy, its causes should be considered. Neuropathy (neuritis) is an inflammation of the ulnar nerve, to which people who work in an office or on a machine shop are predisposed. This statistic is due to the fact that it is precisely people in these professions who place their hand on a hard surface. Of course, there are other factors that influence the occurrence of this unpleasant disease, among which:

  • infectious diseases;
  • hand injuries;
  • alcohol poisoning;
  • hypothermia;
  • little content minerals in organism;
  • habit of resting your elbow on the table;
  • constant work with tools;
  • frequent flexion movements of the arm.

Of course, ulnar nerve neuritis is quite common in modern world. The main reason for its occurrence is work. Often employees of offices and factories complain about this disease, because feeling the symptoms in the evening after work is quite unpleasant.

Ulnar nerve neuropathy may also be associated with damage to the ulnar nerve. This most often occurs with fractures and dislocations of the bones of the shoulder and forearm. One of dangerous reasons It may be that when this nerve is compressed by a tumor, this condition requires surgical intervention.

Any of the causes of this disease is quite dangerous to human health. Even if the cause of the disease is not pathological process, it can develop quite quickly, causing new symptoms. Therefore, if you find even the slightest hint of neuropathy, you need to consult with an experienced specialist to confirm or refute the diagnosis.

When the ulnar nerve is damaged, its function may be impaired. Such disorders are manifested by sensory and motor disorders. In this case, sensory disorders appear first. The exception is a fracture, in which case the disorders occur simultaneously. Exist specific signs which will help determine the onset of this disease. These include:

  1. Partial or complete numbness of the hands for a short time. This symptom creates discomfort and is often accompanied by cramps in the hands. The disease manifests itself most on the fingers, which leads to their tension and resulting numbness.
  2. Decreased performance of the fingers and hand in general. Any work with your hands can be accompanied by aching pain.
  3. Changing fingers. The fingers will begin to look unnaturally bent in different directions, this is especially noticeable in the little finger, which is tilted to the side. In this case, it is impossible to close your fingers into a fist.
  4. Changing the color tone skin fingers.
  5. Brush drooping.

Symptoms of this disease may also indicate the exact location where the damage occurred. Damage to middle third shoulder symptoms are the same as above, but the function of the extensor muscles is preserved. If the upper third of the shoulder is damaged, the symptoms remain the same, but the functions of the extensor muscles are more impaired, which is manifested by a hanging hand. And damage to the upper third of the shoulder causes low sensitivity the back of the hand, and pain in the area is especially noticeable thumb. In order to ensure the accuracy of the proposed diagnosis, the patient is given a set of tasks:

  1. It is necessary to spread his fingers in different directions; if he cannot complete the task, then this is one of the signs of this disease.
  2. With your palms facing upward and your fingers straight, place a sheet of paper on them. Neuritis will not allow you to do such a task.
  3. You need to place your hand on a hard surface and scratch the table with your little finger. Typically people who have ulnar neuralgia cannot do this.

The presence of such symptoms indicates that obvious damage to the ulnar nerve has occurred. And if you do not seek help in a timely manner, they can cause many problems for the patient. Therefore, you need to apply for medical care to experienced specialists who will help solve this problem.

Another common problem associated with the ulnar nerve is cubital tunnel syndrome. This syndrome is caused by compression of the nerve in the cubital canal. There are many reasons for this violation. They can also be associated with playing sports, when a lot of arm movements and lifting barbells are performed. The reasons include external factors, one of which is the habit of placing your elbow on the side of the car, and, of course, severe bruise elbow. Among the symptoms of this disease are the following:

  • obvious pain in the elbow area;
  • burning;
  • tingling;
  • twitching of fingers;
  • difficulty bending fingers.

The peculiarity of the manifestation of these symptoms is that they initially manifest themselves only in the evening and at night. Well, then they manifest themselves constantly, and at the same time they can cause severe discomfort and discomfort. The sensitivity of the little finger gradually disappears and ring finger, after which disturbances in motor activity may occur, which is accompanied by severe pain. You can check the accuracy of the assumption of this disease using the same set of tasks. This syndrome is dangerous due to its rapid onset of pain, which causes terrible sensations, and therefore requires prompt examination by a doctor.

When the ulnar nerve is compressed in the area of ​​the canal in the wrist, this indicates the presence of Guyon's canal syndrome. It has similarities with both neuropathy and cuboid tunnel syndrome, but it also has its own special features. This disease has a number of causes. This condition can occur:

  1. With heavy loads on the wrist, which are provoked by grasping and rotational movements. It is most often observed in people who work with their hands, for example, in a factory.
  2. Due to an injury that causes swelling and pressure on the ulnar nerve. Or as a result of irritation, which can also cause Guyon's syndrome.
  3. The result is a fracture of the hamate, which can damage the ulnar nerve by being pierced by bone fragments.

The symptoms of this disease are quite similar to ulnar nerve neuropathy, but at the same time they have their own characteristics of manifestation. The first of these is that this syndrome causes severe aching pain in area wrist joint and palmar surface of the hand. In this case, the back of the hand does not experience such manifestations of pain and does not lose sensitivity. Guyon's syndrome is accompanied by motor disorders, such as incomplete flexion of the fingers and difficulties in spreading them.

Of course, all manifestations of ulnar nerve diseases have some similarity, which causes difficulties in diagnosis. Therefore, if these symptoms are detected or if it is difficult to perform the above tasks, you should seek qualified medical help.

Neuropathy, like any other disease, has its own unpleasant symptoms, when they appear, people consult a doctor. It is the doctor who makes the correct diagnosis, after which treatment is prescribed. If neuropathy is suspected, the doctor conducts a neurological examination of the patient. It is produced using a tapping test. This suggests the presence of a disease.

Froman tests are often used, which involve performing certain tasks related to hand movements. Based on the results of these tests, the doctor can determine the presence of this disease. These tests have been used for quite a long time in diagnosing the disease. Moreover, they always give very accurate results.

Among the main methods for detecting this disease are: X-ray examination, thanks to which it is possible to identify all kinds of bone defects that may be possible reasons compression of the ulnar nerve. Ultrasonography also allows you to see all structural changes and identify areas in which the channel is pinched.

One of the most precise methods The detection of ulnar nerve neuritis is electroneuromyography, it makes it possible to see the level of damage to all nerve fibers.

Don’t be afraid of going to the doctor, much less self-medicate, which will most likely only cause complications of neuritis. There is nothing difficult or dangerous in diagnosing neuritis. All procedures occur quite quickly, and the violations that provoked the disease are immediately identified. After full diagnostics the doctor is already creating a complete clinical picture and prescribes the correct course of treatment. Thanks to it, the manifestations of all these unpleasant symptoms will decrease.

IN international classification diseases of ICD 10, damage to the ulnar nerve is coded G56.2. The severity of this disease is quite high, and therefore requires the help of a qualified specialist. Treatment of neuritis is prescribed depending on what exactly caused it.

When the cause is a bone fracture with fiber damage, it is likely that surgery will be necessary to help restore the nerve. Fractures with complete ruptures of fibers are quite dangerous. Such damage is repaired using stitching. It will take about 6 months to heal.

If the cause of neuritis is prolonged compression of the ulnar nerve, then methods are first used conservative treatment, which are aimed at restoring the integrity of the nerve. Quite often, special fixing devices are used, thanks to which the hand is fixed in the required position and its strength is reduced. physical activity. However, this method of treatment is not entirely universal, because fixing the hand in one position will cause many everyday inconveniences. Therefore, such devices are worn by the patient at night.

To reduce inflammation, in addition to fixation devices, they are prescribed medications. They have anti-inflammatory properties and reduce pain. Sometimes inflammatory process too strong, and the medications don’t cope, then special injections are prescribed.

Physiotherapy is often used to treat ulnar neuritis. In this case, it can include massage, physical therapy, ultrasound and electrophoresis. This method is quite effective and, with the right approach, gives quick results.

Unfortunately, patients with this disease are not always in a hurry to seek treatment on time.

Sometimes it happens that neuropathy reaches irreversible processes, in which case surgical intervention is necessary.

During the operation, the surgeon releases the ulnar nerve from compression. Of course, not immediately, but the patient feels an improvement in his condition, and after recovery, all the previous skills return to his hands.

Thus, the doctor chooses the method of treatment after necessary research. Most often used conservative method. The result of treatment depends not only on the doctor, but also on the efforts the patient puts into it.

This site is intended for persons over 18 years of age; it contains a number of photos and videos that are not intended for viewing by persons with an unprepared psyche.

The materials on the site are for informational purposes only. For staging correct diagnosis and the choice of further treatment tactics requires consultation with a specialist.

  • Clinical examination
  • Electromyography
  • Magnetic resonance imaging
  • X-ray

Possibilities of ultrasound diagnostics in studies of peripheral nerves

IN last years as additional method instrumental diagnostics increasingly used for peripheral nerve diseases sonography. The emergence of wideband multi-frequency linear sensors (from 11.0 to 17.0 MHz) and latest developments software Ultrasound devices made it possible to obtain a sonographic image nerve trunk and those around him anatomical structures With high level tissue differentiation.

Normal nerve: uniform thickness, moderate echogenicity, clear differentiation of epineurium, perineurium and nerve fiber bundles

Advantages of ultrasound compared to other imaging methods:

Ease of execution and data interpretation. Low cost

No effect on the body ionizing radiation(compared to CT and radiography)

The highest in comparison with all existing methods visualization of the level of differentiation of the nerve trunk and its fibrous structure

No restrictions associated with the presence of: metal implants, pacemakers, claustrophobia (compared to MRI)

Ability to evaluate in real time the dynamic characteristics of moving structures

Possibility of conducting multiple studies

Usage Doppler techniques to assess blood flow

On the limbs available for visualization:

Median, Ulnar, Radial, Femoral, Isciatic, Tibial,
Peroneal nerves. Brachial plexus.

In pathology, due to the thickening of the nerve trunk and a decrease in its density, the level of visualization increases, which makes it possible to analyze smaller nerves that are normally inaccessible ( lateral cutaneous nerve of the thigh, branches of the radial and peroneal nerves, interdigital and other nerves).

Lipoma (dashed arrows) of the popliteal fossa with compression of the peroneal nerve (white arrows). Nerve thickening and loss of fibrous structure proximal and distal to the compression site

Ganglion cyst (dashed arrow) in the distal carpal tunnel with compression median nerve(white arrows)

Limitations of the sonographic method:

Inability to visualize nerve trunks in places where they pass under bone structures(subclavian brachial plexus)

Reduced visualization quality with a deep location of the nerve trunk, especially in patients with large body weight ( tibial nerve in the middle 1/3 of the shin, sciatic nerve in the gluteal region)

Diagnostic capabilities of ultrasound:

Determining the location of nerve compression by a combination of three signs:

Nerve flattening at the point of compression.

For the median nerve, the flattening coefficient is calculated, defined as the ratio of the maximum width of the nerve to its thickness. Values ​​above 3.3 are considered pathological.

Nerve thickening proximal and distal to the compression site.

The increase in cross-sectional area is higher than the statistical standard and, in comparison with the contralateral nerve, is assessed as pathological.

Structural changes nerve: decreased echogenicity of the nerve, thickening of individual bundles of nerve fibers, and later loss of fibrous structure.

Visualizing the cause of nerve compression with an assessment of its sonographic characteristics (size, structure, vascularization, relationship with the nerve trunk).

Visualization of a nerve trunk rupture. Assessment of the size of diastasis and the condition of the ends at complete break nerve.

Detection of intraneural hypervascularization with inflammation and/or degenerative changes in the nerve.

Determining the cause of chronic nerve irritation during the movement of perineural anatomical structures (tendons, muscles, fascia, bone protrusions).

Carpal tunnel syndrome. Flattening of the nerve in the tunnel (dashed arrow). Swelling and thickening of the nerve proximal and distal to the compression site
(white arrows). Reduced echogenicity.
Loss of fibrous echostructure.

Well-defined education
(dashed arrows) originating from the ulnar nerve
(Ultrasonic signs of schwanoma)

Causes of nerve damage available for sonographic analysis:

Conditions predisposing to development compression syndrome: More often these are abnormal muscles and vessels in the tunnels.

Factors directly causing acute or chronic nerve compression:

    o Intraneural and perineural tumors and cysts
    o Synovitis with expansion of the cavity of the joints and tendon sheaths
    o Vascular pathology (thrombosis, aneurysm)
    o Thickening of the ligament or fascia limiting the tunnel
    o Osteophytes
    o Perineural edema or hematoma
    o Infiltration and compaction of the soft tissues surrounding the nerve in a number of diseases (endocrinopathies, storage diseases, multiple myeloma, gout, etc.)
    o Fractures and dislocations of bones
    o Metal structures