Meralgia paresthesia - Bernhardt-Roth syndrome

Meralgia paraesthesia Bernhardt-Roth syndrome is a painful mononeuropatie lateral femoral cutaneous nerve. It is manifested by pain and sensation of irritation felt anteriolaterala front of the thigh. It is due to local compression of the nerve near the inguinal ligament lateral passing. Rarely have other etiologies such as direct trauma, stretch, or ischemia injuries. Clinical history and examination are usually sufficient to diagnose. However it can be confirmed by nerve conduction studies.
A patient who shows meralgie paraesthesia idiopathic or due to mechanical damage or paresthesia diestezii can describe the cutaneous nerve distribution. Paraesthesia are seen as abnormal tingling sensations, numbness, burning, itching, cold or heat and are triggered by physical evidence of cutaneous stimulation.Diesteziile is distorted perception of tactile or painful stimuli.Changes in posture can cause discomfort. These symptoms may disappear and reappear.
Treatment is usually conservative. Removal is the best case compression therapy. In some patients, weight loss and quitting is narrow enough clothes therapy. Most patients have mild symptoms with paraesthesia meralgie who respond to conservative therapy.When pain is severe you can choose a focal nerve block at the inguinal ligament with lidocaine and corticosteroids. This therapy should improve symptoms temporarily for several days to weeks.Drugs for neurogenic pain as carbamazepine and gabapentin are not helping. If injuries are not severe nerve condition heals spontaneously. Paresthesia resolves slowly over time but may persist nerve numbness in the distribution.
Prognosis depends on the etiology of lateral femoral cutaneous nerve injury. Meralgia paraesthesia simple mechanical injury caused by benign external resolves spontaneously. For most patients this condition through medical education, self-limiting and patients learn to tolerate the symptoms and modify their activity so avoiding surgery and aggressive treatments.
Pathogenesis
Metabolic conditions such as diabetes, alcoholism and thyroid disease can contribute to the development of lateral femoral cutaneous nerve neuropathy and other nerve. In most cases the etiology meralgiei paresthesia involving excessive pressure on the nerve at various locations of incarceration. The pressure may be due to internal causes such as obesity, pregnancy or pelvic tumors.There is a high incidence of obesity in patients with paraesthesia meralgie which strongly suggests that this is an independent risk factor. Alternatively external causes such as corsets and waist belts can cause the condition. Iatrogenic nerve can be damaged by local trauma during surgical procedures. Reconstruction of hip, iliac crest bone grafting, appendectomy, inguinal lymph node dissection, aortofemural bypass, uterine surgery, and cesarean surgery on the quadriceps may be involved in meralgia paraesthesia causative.
Along the path or lateral femoral cutaneous nerve is vulnerable to compression in different places. The nerve exits the psoas muscle, crosses the inguinal ligament, anterior superior iliac bypass spina and exits through the fascia lata. Meralgia paresthesia occurs most often through nerve compression in the pelvis.
Peripheral nerve lesions are dependent on the nature described in terms of injury and associated prognosis. A compressive force neuropraxica cause nerve damage characterized by loss of myelin sheath without damaging the axon or axonal. Neuropraxice lesions have the best prognosis and can be cured in a few hours to month, depending on severity. Its sheath or axon loss is more severe nerve damage and a worse prognosis for healing since suffering nerve degeneration or destruction waleriana nerve fibers distal to the lesion site.If the lesion involves only the axons and axonal sheath avoid patient may heal slowly. If axonal sheath is affected adversely the prognosis for spontaneous healing. Most often, compressive forces tend to cause injuries and improve their neuropraxice initiates the healing process.
Risk factors:-Pregnancy clothes narrow and obesity predispose to nerve compression at the inguinal ligamentAdopted adult-fetal position for extended periods-DiabetesNerve by neoplasms, incarceration, iliopsoas muscle hemorrhage contained.
Causes:
Trauma:-Compression of the nerve at the inguinal ligament acute by the rapid deceleration of car accidents-Pelvic fracture.Iatrogenic:Iliac crest bone-grafting-Pelvic osteotomy-Operation of the acetabular failure-Inguinal lymph node dissection-Appendectomy, total abdominal hysterectomy.Subacute retroperitoneal mechanicalInvasive tumor, hemorrhage, abscess.Obstetric / gynecologic:-Endometriosis-pain comes and goes along with her periodsFetal-compression of the second and third pregnancy trimester.Chronic compression or stretching of the inguinal ligament:Belt-wearing, obesity, ascites-L2-3 nerve root compressionMultiple-radiculopatiile, diabetes, herpes zoster.
Signs and symptoms
Meralgia paraesthesia is a common but unrecognized condition manifested by pain, numbness and tingling in parts of the anterior and lateral thigh. The disease is caused by the lateral cutaneous femoral nerve incarceration with pain and sensory abnormalities in the anterolateral thigh. Lateral femoral cutaneous nerve is purely sensory receiving roots innervate the lumbar L2-3 and includes fibers sudomotorii. Sudomotorii changes as moderate sweat nerve territory distribution may be obvious though unusual.Because the nerve is purely sensory changes are not present or motor reflexes.
Medical and surgical history is important to correctly diagnose meralgia paraesthesia. Physical examination in patients with paraesthesia meralgie discovery is remarkable for altered sensitivity in anterolateral thigh, including pain, tingling, and burning hiposensibilitatea. Symptoms typically begins insidiously and do not extend below the knee. The pain tends to be sharp or burning, but may be in the form of cramps. The patient may approach the abnormal positions or movements that contribute to symptoms.Position prolonged bipedal bipedal position or adoption after a period of sitting aggravates symptoms. Examinations of motor function and reflexes are normal. If the patient has back pain or motor weakness should be suspected other diagnoses as lateral femoral cutaneous nerve is purely sensory. Points painful lumbar radiculopathy, and pathology plexopatia similar balance can occur meralgia paraesthesia.
Diagnosis
Laboratory studies:Laboratory evaluation for diabetes and thyroid disease may also indicated in some cases.Imaging Studies:They are of no benefit in diagnosing the condition. If you suspect a fracture or a tumor mass can be recommended as a causative imaging.Electrodiagnostic evaluation comprising electromyography and nerve conduction studies are usually required but may be helpful for history and physical examination in the diagnosis of meralgie paraesthesia and establish a prognosis. Nerve conduction tests help determine the severity of nerve damage by comparing the results with standard values ​​and with those of the opposite limb.The more the amplitude is small compared with both limb dysfunction is higher.
Treatment
Treatment for meralgia paraesthesia is directed towards identifying and improving the compression forces on the lateral femoral cutaneous nerve. A belt or corset narrow clothes may cause symptoms. In obese patients weight loss is extremely beneficial. Patients should be advised of the prolonged effects of adopting positions that increase pressure on the nerve.Conservative modalities such as application of ice, local heat and electrical stimulation can be used for pain relief.
In many cases heal spontaneously if nerve compression is high. If symptoms continue it may indicate anti-inflammatory drugs, local injections nonchirurgicale other ways. If these methods fail surgery may be an option. The decision to intervene surgically depends on the extent and nature of symptoms. Neuroliza with transposition of the nerve and nerve transect are the surgical procedures performed meralgia paraesthesia.
Meralgia paresthesia is a benign condition. In patients treated conservatively complications are limited to persistent symptoms despite treatment. In this pathological condition, there should be no muscular weakness or motor disabilities. Surgical complications include bleeding and infection, however, permanent anesthesia anterolateral thigh is a common consequence of the transection. It can develop neuromas. Administration of NSAIDs can cause gastrointestinal ulcers, renal and hepatic function alter exacerbate hypertension. Anticonvulsant medication may precipitate onvulsiile, cause excessive fatigue. Common effects are dry mouth and tricyclic antidepresantelor urinary retention.