EPIDEMIOLOGIA DELLE LESIONI
NERVOSE PERIFERICHE
ALBERTO POLO
U.O. NEUROLOGIA
ULSS 17
Neuropatie focali
Incidenza x 100.000/anno
• R Latinovic et al. J Neurol Neurosurg Psychiatry 2006
EPIDEMIOLOGIA
E’ LA FORMA FORMA PIU’ COMUNE DI
NEUROPATIA DA COMPRESSIONE AGLI ARTI
SUPERIORI DOPO
LA SINDROME DEL TUNNEL CARPALE
Sindrome del tunnel cubitale
• Lo studio neurofisiologico di routine:
E’ necessario
Non è necessario
• Appare Non necessario poichè il 76% dei
pazienti con sintomi caratteristici ha normali
risultati ed il 75% dei pazienti con alterazioni
patologiche comunque recupera.
• J Hand Surg Eur 2009
STC
Popolazione
generale
Incidenza
Prevalenza
Donne/uomini
0,125 % - 1 %
139,4/67,2
5 % - 16 %
Età media: 50 /51
JAMA 1999
Am J Public Health 1994
Eur J Neurol 2003
J Neurol Neurosurg
Psychiatry 2003
Occupazionale
5%
Orthop
Clin North Am
PREGANCY AND CTS
• 63 patients :CTS was clinically diagnosed in
more than half of women (62%).
Neurophysiological evaluation provided
diagnosis of CTS 43%of women in one hand
at least.
• Acta Neurochir (Wien). 2006
Diagnostic properties of nerve
conduction tests in population-based
carpal tunnel syndrome
Using the clinical diagnosis of CTS as the
criterion standard, nerve conduction
tests had moderate sensitivity and
specificity and a low positive predictive
value in population-based CTS.
Measurement of median-ulnar sensory
latency difference had the highest
diagnostic accuracy
BMC Musculoskeletal Disorders 2003
• The overall prevalence of radial
nerve palsy after fracture of the
shaft of the humerus in 21 papers
was 11.8% (532 palsies in 4517
fractures).
• Studies published in the past 40
years of 391 papers identified
initially, 35 papers met all our
criteria for eligibility.
Shao YC et al
J Bone Joint Surg Br. 2005
Iatrogenic nerve palsy
• A total of 707 humerus shaft fractures
were treated operatively at our two
hospitals over a 10-year period. Of
these, 30 patients sustained iatrogenic
radial nerve palsy.
• Wang J et al. J Trauma. 2009
Rare
• Incidence: Obstetrical brachial plexus palsy
occurs at a frequency of 0.38 to 1.56 per
1000 deliveries
J Pediat Orthop. 2005.
• Prevalence: Neuralgic amyotrophy 1.64 cases
per 100,000 population
• Neurology 1985
Familiar painless - recurrent
brachial plexus palsy
*
*
*
*
*
*
*
*
*
*
HNPP : deletion or abnormal structure of the
PMP22 gene on 17p12-p11.2
BRACHIALGIA ACUTA
CAUSE FREQUENTI
> 100/10000
CAUSE NON FREQUENTI CAUSE RARE
5 - 100 /10000
< 5/100000
DISCOPATIA CERVICALE RADICOLOPATIA POSTTRAUMATICA
EMATOMA EPIDURALE
(tao)
STC
NEURITE H-Z
CRPS
INFARTO MIOCARDICO
OCCLUSIONE
VASCOLARE
S DI PANCOAST
NEUROPATIE
prevalenza
NP
5-8/102
CTS
5-16/102
CIDP
1-2/105
100/105
2-3/105
GBS
KD
incidenza
1/5x104
(Maschi nati vivi)
NEUROPATIE
prevalenza
83/105
CER RAD
N ERED
28-41/105
DIABETE 9/102
3-4/102
LEBBRA
116/105
BP
incidenza
(ASIA)
23/105
EMG – VdC ULSS 17 - 2008
N° PAZIENTI
MONSELICE
1414
ESTE
794
TOTALE
2208
POPOLAZIONE
ABIT / EMG
183000
83,03
Pazienti 2008 - monselice
stc
753
64%
radicolop
228
20%
neuropat
156
13%
22
2,5%
800
mnd
700
600
miopatia
7
<1%
500
MG
7
<1%
GBS
2
0,3%
CIDP
2
0,3%
MNCB
1
0,1%
400
300
200
100
24%
TR
O
AL
M
NC
B
P
CI
D
G
BS
G
pa
io
m
M
t ia
nd
m
ur
op
ne
ra
d
ico
lo
pa
st
c
t ia
at
ia
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