Neurovascular syndrome

Kennedy J, Buchan AM (2004) Acute neurovascular syndromes hurry up, please, it s time. Stroke 35 360-362 Kertesz A (1993) Clinical forms of aphasia. Acta Neurochir Suppl (Wien) 56 52-58... 

Whole-body Irradiation. Whole-body irradiation, where absorbed doses are high and acquired over short periods of time, will result in acute radiation sickness. There are three characteristic syndromes that make up the typical clinical pattern of acute radiation sickness. These are the hematopoietic, gastrointestinal, and neurovascular syndromes which occur with increasing dose, respectively. 

C. Neurovascular Syndrome. The neurovascular syndrome is associated with absorbed doses in the supralethal range and would be seen quite rarely since heat and blast effects would cause immediate lethality in most situations where the required very high radiation doses would be sustained. Exceptions could occur in aircrews exposed to prompt nuclear radiation from high altitude detonations and personnel protected against heat and blast in hardened sites below the surface or personnel in vehicles or shelters in the proximity of enhanced weapons detonations. The latent period is very short varying from several hours to 1 to 3 days. 

Table 6.5 The spectrum of acute radiation sickness ARS. Radiation syndrome should be considered as a spectrum of severity from asymptomatic mild exposure to neurovascular syndrome with a very poor prognosis (see text)...

C. Manifest Phase. This phase presents with the clinical symptoms associated with the major organ system injured (marrow, intestine, neurovascular system). A summary of essential features of each syndrome and the doses at which they would be seen in young healthy adults exposed to short, high dose single exposures is shown in Figure 6-1 of Part I of FM 8-9. 

A risk factor is defined as an attribute or exposure that increases the probability of a disease or disorder (Putz-Anderson, 1988). Biomechanical risk factors for musculoskeletal disorders include repetitive and sustained exertions, awkward postures, and application of high mechanical forces. Vibration and cold environments may also accelerate the development of musculoskeletal disorders. Typical tools that can be used to identify the potential for development of musculoskeletal disorders include conducting work-methods analyses and checklists designed to itemize undesirable work site conditions or worker activities that contribute to injury. Since most of manual work requires the active use of the arms and hands, the structures of the upper extremities are particularly vulnerable to soft tissue injury. WUEDs are typically associated with repetitive manual tasks with forceful exertions, such as those performed at assembly lines, or when using hand tools, computer keyboards and other devices, or operating machinery. These tasks impose repeated stresses to the upper body, that is, the muscles, tendons, ligaments, nerve tissues, and neurovascular structures. There are three basic types of WRDs to the upper extremity tendon disorder (such as tendonitis), nerve disorder (such as carpal tunnel syndrome), and neurovascular disorder (such as thoracic outlet syndrome or vibration-Raynaud s syndrome). The main biomechanical risk factors of musculoskeletal disorders are presented in Table 22. 

A musculoskeletal injury that arises gradually as a result of repeated microtrauma. CTDs are characterized by injuries to the tendons, nerves, or neurovascular system. Muscles and joints are stressed, tendons are inflamed, nerves are pinched, or the flow of blood is restricted. Examples of CTDs include tendinitis, tenosynovitis, carpal tunnel syndrome, thoracic outlet syndrome, and Raynaud s phenomenon (white finger disease). 

The dislocation is described according to the direction of tibial displacement relative to the femur. Anterior dislocation is the commonest type, and is associated with disruption of the anterior cruciate ligament, the posterior joint capsule and popliteal artery damage. Posterior dislocation can also be associated with arterial injury. Rotary or posterolateral dislocation is caused by force abduction and internal rotation. On the lateral radiograph, the femoral condyle is in profile but the tibia is rotated posterolaterally and the proximal tibiofibular joint is seen in its entirety. An early complete assessment and documentation of the neurovascular status of the leg distally is vital. Also look for signs of compartment syndrome. 

The lirst rib is probably the rib most commonly involved in somatic dysfunction of all the ribs. It is affected by trauma, stress, and posture as well as by dysfunction ofthe C7-T1 complex. The patient may report "shoulder" pain, stiff neck, upper back or neck pain, and an inability to turn the head while driving. The first rib can impinge the neurovascular bundle as it passes between it and the clavicle through the costoclavicular space. The anterior and middle scalene muscles, which raise the first rib, may likewise compress the brachial plexus when they are in spasm and result in thoracic outlet syndrome symptoms. The patient s symptoms are then described as pain, numbness, or paresthesias ofthe arm or hand on the involved side. The physician needs to be aware that this may cause confusion should the patient demonstrate a herniated cervical disc on magnetic resonance imaging [MRO. The symptoms may be caused by the rib dysfunction rather than the herniated disc, so evaluation ofthe rib for normal motion and treatment of any dysfunction should be performed in these cases. Osteopathic manipulation may save the patient unnecessary surgery. 

Generally speaking, the clinically relevant structures of the thoracic outlet region are the brachial plexus nerves, the subclavian artery and the subclavian vein. The causes of brachial plexopathy include trauma, intrinsic and extrinsic tumors, radiation plexopathy and Parsonage-Turner syndrome. The neurovascular structures of the thoracic outlet... 

Clinical Anatomy 425 Osseous and Articular Anatomy 425 Tendons and Retinacula 427 Neurovascular Structures 430 Essentials of Clinical History and Physical Examination 433 De Quervain Disease 433 Carpal Tunnel Syndrome 433 US Scanning Technique and Normal US Anatomy 434 Dorsal Wrist 434 Volar Wrist 441... 

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