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Polyneuritic type of sensitivity disorder

The zone and nature of the sensitivity disorder detected in a patient can contribute to the solution of the question of the localization of his pathological focus. Topical diagnostics will undoubtedly become more reliable if this also takes into account information about other changes in the neurological status associated with disorders of sensitivity.

With the defeat of various levels of the system of common types of sensitivity, certain neurological syndromes are characteristic.

1) Peripheral nerves, sensitive or mixed, having in its composition fibers, providing a sensitive innervation of certain parts of the body. These areas do not correspond to dermatomes due to the fact that most of the peripheral nerves (with the exception of only intercostal nerves) are formed in the nerve plexus, functionally connected with several segments of the spinal cord located next to each other. Having identified a sensitivity disorder in the innervation zone of a specific peripheral nerve (or nerves), we can speak about the presence of a neural variant in the patient with a sensitivity disorder of the peripheral type and, thus, determine the affected nerve (Fig. 3.4a, right half of the human body).

Impulses of all types of sensitivity pass along the peripheral nerve from a certain part of the body, therefore, with its total damage in the corresponding zone, all types of sensitivity (hypesthesia or anesthesia) decrease or disappear. However, due to the fact that sometimes fibers of a certain modality are selectively affected in the peripheral nerve, the degree of disturbance of different types of sensitivity in the innervation zone of the affected nerve may vary.
In addition, it must be borne in mind that this zone is partially overlapped by adjacent areas innervated by adjacent nerves, so even the dissection of the peripheral nerve usually manifests anesthesia only in the central (autonomous) part of the zone it innervates.

Due to the fact that most of the peripheral nerves are mixed (contain sensory, motor and autonomic fibers), in the zone innervated by the affected nerve, motor and autonomic disorders are possible along with sensory nerves.

2) The lesion of the nerve plexus leads to impaired sensitivity and other functions in areas innervated by peripheral nerves that form in this plexus.

3) In case of multiple lesions of the parts of the peripheral nerves (polyneuropathy), the sensitivity is usually impaired in the symmetrical parts of the extremities “like gloves and socks”. Such a disorder can be called the distal (polyneuritic) variant of sensitivity disorder in the peripheral type (Fig. 3.5a).

In this variant, sensitivity disorders in the same distal extremities may cause motor disturbances (peripheral distal paresis) and autonomic disorders.

TYPES OF DISTURBANCE OF SENSITIVITY



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Polyneuritic type of sensitivity disorder

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