Nörofizyoloji Laboratuvarına Düşük Ayak Tanısıyla Yönlendirilen Olguların Retrospektif Değerlendirilmesi

Şeyma Aykaç; Gülcan Neşem Başkan; Fikret Bademkıran; Burhanettin Uludağ; Zafer Çolakoğlu; İbrahim Aydoğdu

doi:10.19161/etd.1403022

TR EN

Nörofizyoloji Laboratuvarına Düşük Ayak Tanısıyla Yönlendirilen Olguların Retrospektif Değerlendirilmesi

Öz

Amaç: Bu çalışmamızda düşük ayak ön tanısı düşünülerek nörofizyoloji laboratuvarına yönlendirilen olguların etiyolojik ve elektrofizyolojik özelliklerini ortaya koymayı amaçladık. Gereç ve Yöntem: Ocak 2019 - Eylül 2022 arasında düşük ayak kliniği nedeniyle elektromiyografi (EMG) laboratuvarına yönlendirilen 127 olgunun klinik ve elektrofizyolojik bulguları retrospektif olarak değerlendirildi. Bulgular: Çalışmaya dahil edilen 114 olgunun yaşları 18-85 (ort. 49,6) aralığında değişmekteydi. Olguların %31 i kadın, %69 u erkekti. 79 olgu dahili, 35 olgu ise cerrahi branşlardan yönlendirilmişti. Düşük ayak etiyolojisi olarak en sık fibuler sinir hasarı (%44.7) saptanmakla birlikte, sıklık sırasına göre radikülopati %21.9, siyatik sinir hasarı %16.7, polinöropati %10.5, lumbosakral pleksopati %4.4, ön boynuz motor nöron hastalığı %1,8 oranında saptanan diğer etiyolojilerdi. Olguların %83 ünde tek taraflı, %17 sinde bilateral düşük ayak mevcuttu. Bilateral düşük ayak saptanan 19 olgunun 12 sinde polinöropati, 3’ünde radikülopati (L4-5, S1 kök), 2’sinde fibula başı nöropatisi, 1’inde lumbosakral pleksopati, 1’inde ön boynuz motor nöron hastalığı mevcuttu. Elektrofizyolojik bulgular, olguların %85’inde aksonal, %11’inde demiyelinizan özellik göstermekteyken, %4 olguda demyelinizan veya aksonal hasar ayırdedilemedi. Fibular sinir hasarı dahili ve cerrahi branşlardan yönlendirilen olgularda en sık etiyolojik etken olmakla birlikte, dahili branşlarda polinöropati cerrahi branşlara göre daha sık saptandı. Tüm olgularda klinik olarak etkilenen bölge ile patolojik elektrofizyolojik bulguların elde edildiği bölge birbiri ile uyumluydu. Sonuç: Düşük ayak kliniği ile yönlendirilen hastalarda etiyolojide fibular sinir nöropatisi sık olsa da, farklı etiyolojiler saptanabilir Elektrofizyolojik testler bu olgularda periferik patolojinin belirlenmesinde yol göstericidir. Bu nedenle düşük ayak kliniği olan olgularda lezyon lokalizasyonunun belirlenmesinde, etiyolojiye yönelik yapılması gereken tetkiklerin planlanmasında, nörolojik muayene ile birlikte elde edilen elektrofizyolojik bulgular mutlaka göz önünde bulundurulmalıdır. Not: Bu çalışma 38.Ulusal Klinik Nörofizyoloji EEG-EMG Kongresi’nde (26-30 Ekim 2022) sözel bildiri şeklinde sunulmuştur.

Anahtar Kelimeler

Retrospective evalution of patients with foot drop sent to neurophysiology laboratory

Abstract

Objective: In this study, we aimed to reveal the etiologic and electrophysiologic characteristics of patients with foot drop referred to the neurophysiology laboratory. Materials and Methods: The clinical and electrophysiologic findings of 127 patients referred to the electromyography (EMG) laboratory between January 2019 and September 2022 were retrospectively evaluated. Results: The ages of the 114 patients included in the study ranged between 18-85 years (mean 49.6). 31% of the patients were female and 69% were male. 79 cases were referred from internal medicine and 35 cases were referred from surgery. The most common etiology of foot drop was fibular nerve injury (44.7%), followed by radiculopathy 21.9%, sciatic nerve injury 16.7%, polyneuropathy 10.5%, lumbosacral plexopathy 4.4%, anterior horn motor neuron disease 1.8%. Unilateral and bilateral foot drop was present in 83% and 17% of the cases, respectively. Of the 19 patients with bilateral foot drop, 12 had polyneuropathy, 3 had radiculopathy (L4-5, S1 root), 2 had fibular head neuropathy, 1 had lumbosacral plexopathy, and 1 had anterior horn motor neuron disease. Electrophysiologic findings were axonal in 85% of cases and demyelinating in 11%, while demyelinating or axonal damage could not be differentiated in 4% of cases. Fibular nerve injury was the most common etiologic factor in cases referred from internal and surgical branches, but polyneuropathy was more common in internal branches (13% of cases) than in surgical branches (5% of cases). In all cases, the clinically affected area and the area of pathologic electrophysiologic findings were consistent with each other. Conclusion: Although fibular nerve neuropathy is common in the etiology of patients referred with foot drop, different etiologies may be detected. Electrophysiologic tests are guiding in the determination of peripheral pathology in these cases. Therefore, electrophysiological findings obtained together with neurological examination should be taken into consideration in determining the lesion localisation and planning the investigations to be performed for the etiology in patients with foot drop.

Keywords

References

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Details

Primary Language

Turkish

Subjects

Neurology and Neuromuscular Diseases

Journal Section

Research Article

Authors

Şeyma Aykaç ^*
0000-0003-3994-0019
Türkiye

Gülcan Neşem Başkan
0000-0003-1205-9889
Türkiye

Fikret Bademkıran
0000-0001-8703-0074
Türkiye

Burhanettin Uludağ
0000-0001-5023-4321
Türkiye

Zafer Çolakoğlu
0000-0003-3591-0015
Türkiye

İbrahim Aydoğdu
0000-0001-7209-7161
Türkiye

Publication Date

September 9, 2024

Submission Date

December 11, 2023

Acceptance Date

January 10, 2024

Published in Issue

Year 2024 Volume: 63 Number: 3

DOI

https://doi.org/10.19161/etd.1403022

IZ

https://izlik.org/JA44CX44UX

Cite

RIS / Bibtex

Vancouver

1.Şeyma Aykaç, Gülcan Neşem Başkan, Fikret Bademkıran, Burhanettin Uludağ, Zafer Çolakoğlu, İbrahim Aydoğdu. Nörofizyoloji Laboratuvarına Düşük Ayak Tanısıyla Yönlendirilen Olguların Retrospektif Değerlendirilmesi. EJM. 2024 Sep. 1;63(3):323-31. doi:10.19161/etd.1403022