Introduction
This chapter discusses the diseases of muscle and peripheral nerve that are associated with cerebrovascular events. The peripheral nervous system, defined anatomically by neural structures enveloped by a Schwann cell plasma membrane, includes cranial nerves III to XII, the spinal roots, the nerve trunks, the dorsal roots, the autonomic centers, ganglia and their nerves.
Involvement of muscle or peripheral nerve or autonomic system associated with cerebrovascular events, designated herein as multiple neurological complications (MNCs), may occur with varying frequency and pattern and may be seen as primary or secondary (Table 24.1). Early diagnosis of primary MNCs can give valuable information about a patient's causal disease, a vasculitis, for example, cardiomyopathy or mitochondrial changes in both muscles and central nervous system (CNS) cells. Secondary MNCs may induce increased mortality and morbidity rates of stroke. The large variety of presentations of these disorders means that the MNCs represent a potentially frequent problem in neurologic practice. The full characterization of MNCs, however, needs investigations, including radiological, immunological, biochemical and genetic analyses, as well as electrophysiologic and autonomic function tests coupled with muscle or nerve biopsies.
Primary changes
Primary MNCs can result from vascular and cardiogenic embolisms, dissection of large vessels, primary and secondary vasculitis and mitochondrial cytopathies (Table 24.1). Prognosis will be determined by, and therapy tailored to, each specific cause.
Vascular and cardiogenic embolism
Simultaneous or delayed involvement of the neuromuscular system and the CNS in embolism has received little attention except in infective endocarditis (IE) where neuropathy is known to be a possible initial complication of the disease.