These chemicals promote the migration of different kinds of cells that are heterozygous for the NF1 gene into the hyperplastic lesions created by the nonmyelinating Schwann cells. These cell types include fibroblasts, perineurial cells, endothelial cells, and mast cells. The mast cells then secrete mitogens or survival factors that alter the developing tumor microenvironment and result in neurofibroma formation. Dermal and plexiform neurofibromas differ in later development stages, but the details are unclear at this point. Diagnosis
Dermal neurofibromas may be 2 to 20 mm in diameter, is soft, flaccid, and pinkish-white, and frequently this soft small tumor can be invaginated, as if through a ring in the skin by pressure with the finger, a maneuver called "button-holing". : 619 A blood test for protein melanoma inhibitory activity may be used to detect the presence of neurofibromas.A biopsy can be used for histopathology diagnosis. Treatments
Dermal neurofibroma
Dermal neurofibromas are not usually surgically removed unless they are painful or disfiguring, because there are generally so many of them and they are not dangerous. CO2 lasers have been used to remove dermal neurofibromas. In a paper titled Hypertrophic Scars After Therapy with CO2 Laser for Treatment of Multiple Cutaneous Neurofibromas Ostertag et al. said this about treatment by laser: "The cosmetic disfigurement is the most important issue in the decision to treat cutaneous symptoms of neurofibromatosis. Treating patients with extensive neurofibromas with [a] CO2 laser is still the best choice.
Spinal extradural haematoma or spinal epidural hematoma (SEH) is bleeding into the epidural space in the spine. These may arise spontaneously (e.g. during childbirth), or as a rare complication of epidural anaesthesia or of surgery (such as laminectomy). Symptoms usually include back pain which radiates to the arms or the legs. They may cause pressure on the spinal cord or cauda equina, which may present as pain, muscle weakness, or dysfunction of the bladder and bowel. Pathophysiology
The anatomy of the epidural space is such that spinal epidural hematoma has a different presentation from intracranial epidural hematoma. In the spine, the epidural space contains loose fatty tissue and a network of large, thin-walled veins, referred to as the epidural venous plexus. The source of bleeding in spinal epidural hematoma is likely to be this venous plexus. Diagnosis
The best way to confirm the diagnosis is MRI. Risk factors include anatomical abnormalities and bleeding disorders. Treatment
Treatment is generally with emergency surgery. The risk following epidural anaesthesia is difficult to quantify; estimates vary from 1 per 10,000 to 1 per 100,000 epidural anaesthetics. == References ==