Abstract
BackgroundPeroneal nerve is susceptible to injuries due to its anatomical course. Excessive weight loss, which reduces the fatty cushion protecting the nerve, is considered a common underlying cause of peroneal palsy. Other predisposing factors, such as prolonged postures, traumas of the region or concomitant pathologies (for example diabetes mellitus) contribute to the nerve damage. This study aims to reveal the multiple predisposing factors of peroneal nerve mononeuropathy after substantial weight loss that coexist in psychiatric patients and to make suggestions on their management.MethodsNine psychiatric inpatients, major depressive or schizophrenic, with foot drop underwent a complete clinical neurological and neurophysiological examination. All had excessive weight loss, which was completed in a short period of time and had not resulted from a well-balanced low-calorie diet, but was due to their psychiatric illness. Data regarding predisposing factors to peroneal nerve mononeuropathy were gathered, such as habitual leg crossing, squatting or other prolonged postures.ResultsThe clinical examination and the neurophysiological evaluation in all patients were indicative of a focal lesion of the peroneal nerve at the fibular head.ConclusionPatients with major depressive and schizophrenic disorders gather multiple predisposing factors to peroneal palsy, adequate to classify them at a high risk group. The better focus of the attendant medical and nursing staff on this condition, the early clinical and neurophysiologic evaluation and surgical interventions may enable an improved management and prognosis of these patients.
Highlights
Peroneal nerve is susceptible to injuries due to its anatomical course
We present nine psychiatric inpatients, suffering from major depressive or schizophrenic disorders who developed peroneal nerve mononeuropathy after substantial weight loss
Five patients suffered from a major depressive episode in the context of a major depressive disorder and four from a schizophrenic disorder, according to the DSM-IV diagnostic criteria [9]
Summary
Excessive weight loss, which reduces the fatty cushion protecting the nerve, is considered a common underlying cause of peroneal palsy. Other predisposing factors, such as prolonged postures, traumas of the region or concomitant pathologies (for example diabetes mellitus) contribute to the nerve damage. The main presenting symptom in lesions of PN is footdrop, due to paresis of the dorsiflexor muscles of the foot and toes When severe, it can be noticed as a change in the patient's gait (steppage gait) (i.e. the patient raises the foot higher, when swinging it forward, to avoid striking the toes on the ground). Sensory deficits, such as decreased touch and pin-prick sensation over the anterolateral leg and dorsum of the foot, are more common in such cases, rather than pain or paresthesias [1]
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