Post-herpetic like Median Nerve Neuralgia by Brachial Artery Pseudoaneurysm Impingement: A Case Report

Abstract

Brachial artery pseudoaneurysms are exceedingly uncommon but should be considered in the workup of a patient with median neuralgia and/or neuropathy following arterial punctures in the cubital fossa. We reported on a case in which the prodromal symptoms of median nerve compression caused by a brachial artery pseudoaneurysm led to the misdiagnosis of post-herpetic neuralgia before the occurrence of full blown neuropathy symptoms.This 63 year-old male patient, who suffered from spontaneous subarachnoid hemorrhage, received continuous arterial pressure monitoring at right brachial artery in intensive care unit. Following removal of the arterial catheter, the patient developed dysesthetic burning pain in the right forearm along median nerve dermatome, which was initially diagnosed as post-herpetic neuralgia by dermatologists. In the following weeks, a pulsatile swelling at cubital fossa was noticed, and signs of median neuropathy also occurred. Nerve conduction studies (NCS) showed no responses in the median motor and sensory nerves. Both ultrasonography and arterial angiography confirmed the presence of a large pseudoaneurysm. Surgical excision of pseudoaneurysm was then performed, followed by brachial artery reconstruction using interposition basilic vein graft. After surgery, median neuropathy remained, but dysesthetic pain resolved. One year after operation, NCS still failed to show responses in median nerve. Our case demonstrated that, in the presence of median neuralgia following medical procedures in the cubital fossa, the importance of early suspicion and treatment of pseudoaneurysm formation cannot be overemphasized in order to avoid permanent palsies of median nerve.