Nerve Lesions Research Articles

Ultrasonography of peripheral nerve tumours: a case series.

Peripheral nerve tumours (PNTs) are rare, but important cause of peripheral nerve dysfunction. The aim of the study was to present a series of consecutive patients with PNTs evaluated in authors' ultrasonography (US) practice. The electronic medical records of patients with PNTs examined at our US laboratory from February 2013 to May 2020 were retrospectively reviewed. Data on gender, age, clinical features, PNT location, electrodiagnostic (EDx) features and US findings were collected. In the analyzed period 2845 patients were examined in our US laboratory. From these 15 patients (0.5%) with PNTs were identified. Four of them (3 with confirmed neurofibromatosis) had multiple PNTs. Half of patients (53%) presented with features of peripheral nerve damage, and others with palpable mass or pain. The most often involved nerve was ulnar (36%). PNT cross sectional areas varied from 24 mm2 to 1250 mm2 (median, 61 mm2). Based in 5 patients on histological and in remaining patients on US features, schwannoma was diagnosed in 40%, neurofibroma in 27%, and perineurioma in 27% of patients. As in previous reports, PNTs in our series presented with neurological symptoms, palpable mass or pain. In contrast to other focal neuropathies, particularly nerves with schwannomas, in spite of their large thickening, often demonstrated well preserved function. Adding US to our clinical practice, enabled us to diagnose these rare peripheral nerve lesions that we missed before.

Treadmill training of rats after sciatic nerve graft does not alter accuracy of muscle reinnervation.

After peripheral nerve lesions, surgical reconstruction facilitates axonal regeneration and motor reinnervation. However, functional recovery is impaired by aberrant reinnervation. We tested whether training therapy by treadmill exercise (9 × 250 m/week) before (run-idle), after (idle-run), or both before and after (run-run) sciatic nerve graft improves the accuracy of reinnervation in rats. Female Lewis rats (LEW/SsNHsd) were either trained for 12 weeks (run) or not trained (kept under control conditions, idle). The right sciatic nerves were then excised and reconstructed with 5 mm of a congenic allograft. One week later, training started in the run-run and idle-run groups for another 12 weeks. No further training was conducted in the run-idle and idle-idle groups. Reinnervation was measured using the following parameters: counting of retrogradely labeled motoneurons, walking track analysis, and compound muscle action potential (CMAP) recordings. In intact rats, the common fibular (peroneal) and the soleus nerve received axons from 549 ± 83 motoneurons. In the run-idle group, 94% of these motoneurons had regenerated 13 weeks after the nerve graft. In the idle-run group, 81% of the normal number of motoneurons had regenerated into the denervated musculature and 87% in both run-run and idle-idle groups. Despite reinnervation, functional outcome was poor: walking tracks indicated no functional improvement of motion in any group. However, in the operated hindlimb of run-idle rats, the CMAP of the soleus muscle reached 11.9 mV (normal 16.3 mV), yet only 6.3-8.1 mV in the other groups. Treadmill training neither altered the accuracy of reinnervation nor the functional recovery, and pre-operative training (run-idle) led to a higher motor unit activation after regeneration.

Occult lipomatosis of the nerve as part of macrodystrophia lipomatosa: illustrative case.

Macrodystrophia lipomatosa (MDL) is characterized by progressive overgrowth affecting soft tissues and bony structures and is part of lipomatous overgrowth syndromes. MDL has been associated with lipomatosis of the nerve (LN), an adipose lesion of nerve that has a pathognomonic magnetic resonance imaging (MRI) appearance as well as a mutation in the PIK3CA gene. The authors present a case of occult LN in the setting of MDL. A 2-year-old boy with progressive soft tissue overgrowth of his proximal right lower extremity was initially diagnosed with neurofibromatosis type 1 (NF1). At our institution, NF1 as well as other overgrowth syndromes including PTEN hamartoma tumor syndrome were excluded. He was diagnosed as having so-called MDL. Upon reinterpretation of the patient's MRI studies, short-segment LN involving the proximal sciatic nerve and part of lumbosacral plexus was identified. He underwent 2 debulking/liposuction procedures for soft tissue overgrowth. Genetic testing of tissue revealed a mutation in PIK3CA. Thorough clinical examination (for signs of overgrowth) as well as an MRI study of the entire neural pathway is a critical part of the diagnostic workup to evaluate for LN. The authors believe that an increasing association of LN, even when occult, will emerge that will explain many cases with marked nerve-territory overgrowth.

Effect of a Combinational therapy of Erythropoietin, Pentoxifylline, and Vitamin D on the Glasgow Outcome Scale in Patients with Traumatic Brain Injury

Background: Diffuse axonal injury (DAI) is the most prevalent nerve lesion in brain trauma. Given the known effects of erythropoietin and pentoxifylline on the reduction of cell death following hypoxia. Objectives: The current study assessed the possible effects of a combination of erythropoietin, pentoxifylline, and vitamin D on patients' consciousness level. Methods: The present research is a double-blind clinical trial with parallel groups addressing 64 DAI patients (average age: 26.5). The intervention group included 32 patients who, apart from the routine treatment, received a combination of erythropoietin, pentoxifylline, and vitamin D3. The control group also encompassed 32 patients who only received routine treatment. The effects of the interventions were assessed based on Glasgow Coma Scale (GCS), Glasgow Outcome Scale (GOS) scores, and hospitalization duration. Results: The findings of the current research revealed that the GCS scores of the supplement (13.6±0.5) and control groups (12.4±1.6) were significantly different (P=0.043), being higher in the supplement group. The supplement group gained a higher GOS score compared to the controls (4.62±0.15 and 3.8±0.16, respectively, P=0.045). Moreover, a significant difference was observed in the hospitalization duration of the supplement (26.5±5.2) and control groups (21.4±3.2) (P=0.020). Nonetheless, the analysis of the extubation time and blood pressure of the two groups exhibited no substantial difference. Conclusion: In this study, GCS and GOS improved after supplementation. The patients in the supplement group displayed a significantly shorter hospitalization duration. No significant difference was, however, detected when the tube was removed.

Myelin oligodendrocyte glycoprotein antibody-associated disease in children: Are there MRI predictors of relapse?

Background and PurposeMyelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is increasingly recognized in children. Some children have isolated disease while others relapse. The study evaluates clinical, demographic and imaging features children with positive anti-MOG antibodies comparing to previously reported findings and correlate patterns on MR imaging with a relapsing course in MOGAD. Material and methodsAll pediatrics patients with serum anti-MOG antibodies were reviewed. Demographic, clinical, and imaging data were evaluated. Patients with a relapsing course were compared to those with a single event. We assessed initial MR images of the brain, orbits and spine obtained at the onset of clinical symptoms, whether performed at our institution or elsewhere. ResultsThirty patients were included, fourteen with a single event and sixteen with more than one clinical event. The mean age was 8.1 years, with a mean follow-up of 58 months (range of 0.67 to 238 months). The relapsing patients had a mean of 3.5 relapses (range 2–12). 55% of patients had long segment optic nerve lesions, 53% of patients had cortical or peripheral white matter lesions, and 46% of patients had thalamic lesions. 43% of patients had spinal cord lesions, with 39% involving the central cord and 26% with long segment involvement. The imaging features between the groups were not statistically significant. ConclusionThere were no distinguishing features in relapsing versus non-relapsing patients. In the absence of any predictive characteristics for future relapse, patients should have regular clinical and imaging follow up.

Peroneal Nerve Injury Due to Hip Surgery Located at the Knee Level: A Case Report

Background: The hip surgery may be complicated with an iatrogenic peroneal nerve injury. The spontaneous recovery of these patients is usually poor, and majority of them require additional surgical treatment. In this paper, we presented a case of iatrogenic peroneal nerve injury following posttraumatic hip surgery, which was decompressed at the knee level, and achieved complete postoperative recovery.
 The case: A 32-year-old woman was admitted to our department due to EMNG-verified peroneal nerve lesion. Eight months before, the patient was injured in a traffic accident, followed by knee dislocation, hip dislocation, and acetabular fracture. After open reduction of the acetabular fracture performed by the orthopedic surgeons, the peroneal nerve palsy followed. At the admission, the clinical findings included left sided incomplete peroneal nerve palsy (MRC=2), pain in the lateral lower leg (VAS=3), and gait disturbances. Using EMNG, the nerve lesion was located at the knee level, while US indicated suspectable nerve compression, due to visible nerve thickening. The PNSQoL and SF-36 scores indicated a significant decline in patients' quality of life (QOL). Following GETA, the external neurolysis, decompression, and complete nerve deliberation were performed at the knee level, with preservation of all nerve branches. The patient reported immediate relief, while completely recovered 8 months following the surgery (MRC = 5, VAS = 0). In order to assess postoperative QOL, a prolonged follow-up is needed.
 Conclusion: The iatrogenic peroneal nerve injury following hip surgery may not always be located in the hip region. A proper anamnesis, physical examination, and diagnostic evaluation are necessary for proper treatment of these patients.

Pediatric Thyroidectomy: Experience From a Portuguese Hospital.

Background and objective Pediatric thyroid disease requiring surgery is rare. Thyroid nodules are a frequent indication for surgery and are mostly benign. However, up to 25% of cases can be malignant. In this study, we aimed to describe our center's experience with regard to pediatric thyroid surgery. Methods This was a retrospective transverse study involving pediatric patients who underwent thyroid surgery at a tertiary hospital between January 2010 and December 2021. Results A total of 14 patients underwent 15 surgeries. The main reason for referral to pediatric endocrinology was thyroid nodules (n=10). Thirteen fine needle aspirations (FNAs) were performed, with follicular tumor (n=6) being the most common finding. The median age of patients at surgery was 15.9 years [interquartile range(IQR): 14.0-16.8]. The most common surgical indications were the presence of a follicular tumor on FNA (n=5) and thyroid nodule size causing symptoms (n=5). There was one case of prophylactic thyroidectomy due to the identification of a multiple endocrine neoplasia type 2A (MEN2A) mutation. The most frequently described histopathology results were follicular adenoma (n=6) and colloid nodular goiter (n=6). Three postoperative complications were observed in three different patients: bilateral lesion of the recurrent laryngeal nerve, cervical hematoma, and transient hypoparathyroidism with hypocalcemia. Conclusion In our study, the most frequent surgical indication was a follicular tumor. A good correlation was found between FNA cytology and final histopathology results, which is in accordance with previous studies. This reinforces the importance of FNA in diagnosis and surgical planning. The rate of complications in our study is comparable to that in larger single-center series in the literature.

Survey of age on median motor nerve conduction variables to well population of Malwa region

Background: Nerve conduction velocities (NCVs) represent correct methods to study the peripheral nerve being capable in estimating nerve-related situation. It aids in distinguishing from a nerve injury to situation where muscles are pretentious due to a nerve lesion, while, in that respect, many dissimilarities in testimonial use to NCV in dissimilar nerves with regard to place, sex, mass, and other ethnographical facts, i.e., span of life. This has been viewed in performing nerve conduction studies while ethnographical part differs for different geological region. Aims and Objectives: The view of present work is to do the NCV studies in right median nerve with usual grown-up people and to study the outcome of age on it. Materials and Methods: A total 110 healthy participants for length of life of 20 and 50 years, with none nerve lesion, examined at IMCHRC, Malwa. Each of the trial had been carried out in JAVA RMS Aleron-201 version. Analysis on SPSS-10 version. Results: The mean of NCV firstly rises among the ages of 20–30 years and 31–40 years, comes after by a fall in the mean NCV of elbow–wrist segment significantly fall while the mean of age rises with proceeding length of life. It is to be noted that NCV was conversely connected with rise in length of life of the volunteer with mean NCV of Set 1 >Set 2, Set3, Set 4 with P < 0.05 which is toply remarkable. Conclusion: Usual parameter for conductivity in peripheral nerves has been used in the test of peripheral nerve lesion. Age has a definitive effect on NCV. Hence, these biotic factors have to be taken into consideration during interpretation of results during nerve conduction studies. Therefore, it should also be used for research purposes and in analytic approach.

The best of both worlds: mastering nerve regeneration combining biological and nanotechnological tools.

The best of both worlds: mastering nerve regeneration combining biological and nanotechnological tools.

Iatrogenic Nerve Injuries of the Upper Extremity: A Critical Analysis Review.

Iatrogenic nerve injuries may occur after any intervention of the upper extremity. Causes of iatrogenic nerve lesions include direct sharp or thermal injury, retraction, compression from implants or compartment syndrome, injection, patient positioning, radiation, and cast/splint application, among others. Optimal treatment of iatrogenic peripheral nerve lesions relies on early and accurate diagnosis. Advanced imaging modalities (e.g., ultrasound and magnetic resonance imaging) and electrodiagnostic studies aid and assist in preoperative planning. Optimal treatment of iatrogenic injuries is situation-dependent and depends on the feasibility of direct repair, grafting, and functional transfers.

Pre-operative electrodiagnostic studies and intraoperative neurophysiologic monitoring: power and pitfalls

Outpatient electrodiagnostic studies and intraoperative monitoring are essential tools for the surgical management of nerve injury. Decisions are based on the diagnostic certainty afforded by outpatient electrodiagnostic studies, which are more sensitive and specific than clinical examinations regarding the nature and localization of a nerve lesion. Intraoperative neurophysiologic monitoring detects changes in neurologic function during surgery. It provides significantly better information than visual inspection of the operative field, minimizing postoperative neurologic deficits due to surgical manipulation (e.g., stretching, compression, heating from electrocauterization, constriction, or clamping of local blood vessels). These techniques exploit similar neurophysiologic principles to afford enhanced diagnostic and real-time functional data during surgery. However, an understanding of their limitations is critical for the interpretation of these data. This review discusses these techniques, including their use, advantages, and disadvantages in diagnosing and managing three essential nerve lesions amenable to surgical management-radiculopathy, mononeuropathy, and brachial plexopathy.

Masseter-to-facial nerve transfer for facial nerve reanimation.

Smooth symmetric facial muscle function is important for social interactions. When lesions of the facial nerve occur, achieving complete restoration of balanced and spontaneous facial function can be challenging. In this video, the authors demonstrate the surgical details and long-term follow-up of a masseter-to-facial nerve transfer in a 3-year-old girl who had insidious onset of a left facial palsy due to a facial nerve schwannoma. After resection, she underwent distal nerve repair with a masseter-to-zygomatic branch transfer. She demonstrated decreased lagophthalmos and good activation and excursion on the left side with near symmetry to the right side, but lacked left frontalis function. The video can be found here: https://stream.cadmore.media/r10.3171/2022.9.FOCVID22107.

DISTAL NEUROTIZATION OF THE ANTERIOR INTEROSSEOUS NERVE TO RECOVER HAND GRASPING.

To demonstrate our strategy, technique, and results in the reinnervation of the AIN in lesions isolated from the lower trunk of the brachial plexus in four cases of high lesion of the median nerve. Prospective cohort study in which four patients underwent neurotizations. The treatment was directed to the recovery of the fingers' flexors of the hand and the grip. All patients presented reinnervation of the flexor pollicis longus (FPL) and deep flexors of the 2nd, 3rd, and 4th fingers. The deep flexor of the 5th finger also showed reinnervation but with reduced strength (M3/4) comparing to the others (M4+). Despite the limited number of cases in this and other studies, the results are uniformly good, allowing to consider this treatment predictable. Level of Evidence IV, Case Series.

Neurophysiological confirmation of phrenic nerve affection in a patient with dyspnea and herpes zoster

Introduction. Herpetic lesion of the phrenic nerve is quite uncommon. These lesions are usually unilateral, and for most clinicians, the clinical manifestation of herpes zoster in the cervical or thoracic region and diaphragmatic paralysis on the same side is sufficient for making a diagnosis of segmental herpes zoster phrenic nerve palsy. We report a patient with a classic clinical picture, in which we confirmed phrenic nerve affection on nerve conduction study. Case report. A 58-year-old female patient came for an examination due to shortness of breath. The patient had a herpetic rash on her right shoulder two and a half months earlier. The elevation of the right hemidiaphragm was seen on chest X-ray imaging. Asymmetry was evident in the nerve conduction study of the phrenic nerve: prolonged latency and reduced amplitude of her right phrenic nerve. The patient was treated with acyclovir, pregabalin, and B complex vitamins. After six months, the motor deficit was reduced completely. Conclusion. A nerve conduction study of the phrenic nerve is useful in making the definitive diagnosis. Good outcome, as in this patient, is rare in patients with this diagnosis and may be linked to timely treatment with acyclovir.

Needle electromyography abnormalities in the upper trapezius muscle in neuromuscular disorders.

: Needle electromyography (EMG) abnormalities in the trapezius muscle (TM) can be seen in neuromuscular disorders. The aim was to determine the characteristics of needle EMG abnormalities observed in the TM in neuromuscular disorders. The data of patients who applied to the Clinical Neurophysiology Laboratory of University of Health Sciences Adana City Training and Research Hospital between December 2018 and October 2021 were reviewed. Polio survivors, amyotrophic lateral sclerosis (ALS) patients, patients with sensorimotor polyneuropathy, patients with spinal cord lesions involving C2/C3/C4 segments, patients with spinal accessory nerve (SAN) lesions, neuralgic amyotrophy (NA) patients, and patients with myopathy were included. Needle EMG findings of the upper TM of the patients were analyzed. Positive sharp waves, fibrillation potentials, fasciculation potentials, myotonic discharges, and motor unit action potential (MUAP) changes were considered needle EMG abnormalities. Eighty-one polio survivors, 23 ALS patients, 39 patients with sensorimotor polyneuropathy, 10 patients with cervical spinal lesions, eight NA patients, seven patients with SAN lesions, and three patients with myopathy were included in the study. Fifteen (65.2%) ALS patients, 18 (22.2%) polio survivors, three (30%) patients with cervical spinal lesions, two (5.1%) patients with sensorimotor neuropathy, one (12.5%) NA patient, seven (100%) patients with SAN lesions, and two (66.7%) patients with myopathies had at least one needle EMG abnormality in the TM. Fasciculation potentials in the TM were seen in 10 (43.5%) ALS patients. In four patients with SAN lesions and one polio survivor, MUAP could not be obtained from the TM. There may be more frequent needle EMG abnormalities, particularly in ALS patients and patients with SAN lesions. Since the number of patients with myopathy included in this study was low, it is difficult to comment on the needle EMG features of the TM for these patients. In addition, this study indicated that fasciculation potentials in the TM are typical in ALS patients and that MUAP may not be obtained from the TM in patients with SAN lesions.

OUTCOMES OF MICROSURGICAL DIGITAL REVASCULARIZATION WITH LOCAL ANESTHESIA: IS IT WORTH IT?

OBJETIVE. Report the outcomes of patients with non-viable incomplete amputations at the level of the phalanges of the hand with evidence of vascular compromise undergoing digital revascularization using local anesthesia without epinephrine – no tourniquet. METHODS The authors technique proposes microsurgical digital revascularization using local anesthesia without the use of vasoconstrictor and without tourniquet following the inclusion criteria of non-viable incomplete amputation, single vascular lesion or associated with nerve, tendon, and bone lesions. Data are obtained from 20 patients from January 2022 to June 2022 and a three-month postoperative follow-up is performed where vitality, functionality and rehabilitation results are evaluated. RESULTS Successful revascularization in 100% of the cases, the most affected area was the distal phalanx in a 75% and second and third phalanges was the most affected fingers. Despite not using vasoconstrictor and no tourniquet, adequate visibility and control of the surgical field was achieved, allowing digital revascularization in a time not exceeding 1 hour with adequate results in terms of digital vitality and functionality. CONCLUSION Digital revascularization performed under local anesthesia without epinephrine and sedation provides the hand surgeon a prudent time to perform the procedure with pain, bleeding, and digital movements control, minimizing the rate of complications and adequate functional results.

Evaluation of the Physical Treatment Success in Patients with Peripheral Nerve Injury Caused by Firearm

Background: All wars bring high incidence of patients with peripheral nerve injuries, and many of today's knowledge about degeneration, regeneration and surgical treatment in this casuistry come from the period of the global world conflict. Such injuries do not endanger life, but the function of the extremities is threatened, which manifests itself in motor and sensory outbursts, as well as negative psychological implications. Objective: The aims of this article were: a) To present the method of monitoring physical treatment in a patient with a peripheral nerve injury; b) To perform a quantitative analysis of nerve lesions caused by firearms (n = 445);; c) To present the effects of physical treatment for this condition;; d) To analyze the time interval from injury to healing (n = 220);; e) Determine the time from injury until the surgery. Results: Anatomical disruption of axons with complete Waler degeneration. The connective tissue network remains intact and the endoneurium can guide the regenerated nerve fibers to their destination. Spontaneous functional recovery can be expected in 12 to 18 months. Clinical evaluation shows a deficit in the innervation area of damaged axons with muscle atrophy and loss of sensitivity. Nerve recovery can be inhibited by scar formations at the site of injury. Complete interruption of the nerve. Functional recovery is not possible without surgical intervention. Paralysis of mm. atrophy, anesthesia and atrophic skin changes are visible. Conclusion: Rehabilitation is a delicate problem and requires long-term treatment and multidisciplinary cooperation, and is carried out in accordance with the principles of peripheral nerve repair. Factors that facilitate successful regeneration are: a) Pre and post-operative physical treatment; b) Younger age; c) Shorter time since injury (<6 months); d) More distal level of the lesion; e) Absence of factors complicating the injury (infection); and f) The first signs of nerve recovery are the return of sweating and pain.

Novel neuron-Schwann cell co-culture models to study peripheral nerve degeneration and regeneration.

Novel neuron-Schwann cell co-culture models to study peripheral nerve degeneration and regeneration.

Outcomes after Anterior Interosseous Nerve to Ulnar Motor Nerve Transfer.

Background Ulnar nerve lesions proximal to the elbow can result in loss of intrinsic muscle function of the hand. The anterior interosseous nerve (AIN) to deep motor branch of the ulnar nerve (DBUN) transfer has been demonstrated to provide intrinsic muscle reinnervation, thereby preventing clawing and improving pinch and grip strength. The purpose of this study was to evaluate the efficacy of the AIN to DBUN transfer in restoring intrinsic muscle function for patients with traumatic ulnar nerve lesions. Methods We performed a prospective, multi-institutional study of outcomes following AIN to DBUN transfer for high ulnar nerve injuries. Twelve patients were identified, nine of which were enrolled in the study. The mean time from injury to surgery was 15 weeks. Results At final follow-up (mean postoperative follow-up 18 months + 15.5), clawing was observed in all nine patients with metacarpophalangeal joint hyperextension of the ring finger averaging 8.9 degrees (+ 10.8) and small finger averaging 14.6 degrees (+ 12.5). Grip strength of the affected hand was 27% of the unaffected extremity. Pinch strength of the affected hand was 29% of the unaffected extremity. None of our patients experienced claw prevention after either end-to-end ( n = 4) or end-to-side ( n = 5) AIN to DBUN transfer. Conclusion We conclude that, in traumatic high ulnar nerve injuries, the AIN to DBUN transfer does not provide adequate intrinsic muscle reinnervation to prevent clawing and normalize grip and pinch strength.

Prediction of Retinal Loss Based on Lesion of the Optic Nerve in Acute Stage of Optic-Neuritis

Aim: To assess the predictive features of optic neuritis in retinal loss through optic nerve lesion identification. Study design: Prospectively longitudinal study Place and duration of study: Ghulam Muhammad Mahar Medical College Sukkur and Shaheed Mohtarma Benazir Bhutto Medical University Larkana from 1st January 2021 to 30th June 2022. Methodology: One hundred and ten patients suffering from acute optic neuritis ≤8 weeks were enrolled. Retinal optical-coherence tomography was performed in all patients. Fifty five patients in the whole cohort while clinically isolated syndrome (CIS) 25 patients and relapsing remitting multiple sclerosis (RRMS) as well as neuromyelitis-optica spectrum disorders (NMOSD) and isolated optic neuritis as 20, 3 and 7 respectively. Brain optic nerve magnetic resonance imaging which included three-dimensional double inversion recovery sequence was also conducted at acute phase (M0) and then post 12 months (M12). Results: The mean age of the cases was 30.85±8.9 years. There was a higher frequency of males then females. The duration of the disease was found highest in RRMS cases with 50.31±77.45 months. The variance in estimated and standard error of the ganglion cell-inner plexiform layer volume change was significantly different in whole acute optic neuritis cases as well as the one with CIS and multiple sclerosisat cohort. Conclusion: Optic nerve-lesion length in prediction of retinal-neuroaxonal loss in cases of optic neuritis. The optic-nerve lesion length can also be considered as a biomarker for the process of retinal remodeling as well as visual impairment. Key words: Optic nerve lesion, Acute phase, Optic neuritis (ON), Retinal neuronal loss