Superficial Nerve Research Articles

Clinical Presentation along with Imaging Features of Superficial Peroneal Nerve Shwannoma: A Rare Case Report

Schwannomas are encapsulated, benign, slowly growing tumors arising from Schwann cells of peripheral nerve sheath. Although they represent the commonest benign peripheral nerve sheath tumors, the occurrence on the lower limbs and especially from the superficial peroneal nerve is exceptionally rare. We present the clinical manifestations and imaging findings of a superficial nerve Schwannoma presenting as a painful mass in the external compartment of the calf, which was confirmed histologically and we correlate our experience with previously reported cases.

Versatility of the Reversed Superficial Peroneal Neurocutaneous Island Flap in the Coverage of Ankle and Foot

In the last decades, the skin island flap supplied by the vascular axis of sensitive superficial nerves, like the sural and saphenous nerves, has emerged as one of the most ideal reconstructive options for soft tissue coverage of lower limbs. The nutrient vessels of reversed superficial peroneal neurocutaneous island flap have been well described; however, it is still not commonly clinically applied. The aim of this study was to evaluate the efficacy of reversed superficial peroneal neurocutaneous island flap for coverage of ankle and foot. This is a retrospective and descriptive study of reversed superficial peroneal neurocutaneous island flap which was carried out for reconstruction of ankle and foot. This study was conducted at the Department of Repair and Reconstructive Surgery, the 6th People's Hospital affiliated to Shanghai Jiaotong University, during a period of 51 months from July 2008 to October 2012. A total of 12 patients with soft tissue defect of ankle and foot were included in the series; reversed superficial peroneal neurocutaneous island flap was performed on each case if relevant indications permitted. Preoperative and postoperative data of each patient, including etiology, size of defect, dimension of flap, complications, and functional and aesthetic results were noted. Among the 12 patients, there were 8 men and 4 women with an average age of 40.7 years (22-65 years) and with a mean follow-up time of 17.3 months (10-23 months). Most patients (11 patients) were posttraumatic. The size of the flap ranged from 48 to 108 cm2. Postoperatively, 11 flaps survived uneventfully, whereas marginal venous congestion was seen in the remaining patient, and secondary healing was achieved by conservative treatment. The reversed superficial peroneal neurocutaneous island flap could be an excellent alternative to other neurocutaneous perforator flap in the soft tissue reconstruction of foot and ankle.

Recalcitrant cubital tunnel syndrome

Ulnar nerve neuropathy at the elbow represents the second most frequent compression neuropathy of the upper extremity. Of the five different anatomical areas responsible for ulnar nerve compression at the elbow region, the epitrochlear-olecranon channel and Osborne's arcade are the most common. An additional cause of nerve damage is a dynamic process in which the ulnar nerve dislocates anteriorly at the epitrochlear-olecranon level during elbow flexion, partially or completely, causing nerve friction and constriction leading to chronic neuropathic pain. Failure after primary surgery is generally secondary to procedural errors or technical omissions, frequently represented by incomplete nerve decompression, failure to recognize nerve instability after nerve decompression, loosening of the nerve anchor after superficial nerve transposition with consequent spontaneous nerve relocation in the epitrochlear-olecranon channel, perineural fibrosis and neurodesis, which creates new nerve compression. In association with the clinical evaluation, electromyography studies, magnetic resonance imaging and ultrasound are useful tools that may aid in the decision-making process when considering revision surgery. Superficial anterior transposition is the most commonly employed technique but also has a high failure rate, as opposed to anterior deep transposition that is the method of choice for many surgeons despite being more technically demanding. The results of revision surgery following recalcitrant ulnar nerve compression at the elbow are inferior to those obtained after primary surgery. Nonetheless, the clinical advantages remain relevant provided that the revision surgery is performed by an expert surgeon. To avoid misinterpretation, the patient is completely informed of the quality of results.

Understanding the three-dimensional anatomy of the superficial lymphatics of the limbs.

There are minimal data in the current literature regarding the depth of the superficial lymphatic collectors of the limbs in relation to the various subcutaneous tissue layers. Injection, microdissection, radiographic, and histologic studies of the superficial lymphatics and the subcutaneous tissues of 32 limbs from 15 human cadavers were performed. Five layers were consistently identified in the integument of all the upper and lower limb specimens: (1) skin, (2) subcutaneous fat, (3) superficial fascia, (4) loose areolar tissue, and (5) deep fascia. Layer 2 was further divided into superficial (2a) and deep (2c) compartments by a thin, transparent, horizontal septum (layer 2b). The main superficial veins and the superficial nerves coursed in layer 4. The lymphatic collectors were found at layer 2c and layer 4. The use of consistent nomenclature to describe the subcutaneous tissue layers facilitates a greater understanding and discussion of the anatomy. In lymphovenous anastomosis for the treatment of lymphedema, indocyanine green lymphography is an unreliable method for identification of the superficial collectors of the thigh. The medial proximal leg, the dorsum of the wrist over the anatomical snuffbox, and the volar proximal forearm provide suitable areas for locating superficial collectors with nearby matching size veins. In vertical medial thigh lift, choosing a dissection plane superficial to the great saphenous vein is unlikely to preserve the collectors of the ventromedial bundle.

Poster 287 The Value of Combined Electrodiagnosis and Ultrasound in the Assessment of a Superficial Radial Sensory Nerve Compression from a Complex Ganglion Cyst: A Case Report

Poster 287 The Value of Combined Electrodiagnosis and Ultrasound in the Assessment of a Superficial Radial Sensory Nerve Compression from a Complex Ganglion Cyst: A Case Report

Cytological features of inflammatory cells infiltration indicates the etiology of infectious keratitis

AbstractPurpose To analyze histological findings of infectious keratitis in corneal epithelium including inflammatory cells infiltrations.Methods We performed in vivo confocal microscopy (HRT III, Rostock Cornea Module) in 190 patients with diagnosed infectious keratitis of various etiology ‐ 72 viral, 66 bacterial, 34 fungal, 18 amoebal keratitis. For corneal scans we used 400x lens and 63x magnification. Microscopic analysis included inflammatory cells infiltration – number, size and shape of cells; superficial corneal nerve plexus (number and characteristics of nerve fibers) and cytology of epithelial cells. Described features were compared between groups.Results Inflammatory cells densities showed no differences between groups, however there was clearly different ratio of round/dendritic inflammatory cells, respectively 0.07, 8.0, 1.0, 1.2 for viral, bacterial, fungal and amoebal keratitis (U‐Mann Whitney test, P<0.05). Additionally inflammatory cells presented various stage of polimorphism and polimegatism depended on keratitis type. Differences were observed also in nerve fiber numbers (U‐Mann Whitney test, P<0.05) and epithelial layer architecture.Conclusion In vivo analysis of corneal epithelial histology shows high specificity and sensitivity in infectious keratitis diagnosis. Correct diagnosis of infectious keratitis is often difficult. In vivo microscopic analysis of both epithelial layer and cytology of inflammatory infiltration might provide fast and highly specific differentiation of keratitis etiology.

Superficial malignant peripheral nerve sheath tumor arising from diffuse neurofibroma in a neurofibromatosis type 1 patient

Malignant peripheral nerve sheath tumors (MPNST) are regarded as sarcomas that arise from peripheral nerves or that display differentiation along the lines of the various elements of the nerve sheath. These tumors occur in deep soft tissues, but superficial primary MPNST with a cutaneous or subcutaneous origin have rarely been reported. A 70-year-old woman presented with a 3-4-year history of a slowly enlarging soft nodule on the left side of her neck. The histopathological diagnosis of the nodule was low-grade MPNST arising from diffuse neurofibroma. There was increased cellularity, but no necrosis or mitotic activity. These histopathological findings pose difficulties in differential diagnosis from a neurofibroma with atypical histological features. We report a rare case of superficial MPNST arising from diffuse neurofibroma associated with underlying occipital bone dysplasia in a neurofibromatosis type 1 patient.

Injury Location and Mechanism for Complex Regional Pain Syndrome: A Nationwide Population-Based Case-Control Study in Taiwan.

Few studies have investigated the relationship between injury location, mechanism and their association with complex regional pain syndrome (CRPS). We conducted a nationwide database survey to explore this issue. This was a population-based case-control study. Five hundred and eighty-nine patients with at least one ambulatory visit or admission with a principal diagnosis of CRPS from 2004 to 2009 were selected. For each CRPS patient, ten age- and sex-matched non-CRPS subjects were randomly selected. The odds ratios (PLoS One. 2013;8:e57205) and 95% confidence intervals (95% CIs) of risk factors for CRPS were derived from multivariate logistic regression models. Injury was a risk factor for CRPS (OR, 2.96; 95% CI, 2.18 to 4.02) independent of age and sex. In adjusted models, open wound on the upper limbs (OR 1.25, 95% CI 1.02 to 1.54) conferred higher CRPS risk. Injury mechanisms including nerve and spinal cord injury (OR 2.42, 95% CI 1.44 to 4.08), muscle and joint sprain and strain (OR 1.69, 95% CI 1.40 to 2.03), superficial injury (OR 1.23, 95% CI 1.00 to 1.51), and contusion (OR 1.44, 95% CI 1.20 to 1.74), but not fracture, increased the risk of CRPS. Injury in the extremities rather than the trunk is an important risk factor for CRPS. Certain injury mechanisms confer higher risk of CRPS. This nationwide study demonstrated that injury increased CRPS nearly threefold. Open wound, sprain and strain, superficial injury, contusion, and nerve and spinal cord injury are main injury mechanisms. Injury in the extremities confers a higher risk of CRPS.

Regionalanästhesie und direkte orale Antikoagulanzien

New oral anticoagulants (NOAC) are increasingly applied after hip and knee replacement and in patients with non-vavular atrial fibrillation. Patients with cardiac disease benefit from regional anaesthesia, especially catheter-provided postoperative pain relief, but are at higher risk for puncture-related haematoma when NOAC are applied simultaneously. Therefore recommended time intervals between drug application and performance of RA including catheter removal of 22-34 h must be respected. The next dose of NOAC must not be given before 6 h have been elapsed; after bloody tap a delay of 24 h is recommended. The respective time intervals are prolonged in patients with renal insufficiency, especially when Dabigatran is applied, until 36 to 72 h. In general, high risk patients with NOAC undergoing surgery benefit from an interdicsciplinary approach and from less traumatic techniques such as spinal anaesthesia or superficial peripheral nerve blocks.

Chondrenchelys problematica(Traquair, 1888) redescribed: a Lower Carboniferous, eel-like holocephalan from Scotland

ABSTRACTChondrenchelys problematica, from the Viséan (Holkerian) of Scotland, is the earliest holocephalan known from extensive cranial and postcranial material. Here, we provide a comprehensive new description of this taxon using three new specimens, in which we observe many morphological features for the first time. Much of the cranial morphology is closer to that of living chimaeroid holocephalans than was previously appreciated. For this reason, we provide original figures illustrating the chondrocranium of a hatchlingCallorhinchus miliidemonstrating these similarities. InChondrenchelys, although the jaw articulation is positioned at the posterior margin of the orbit, the high-walled lamina orbitonasalis and densely-mineralised antorbital crest provide evidence for forward rotation of the jaw adductor musculature. Preserved foramina for the efferent superficial ophthalmic nerves show that the sensory organs on the rostrum were enervated in a manner similar to modern sharks, with the ophthalmic nerves not enclosed in an ethmoid canal, as in modern holocephalans. The conjunction of numerous distinctly holocephalan features with those that are otherwise general to Chondrichthyes demonstrates a decoupling of several of the structural conditions that characterise the distinctive morphological complex of the extant holocephalan skull. The anguiliform postcranium is more elongate than previously reconstructed, and it is now clear that the axial skeleton extended beyond the posterior extremity of the elongate dorsal fin. Morphological characters are reviewed with a view to further phylogenetic analyses. We recommend using the appearance ofChondrenchelysat 336.5 Ma as a hard minimum age for the last common ancestor of elasmobranchs and chimaeroids, because of its secure association with other holocephalans, and current uncertainties concerning elasmobranch stem lineage membership.

The endocranial anatomy ofGogonasus andrewsaeLong, 1985 revealed through micro CT-scanning

ABSTRACTMicro computed tomography has revealed as yet undescribed internal braincase anatomy of the tetrapodomorph fishGogonasus andrewsaefrom the Frasnian Gogo Formation, Paddy's Valley, Kimberley Region, Western Australia. The complete material, including the cranial cavities and channels for blood vessels and nerves, reveals several notable features inside the endocranium. The ethmosphenoid unit includes a median capsule, which lies underneath the median postrostral and rostral series. Based on innervation and association with cutaneous vessels, potential electroreceptive function is inferred for this capsule. Several regions of poor ossification, including foramina for the glossopharyngeal and abducens nerves, as well as the apparent suture separating the ethmoid from the sphenoid portions of the braincase, are possibly indicative of early ontogenetic features. Former interpretations of the course for the superficial ophthalmic nerve inside the nasal capsule ofOsteolepisandGyroptychiusmay be incorrect, with new research supporting a path through the nasal septum, as inGogonasus.

Arthrolysis combined with reconstruction for treatment of terrible triad injury with a poor outcome after surgical as well as conservative intervention

The treatment of terrible triad injury with a poor outcome after intervention has not been successful thus far. The purpose of this study was to evaluate the efficacy of arthrolysis and reconstruction in the treatment of terrible triad injury with a poor outcome after surgical as well as conservative intervention. Twelve patients (12 elbows) with the diagnosis of terrible triad injury were respectively reviewed. All the 12 patients had elbow dysfunction after conservative and surgical treatment of the terrible triad injury. Preoperatively, the flexion arc and forearm rotation were 36.7° ± 28.5° and 51.3° ± 43.4°, respectively, and the Mayo Elbow Performance Score was 56.3 points. The mean interval between the primary injury and our surgical treatment was 6.6 months. Our surgical intervention included elbow arthrolysis, ulnar nerve transposition, radial head replacement, coronoid process and ligament repair, and hinged external fixation. Patients were encouraged to participate in rehabilitation training 24 h after surgery. The mean follow-up duration was 20.1 months; the flexion arc and forearm rotation were 122° ± 18° and 140° ± 20°, respectively, and the mean Mayo Elbow Performance Score was 94.6 points (9 excellent, 3 good). Concentric stability was restored in all elbows. Complications included superficial pin tract infection (1), heterotopic ossification (3), and ulnar nerve palsy (1); the ulnar nerve symptoms had improved at the last follow-up. The combination of open arthrolysis and reconstruction performed at a mean interval of 6-month posttrauma can restore functional mobility in cases of terrible triad injury with a poor outcome after surgical as well as conservative intervention. Thus, it may be an effective alternative for the treatment of the poor outcome terrible triad injury. We recommend early functional rehabilitation with adherence to the guidelines for hinged external fixation.

Influence of different geometric representations of the volume conductor on nerve activation during electrical stimulation.

Volume conductor models with different geometric representations, such as the parallel layer model (PM), the cylindrical layer model (CM), or the anatomically based model (AM), have been employed during the implementation of bioelectrical models for electrical stimulation (FES). Evaluating their strengths and limitations to predict nerve activation is fundamental to achieve a good trade-off between accuracy and computation time. However, there are no studies aimed at clarifying the following questions. (1) Does the nerve activation differ between CM and PM? (2) How well do CM and PM approximate an AM? (3) What is the effect of the presence of blood vessels and nerve trunk on nerve activation prediction? Therefore, in this study, we addressed these questions by comparing nerve activation between CM, PM, and AM models by FES. The activation threshold was used to evaluate the models under different configurations of superficial electrodes (size and distance), nerve depths, and stimulation sites. Additionally, the influences of the sciatic nerve, femoral artery, and femoral vein were inspected for a human thigh. The results showed that the CM and PM had a high error rate, but the variation of the activation threshold followed the same tendency for electrode size and interelectrode distance variation as AM.

Prospective Randomized Comparison of Single-Incision and Two-Incision Carpal Tunnel Release Outcomes

This study analyzes both the subjective and objective symptom and functional outcomes of patients who underwent either traditional single-incision or two-incision carpal tunnel release (CTR). From 2008 to 2009, patients with isolated carpal tunnel syndrome were randomized to undergo either single-incision or two-incision CTR by a single surgeon at a university medical center. Pre-operatively, participants completed a Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire, Brigham and Women's Carpal Tunnel Questionnaire (BWCTQ), as well as grip and pinch strength and Semmes-Weinstein monofilament sensation testing. At 2weeks, 6weeks and at least 6months post-operatively, these measurements were repeated along with assessment of scar tenderness and pillar pain. Data were analyzed using SPSS version 20 software to perform non-parametric tests and Pearson's correlations. Significance was set at p = 0.05. There was no statistically significant difference between the single- and two-incision CTR groups with respect to pre- and post-operative DASH scores, BWCTQ scores, grip strength, pinch strength, scar tenderness, or pillar pain. The only statistically significant difference was improved sensation by Semmes-Weinstein in the single-incision group in the second finger at 6weeks post-operatively and in the third finger at 6months post-operatively. The preservation of the superficial nerves and subcutaneous tissue between the thenar and hypothenar eminences may account for reports of less scar tenderness and pillar pain among recipients of two-incision CTR compared to single-incision CTR in the early post-operative period. However, there is similar post-operative recovery and improvement in grip and pinch strength and sensation after 6+ months post-operatively.

Changes in Rabbit Corneal Innervation Induced by the Topical Application of Benzalkonium Chloride

To investigate the effect of benzalkonium chloride (BAK) on corneal nerves. Fifty-four adult New Zealand Albino rabbits were randomly divided into 3 groups. BAK at concentrations of 0.005%, 0.01%, or 0.02% was applied once daily to 1 eye of each rabbit for 9 days. The contralateral untreated eyes were used as controls. Corneal mechanical sensitivity, aqueous tear production, tear break-up time (BUT), fluorescein, and Rose Bengal staining scores were compared with those of control values on days 3, 6, and 9. Corneal whole mounts were immunostained with a specific antitubulin βIII antibody to label nerve fibers. Epithelial superficial nerve terminal, subbasal, and stromal nerve fiber densities were quantified. The structure of the central cornea was examined by means of in vivo confocal microscopy on day 9. The topical application of BAK resulted in lower corneal sensitivity and higher Rose Bengal staining scores on day 3, whereas there were no significant changes in the BUT, Schirmer, and corneal fluorescein scores. Decreased nerve densities in superficial and subbasal layers were observed in BAK-treated eyes on days 3 and 6, respectively. The eyes treated with 0.02% BAK exhibited significantly reduced Schirmer scores, BUT, and stromal nerve fiber density, and increased fluorescein staining scores on day 9. Corneal superficial epithelial cell size was significantly larger in all BAK-treated eyes compared with that in control eyes. The topical application of BAK can quickly cause corneal hypoesthesia without tear deficiency. Changes in corneal innervation significantly correlate with BAK-induced ocular surface changes.

Branching patterns and localization of the common fibular (peroneal) nerve: an anatomical basis for planning safe surgical approaches

Given the severity and incidence of injury to the common fibular (peroneal) nerve (CFN), there is a need to further clarify its anatomical location and branching patterns. This project attempts to consolidate current anatomical understanding of this nerve and provide physicians with reproducible measurements regarding the CFN and its branches. Dissections were performed on 50 specimens (28 cadavers), both fresh and preserved. The CFN was dissected from its emergence from the fibular tunnel to its anterior tibial recurrent nerve (ATRN), superficial fibular nerve (SFN), and deep fibular nerve (DFN) branches. The CFN branching patterns were assessed and all variations were categorized into four types. Several significant relationships were identified between observable traits and key anatomical characteristics of the CFN. A significant correlation was found between fibular length and distance from the tip of the fibula to the DFN/ATRN branch, as well as between fibular length and distance from the tibial tuberosity to the SFN/DFN and DFN/ATRN branches. An association was identified between length of exposed sub-cutaneous CFN and height. Thickness of the biceps femoris tendon correlated significantly with BMI. These findings allow physicians to better assess a patient's individual CFN anatomy based on correlations with measureable physical traits and will contribute to anatomic education and successful completion of various surgical, anesthetic, and physical therapy procedures.

Treatment of palmar hyperhidrosis with needle-free injection of botulinum toxin A

We read with great interest the article ‘‘Treatment of palmar hyperhidrosis with botulinum toxin type A: results of a pilot study based on a novel injective approach’’ [1]. We praise the authors’ new injective approach using a needle adapter to reduce pain and hand grip weakening. The needle adapter prevents Botulinum Toxin type A (BoNT/ A) from reaching deeper layers, producing less muscle weakening. The authors briefly discussed the treatment of palmar hyperhidrosis with needle-free (jet) injector, the MED-JET , requiring the anesthetic use. There are advantages to using needle-free anesthesia, prior to BoNT/A needle injection, as opposed to direct needle-free injection of BoNT/A: (a) Needle-free injection can waste up to 5 % of BoNT/A through splash and splatter (b) Delivery through a pressurized injector causes agitation, decreasing its efficacy. Newer models of jet injectors used with appropriate parameters reduce this waste [3]. Shome et al. [5] recently reported that agitation does not affect the efficacy of BoNT/A. Direct jet injection of BoNT/A is indicated for palmar hyperhidrosis in the needle-phobic patient. The rapidity and lack of needle use decrease apprehension. A vial of 100 units of BoNT/A is reconstituted in 5 ml of preserved saline. The driving pressure of the MED-JET is set to 140 pounds per square inch (psi) and the volume is set to 0.1 ml per spurt, delivering two units per spurt. The pressure is gradually increased with 10 psi increments until a subepidermal wheal is formed. Most procedures are accomplished with a driving pressure of 140 psi. Traditional jet injectors like the Dermojet are springloaded and have a fixed driving pressure of more than 1,400 psi. According to Mitragorti, these devices cause more pain, due to their deeper penetration level [2]. Naumann et al. [4] have used the Dermojet safely to inject BoNT/A directly into the skin for plantar hyperhidrosis, but do not advocate its use for palmar hyperhidrosis due to the potential damage to superficial nerves and vessels. The MED-JET, powered by carbon dioxide, has pressure settings ten times lower than that of traditional jet injectors. Higher driving pressures, higher volumes per spurt, wider nozzle diameters and shorter distances between the tip of the nozzle and the skin surface correlate with higher pain sensitivity and nerve or vessel damage. Further research is needed to objectively identify measurable parameters to insure safe and effective outcome in BoNT/A jet injection.

Efficacy and Safety of Two-Level Block of Brachial Plexus in Surgeries on Proximal Upper Extremity

Study results for 71 patients (mean age 58.3±3.4 years) who were operated on for the injury of shoulder joint, upper and middle humerus are presented. Surgical intervention was performed under regional anesthesia. Block of superficial cervical plexus and intercostobrachial nerve was applied in all cases. Additionally in the main group (n=37) two-level block of brachial plexus (BBP): interscalene blockade in complex with supraclavicular one was used, in control group (n=34) — one-level block, i.e. either interscalene or supraclavicular was performed. Pain syndrome was assessed by visual analogue scale. It was shown that in surgical interventions on proximal upper extremity two-level BBP provided higher quality of anesthetic effect and postoperative analgesia, enabled to decrease the expenditure of opioid analgesics within the first postoperative day and, hence, the risk of related side effects development. Number of complications was not significantly different between the two groups.

Various epithelial manifestation of herpetic keratitis in corneal confocal microscopy imaging

AbstractPurpose To present different variants of epithelial changes observed in patients with herpetic keratitis in corneal confocal microscopy in vivo images.Methods In 19 patients with diagnosed herpetic keratitis of typical clinical course, we performed the following: basic slit lamp examination, corneal scans using Scheimpflug camera and corneal confocal microscopy in vivo. Full thickness corneal scans were made and compared with corresponding images from healthy objects. Additional imaging of epithelial layer with higher magnification was made to compare detailed changes within all components of epithelial layer.Results On a slit lamp examination we described different size and surface ulceration of typical dendritic shape. In the image from Scheimpflug camera – local turbidity of stroma and lack of superficial layers in place of ulceration. The corneal confocal microscopy images showed different severity of stromal changes in form of hazing, turbidity, keratocytes activation, inflammatory cells infiltration or fibrosis. In epithelial layer scans except mostly diffused inflammatory infiltration, we described changes involving: epithelial cells‐intracellular inclusions, abnormal cells shape and size, degeneration; intercellular matrix‐hazing, inclusions; superficial nerve plexus‐thinning or lack of nerves, mace expand of nerves, nerve fibers proliferation; Bowman membrane and anterior stroma‐epithelial hernias into deeper layers.Conclusion Herpetic corneal inflammations have no typical image in corneal confocal microscopy; however can show repeatable features in epithelial layer, which are helpful in diagnosis. Corneal confocal microscopy is useful tool for recognizing viral keratitis.

Diagnostic traps based on nomenclature of inflammatory changes in corneal confocal microscopy in vivo

AbstractPurpose To present possible misdiagnosis of infectious keratitis in corneal confocal microscopy in vivo images based on typically used nomenclature.Methods Retrospective analysis of in vivo confocal microscopy images from 155 patients with different diagnosis. 63 cases were diagnosed in confocal microscopy as various infectious inflammations and confirmed microbiologically or based on treatment response. 25 of them were recognized as bacterial, 25 as viral, 11 as fungeal and 2 as Acanthoamebal keratitis. For each type of inflammation we selected “key words” typically used for describing characteristic corneal changes. In next step we analyzed other, non‐inflammatory cases and selected images which could be described with nomenclature using typically for inflammatory changes describing (for example “cyst”, “fibers”, “round cells infiltration”, “dendritic/Langerhans cells presence”, etc.).Results From 92 non‐inflammatory cases, 35 could be described with inflammatory “key words”. These cases represented 14 different pathologies: Cogan and Messmann dystrophy, stroma fibrosis, corneal transplant rejection, in‐growth epithelial syndrome, crystal and vortex kerathopathy, after LASIK and after PRK changes, neurotrophic ulcer, superficial nerves outgrowth, diffuse anterior lamellar inflammation after LASEK, ichtyosis and Thygesson inflammation.Conclusion Diagnostic process using confocal microscopy examination cannot be based just on algorithmic analysis of corneal images. For reliable diagnosis microscopy images should be compared with clinical state and anamnesis.