An unusual cause of paralysis of the peroneal nerve—a case report

A 12-year-old boy was referred to our clinic because of progressive paresis of left peroneal nerve. Ultrasound showed a cystic mass close to the proximity of the fibula neck. Puncture revealed jelly-like fluid, but that could not relieve symptoms. Six weeks after onset of symptoms, the boy had complete paresis. Peroneal intraneural ganglia are a rare entity of paralysis of the lower limb in children; more often these symptoms occur because of exostosis. Surgical exploration showed a cystic formation involving the common peroneal nerve. Total recovery of nerve function was seen two years later. Patients with exostosis showed varying outcomes. In children with symptoms suspicious of nerve compression, fast diagnosis and immediate treatment are mandatory to regain best possible recovery.     

Superficial peroneal nerve syndrome: an unusual nerve entrapment. Case report

Lower-extremity pain and paresthesia have multiple origins. Early recognition of the symptoms of peripheral nerve entrapment leads to timely treatment and avoids the cost of unnecessary studies. The authors report on a case of superficial peroneal nerve syndrome resulting from nerve herniation through a fascial defect, which was responsive to surgical treatment. This 22-year-old man presented with pain and paresthesias over the lateral aspect of the right calf and the dorsum of the foot without motor weakness. Exercise led to the formation of a tender bulge approximately 12 cm above the lateral malleolus. Percussion of this site worsened his symptoms. Radiography and electromyography studies were nondiagnostic. The patient underwent surgical decompression that involved division of the fascia overlying the nerve and neurolysis of the superficial peroneal nerve. The operation resulted in symptom-free relief. Superficial peroneal nerve syndrome is an entrapment neuropathy that results from mechanical compression of the nerve at or near the point where the nerve pierces the fascia to travel within the subcutaneous tissue. Surgical decompression of the mechanical entrapment usually provides relief from pain and paresthesia.     

Traumatic paralysis of the common peroneal nerve. Apropos of 43 cases

Forty-three patients with post-traumatic paralysis of the peroneal communicating nerve were followed up and photographed after a mean period of 5 years (range: 2 1/2 to 10 1/2 years). The interest of the study lies in the possibility of comparing clinical and electromyographic findings in 31 cases, enabling establishment of prognostic factors, and of evaluating results of posterior tibial muscle transpositioning after more than 5 years (12 cases).     

Intraneural ganglion of the peroneal nerve: an unusual presentation. Case report

The authors report an intraneural ganglion of the peroneal nerve at the fibular head, in which the external appearance of the nerve was normal at operation. Only the incision of the epineurium permitted discovery of the lesion.     

An unusual cause of bilateral diaphragmatic paralysis.

In a patient who had a sudden onset of bilateral diaphragmatic paralysis after forceful neck manipulation complete, though gradual, recovery in lung function and transdiaphragmatic pressures was seen over three years. This is a previously unrecognised risk of neck osteopathy.     

非创伤性桡神经麻痹24例临床分析

目的对非创伤性桡神经麻痹的病因,临床表现,治疗结果进行分析。方法自 1985年 1月～ 2000年 1月,共治疗 24例患者,其中男 18例,女 6例;年龄 10～ 65岁,平均 38岁。重体力劳动者及手工劳动者 11例。 1例行肌腱移位术, 23例行桡神经探查,其中 18例行神经松解术, 5例将病变神经段切除（ 2例直接吻合, 3例行游离神经移植）。结果行桡神经探查发现,神经卡压性病变 12例,包括 8例卡压部位位于旋后肌, 1例位于指总伸肌起点腱性部分, 3例多部位多重卡压;神经束带样病变 5例,外在肿物压迫 4例 (2例腱鞘囊肿, 1例脂肪瘤, 1例血管瘤 ),神经肿瘤 1例,不明原因神经病变 1例。 18例神经松解患者术后随访 6个月～ 15年, 14例完全恢复, 1例术后无效, 3例恢复不全; 5例神经吻合或移植患者术后随访 4个月～ 6年, 3例恢复满意, 2例 (1例神经吻合, 1例神经游离移植 )由于术后时间短,仍在恢复中。结论非创伤性桡神经麻痹病因较多,手术治疗效果良好。     

Focal subarachnoid hematoma: an unusual cause of delayed third cranial nerve paralysis

We report a case of delayed onset of ultimately permanent oculomotor nerve palsy following a focal aneurysmal hemorrhage into the adjacent interpeduncular cistern. Operative inspection revealed no direct nerve compression by the aneurysmal fundus. Third cranial neuropathies following subarachnoid hemorrhage can occur independently of direct aneurysmal mechanical compression.     

An unusual cause of radial nerve palsy

Neurapraxia frequently occurs following traction injury to the nerve intraoperatively, leading to radial nerve palsy which usually recovers in 5-30 weeks. In our case, we had operated a distal one-third of humeral shaft fracture and fixed it with 4.5 mm limited contact dynamic compression plate. The distal neurovascular status of the limb was assessed postoperatively in the recovery room and was found to be intact and all the sensory-motor functions of the radial nerve were normal. On the second postoperative day, following the suction drain removal and dressing, patient developed immediate radial nerve palsy along with wrist drop. We reviewed the literature and found no obvious cause for the nerve palsy and concluded that it was due to traction injury to the radial nerve while removing the suction drain in negative pressure.     

An unusual cause of depressed skull fracture: case report

BACKGROUND: Camel collision accidents are a common occurrence in Saudi Arabia, with a high rate of mortality and morbidity. Isolated injuries are rare because of the nature of impact sustained by the person. CASE DESCRIPTION: A 4-year-old child with an isolated depressed skull fracture resulting from a camel collision is described. The other occupants of the car were crushed to death. The child sustained only an impact to his head, causing a compound depressed skull fracture with localized cortical damage. CONCLUSIONS: Camel collision accidents are a common cause of mortality and morbidity in Saudi Arabia. Isolated skull injuries are rare and result from a localized impact. This is the first report of a compound depressed skull fracture from such an incident. The extent of the problem and efforts toward prevention are described.     

An unusual cause of massive non-surgical pneumoperitoneum: case report

A case of pneumoperitoneum due to cocaine abuse is presented. Although most commonly associated with surgical disease, pneumoperitoneum may actually be a manifestation of non-surgical intrathoracic pathology. In this patient percutaneous diagnostic peritoneal lavage resulted in return of a large quantity of air and was negative for bleeding or contamination.     

An unusual cause of transient ischemic attacks: Case report

A 42-year-old black man, a physician, presented with a three week history of intermittent right arm and leg numbness and weakness, lasting about five minutes. This was not associated with headache, visual changes, seizures, aphasia or loss of consciousness. There was no history of head trauma, migraines, or previous attacks. Positive findings on physical examination were confined to a blood pressure of 182/80; evidence of hypertensive retinopathy; normal carotid pulses without bruits; and a Grade II/VI systolic ejection murmur with normal sinus rhythm. Initial hematocrit was 25.7%; white blood cell count 14,000 cu/mm with a normal differential; platelet count 532,000 cu/mm. An electrocardiogram showed left ventricular hypertrophy. Duplex scan demonstrated normal carotid bifurcations bilaterally, and arteriogram revealed no carotid or intracranial pathology. Hemoglobin electrophoresis revealed sickle cell disease of the SS type. He was treated with transfusion therapy and has remained asymptomatic at 40 months. Approximately 20% of children with the SS type sickle cell disease will have cerebrovascular symptoms caused by small intracranial artery occlusion due to sludging of the abnormal hemoglobin. This unusual cause of transient ischemic attacks can occur in older patients of African-American ancestry and must be recognized to enable early and effective therapy with exchange transfusion.     

Compression neuropathy of common peroneal nerve caused by an extraneural ganglion: a report of two cases

Peroneal nerve entrapment is most common in the popliteal fossa, but is rarely caused by a ganglion. Although ganglionic cysts are very common lesions, they seldom cause serious complications. Ganglionic cysts developing in the sheath of a peripheral nerve or joint capsule may cause compression neuropathy. We report on two cases of compression neuropathy of the common peroneal nerve caused by an extraneural ganglion and its evaluation with magnetic resonance imaging (MRI) and ultrasonography. The differential diagnosis should involve L5 root pathology, a posttraumatic intraneural hemorrhage, a nerve compression near the tendinous arch located at the fibular insertion of the peroneal longus muscle, and a nerve-sheath tumor. The combination of MRI and ultrasonography is useful for the accurate diagnosis of this condition, and it should be treated by microsurgical exploration as soon as possible.