121 Diabetic ulnar neuropathy with non-localizing electrophysiology: a nerve ultrasound study

IntroductionThe classification and management of diabetic ulnar mono-neuropathy with non-localizing electrophysiology (NL-UN) is challenging, as this could be due to a focal axonal lesion at the elbow that may require surgery or, be part of the mono-neuritis multiplex spectrum of diabetic neuropathy. The distinction cannot be made by clinical examination and electrophysiology.We investigated the value of nerve ultrasound in this situation.MethodsWe analysed ulnar nerve ultrasound in 9 consecutive diabetic patients (5 males, mean age 65.4 years) with 12 NL-UN affected nerves. The ulnar neuropathy was clinically and electrophysiologically severe in 9 nerves and moderate in 3.ResultsUltrasound showed diffuse ulnar nerve abnormality in 9 nerves (75%) and focal nerve abnormalities at the elbow in 3 (25%)ConclusionsThe majority of NL-UNs in this small sample of patients with diabetes were not due to focal lesions at the elbow. This is in contrast with the nerve ultrasound findings in non-diabetic patients with NL-UN, which almost invariably show a focal lesion at the elbow (Pelosi et al, 2018), and confirms that the pathophysiology of ulnar mono-neuropathy is different and more complex in diabetes.Ultrasound appears to be a useful tool to classify NL-UN in the patient with diabetes and larger studies are indicated.ReferencesPelosi, et al. Ulnar neuropathy with abnormal non-localizing electrophysiology: Clinical, electrophysiological and ultrasound findings. Clin Neurophysiol 2018, 129:2155–2161.

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001 Ulnar neuropathy with abnormal non-localising electrophysiology: clinical, electrophysiological and ultrasound findings

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2018-anzan.1 ◽

2018 ◽

Vol 89 (6) ◽

pp. A2.1-A2

Author(s):

Luciana Pelosi ◽

Dominic Ming Yin Tse ◽

Eoin Mulroy ◽

Andrew M Chancellor ◽

Michael R Boland

Keyword(s):

Ulnar Nerve ◽

Significant Role ◽

Diagnostic Tests ◽

Ulnar Neuropathy ◽

Axonal Loss ◽

Nerve Ultrasound ◽

Causative Mechanism ◽

Ultrasound Findings ◽

Significant Disability

IntroductionUlnar neuropathy with abnormal non-localising electrophysiology (NL-UN) is often associated with significant disability that is difficult to manage due to the absence of anatomically defining studies. We studied demographic, clinical and electrophysiological characteristics of NL-UN and used ultrasound in order to assist with classification and to examine the utility of ultrasound over and above the conventional electro-diagnostic approach.MethodNL-UNs were identified from 113 consecutive referrals to a single neurophysiologist with suspected ulnar neuropathy. All received systematic electro-diagnostic tests and ulnar nerve ultrasound. NL-UN severity was graded using clinical and electrophysiological scales.ResultsIn 64 of 113 referrals, an ulnar mononeuropathy was confirmed by electrophysiology. Sixteen of these 64 (25%) had NL-UN, predominantly males (14 out of 16 patients) with severe or moderately severe clinical and electrophysiological ratings in 81%. Ultrasound showed focal ulnar neuropathy at the elbow (UNE) in 13 out of 16, and diffuse ulnar nerve abnormality in three, and identified a likely or possible causative mechanism in 11 UNEs.ConclusionA quarter of ulnar neuropathies, as demonstrated by abnormal electrophysiology, were NL-UN, of heterogeneous aetiology; the majority were males with significant disability and axonal loss. Ultrasound had a significant role in localization and classification of NL-UN that facilitated management.

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5. Segmental changes in ulnar nerve ultrasound across the elbow and their pathophysiological significance in ulnar neuropathy

Clinical Neurophysiology ◽

10.1016/j.clinph.2013.10.027 ◽

2014 ◽

Vol 125 (4) ◽

pp. e2

Author(s):

Neil G. Simon ◽

Jeffrey W. Ralph ◽

Ann Poncelet ◽

John W. Engstrom ◽

Cynthia Chin ◽

...

Keyword(s):

Ulnar Nerve ◽

Ulnar Neuropathy ◽

Nerve Ultrasound

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080 Electrodiagnostic and ultrasound correlates of clinical severity in ulnar neuropathy

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2018-anzan.79 ◽

2018 ◽

Vol 89 (6) ◽

pp. A32.3-A33

Author(s):

Luciana Pelosi ◽

Eoin Mulroy

Keyword(s):

Diagnostic Yield ◽

Clinical Signs ◽

Clinical Severity ◽

Ulnar Neuropathy ◽

Sensory Loss ◽

Nerve Ultrasound ◽

Cross Sectional ◽

Hand Muscles ◽

Ultrasound Findings ◽

Marked Atrophy

IntroductionThis is a retrospective review of 135 consecutive patients (M:F=71:64, mean age 52.6 years; 141 arms) referred to our institution with ulnar neuropathy over a two year period. We analysed electrodiagnostic and ultrasound findings in relation to clinical severity.MethodsAll patients underwent electrodiagnostic (AAN) and ultrasound examination of the symptomatic ulnar nerve(s). Clinical severity was graded on a 4 point scale from ‘very mild’ (symptoms only) to ‘severe’ (sensory loss plus marked atrophy of ulnar-innervated hand muscles).ResultsIn ‘very mild’ neuropathies, the number of abnormal electrodiagnostic and ultrasound studies was 2 and 11 respectively, out of 54; in ‘mild’ neuropathies 19 and 25 out of 40; in ‘moderate’, 23 and 24 out of 24; and in ‘severe’, 23 and 23 out of 23. In 25 arms, (18 of which were clinically ‘severe’ or ‘moderate’), electrophysiology was abnormal but non-localising. Ultrasound showed abnormally large cross-sectional area at the elbow in 22 and diffuse nerve enlargement in three. Ultrasound identified nerve subluxation in 24 (17%) neuropathies, 58% of which were ‘very mild’, 25% ‘mild’ and 17% ‘moderate’ or ‘severe’.ConclusionIn patients with symptoms but no clinical signs, electrophysiological evidence of ulnar neuropathy was present in 3.7%, whereas abnormal nerve ultrasound, often associated with subluxation, was demonstrated in 20%. Ultrasound increased the diagnostic yield of electrophysiology in the ‘very mild’ and, to a lesser extent, the ‘mild’ neuropathies by a combined 11%, and localised the lesion in all ulnar neuropathies with abnormal but non-localising electrophysiology. Nerve subluxation was disproportionately represented amongst the clinically ‘very mild’ neuropathies with abnormal ultrasound.

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Comparison between C-arm cone beam computed tomography and interventional angiography in transarterial chemoembolization of hepatocellular carcinoma

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-019-0053-4 ◽

2019 ◽

Vol 50 (1) ◽

Author(s):

Ibraheim Ahmed Diab ◽

Shaimaa Abdel-hamid Hassanein ◽

Hala Hafez Mohamed

Keyword(s):

Computed Tomography ◽

Hepatocellular Carcinoma ◽

Cone Beam Computed Tomography ◽

Vascular Anatomy ◽

Cone Beam ◽

Focal Lesion ◽

Focal Lesions ◽

Conventional Angiography ◽

Interventional Angiography ◽

Cross Sectional

Abstract Background Hepatocellular carcinoma (HCC) is the most common primary hepatic malignancy of adults. One of the established treatment procedures performed worldwide for HCC is transcatheter arterial chemoembolization (TACE). By using conventional angiography in TACE, we can detect and identify the vascular anatomy of the liver through obtaining 2D images. Recently C-arm cone beam computed tomography (CBCT) is introduced for obtaining cross-sectional and three-dimensional (3D) images for better visualization of small tumors and their feeding arteries. Results The number of detected focal lesions by angiography was 51 compared to 87 focal lesion detected by CBCT; of those, 45 and 77 were active lesions by both procedures respectively. For lesions, less than 1 cm CBCT detected 23 lesions while angiography detected only one lesion. Angiography detected 87 feeding arterial branch while cone beam CT-HA detected 130 branches to the same number of target lesion. Feeder tractability and confidence were better by CBCT. Conclusion CBCT is superior to angiography in tumor detectability, detection of lesions less than 1 cm, feeder detection, and feeder traction; however, conventional angiography and DSA are irreplaceable. Thus, combination of CBCT with angiography during TACE produces better results and less complication.

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Apparent diffusion coefficient for differentiating between benign and malignant hepatic focal lesions

Egyptian Liver Journal ◽

10.1186/s43066-020-00068-2 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Sherif Abugamra ◽

Aya Yassin ◽

Asmaa Saber Mostafa Abdel-Rehim ◽

Dina Sayed Sheha

Keyword(s):

Hepatocellular Carcinoma ◽

Diffusion Coefficient ◽

Apparent Diffusion Coefficient ◽

Focal Lesion ◽

Benign Lesions ◽

Focal Lesions ◽

Significant Difference ◽

Apparent Diffusion ◽

Malignant Lesions ◽

The Mean

Abstract Background The aim of this study was to prospectively evaluate the role of diffusion weight MRI (DWI) in the characterization of hepatic focal lesions by using apparent diffusion coefficient (ADC). Thirty patients (18 women, 12 men; mean age 48.5 years) with hepatic focal lesions were included in this study. Patients underwent DW MR imaging with the SPLICE sequence. ADC of each focal lesion carcinoma was calculated from DW MR Images obtained with low and high b values. ADCs were compared among pathological types of focal lesions. Results Among the 30 patients included in the study, 46 focal lesions were detected. Twenty-four lesions were metastatic lesions from primary cancer, 7 lesions were hepatocellular carcinoma (HCC), 9 lesions were hemangiomas, and 6 lesions were simple cysts. There was highly significant difference between the mean ADC of the malignant lesions (metastasis and HCC) and the mean ADC of benign lesions (hemangiomas and cysts). The ADC of malignant lesion was much less than that of benign lesion. The mean ADC of malignant lesions (n = 31) was 0.73 ± 0.19 × 10−3 mm2/s, and the mean ADC of benign lesions (n = 15) was 1.94 ± 0.68 × 10−3 mm2/s (p value < 0.001). There was no significant difference between the cysts and hemangiomas. There was no statistically significant difference between the metastases and hepatocellular carcinoma. Conclusion ADCs values were able to differentiate benign from malignant lesions. ADC should be considered in the work up of patients with hepatic focal lesions.

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Impaired compensatory coronary artery enlargement in atherosclerosis contributes to the development of coronary artery stenosis in diabetic patients: An in vivo intravascular ultrasound study

European Heart Journal ◽

10.1093/oxfordjournals.eurheartj.a015402 ◽

1997 ◽

Vol 18 (7) ◽

pp. 1090-1094 ◽

Cited By ~ 48

Author(s):

M. Vavuranakis ◽

C. Stefanadis ◽

K. Toutouzas ◽

C. Pitsavos ◽

V. Spanos ◽

...

Keyword(s):

Coronary Artery ◽

Intravascular Ultrasound ◽

Coronary Artery Stenosis ◽

Artery Stenosis ◽

Diabetic Patients ◽

Ultrasound Study

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A CASE REPORT OF ACUTE CUBITAL TUNNEL SYNDROME CAUSED BY VENOUS THROMBOSIS

Hand Surgery ◽

10.1142/s0218810415720016 ◽

2015 ◽

Vol 20 (01) ◽

pp. 137-139 ◽

Cited By ~ 3

Author(s):

Yoshihiro Abe ◽

Masahiko Saito

Keyword(s):

Case Report ◽

Venous Thrombosis ◽

Ulnar Nerve ◽

Cubital Tunnel Syndrome ◽

Nerve Compression ◽

Ulnar Neuropathy ◽

Cubital Tunnel ◽

Ulnar Nerve Compression ◽

Compression Neuropathy ◽

Tunnel Syndrome

Compression neuropathy of the ulnar nerve at the elbow is well-recognised as cubital tunnel syndrome (CuTS). Many causes of ulnar neuropathy at the elbow have been identified. A previously unreported finding of ulnar nerve compression in the cubital tunnel caused by a thrombosed proximal ulnar recurrent artery vena comitans is described.

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