Fascicular torsions of the anterior and posterior interosseous nerve in 4 cases: neuroimaging methods to improve diagnosis

2020 ◽  
Vol 132 (6) ◽  
pp. 1925-1929 ◽  
Author(s):  
Jennifer Kollmer ◽  
Paul Preisser ◽  
Martin Bendszus ◽  
Henrich Kele
Keyword(s):  
Magnetic Resonance ◽  
Surgical Intervention ◽  
Case Series ◽  
Diagnostic Methods ◽  
Posterior Interosseous Nerve ◽  
Nerve Ultrasound ◽  
Magnetic Resonance Neurography ◽  
Surgical Exploration ◽  
Hyperintense Signal ◽  
Emergency Surgical Intervention

Diagnosis of spontaneous fascicular nerve torsions is difficult and often delayed until surgical exploration is performed. This case series raises awareness of peripheral nerve torsions and will facilitate an earlier diagnosis by using nerve ultrasound (NUS) and magnetic resonance neurography (MRN). Four patients with previously ambiguous upper-extremity mononeuropathies underwent NUS and 3T MRN. Neuroimaging detected proximal torsions of the anterior and posterior interosseous nerve fascicles within median or radial nerve trunks in all patients. In NUS, most cases presented with a thickening of affected nerve fascicles, followed by an abrupt caliber decrease, leading to the pathognomonic sausage-like configuration. MRN showed T2-weighted hyperintense signal alterations of fascicles at and distal to the torsion site, and directly visualized the distorted nerves. Three patients had favorable outcomes after being transferred to emergency surgical intervention, while 1 patient with existing chronic muscle atrophy was no longer eligible for surgery. NUS and MRN are complementary diagnostic methods, and both can detect nerve torsions on a fascicular level. Neuroimaging is indispensable for diagnosing fascicular nerve torsions, and should be applied in all unclear cases of mononeuropathy to determine the diagnosis and if necessary, to guide surgical therapies, as only timely interventions enable favorable outcomes.

scholarly journals Characteristics of Patients With Complex Limb Pain Evaluated Through an Interdisciplinary Approach Utilizing Magnetic Resonance Neurography

2021 ◽  
Vol 2 ◽  
Author(s):  
Emily M. Johnson ◽  
Daehyun Yoon ◽  
Sandip Biswal ◽  
Catherine Curtin ◽  
Paige Fox ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Lower Extremity ◽  
Case Series ◽  
Interdisciplinary Team ◽  
Limb Pain ◽  
Magnetic Resonance Neurography ◽  
Treatment Pathways ◽  
Lower Extremity Pain ◽  
Patient Reported ◽  
Team Evaluation

Patients with persistent complex limb pain represent a substantial diagnostic challenge. Physical exam, and tests such as nerve conduction, are often normal even though the patient suffers from severe pain. In 2015, we initiated a team-based approach to evaluate such patients. The approach included physicians from several specialties (Anesthesiology/Pain Medicine, Radiology, Plastic Surgery, Neurosurgery) combined with the use of advanced imaging with Magnetic Resonance Neurography (MRN). This preliminary case series discusses MRN findings identified in patients with previously difficult-to-diagnose peripheral limb pain and describes how this combination of approaches influenced our diagnosis and treatment plans. We extracted demographics, patient characteristics, presenting features, diagnostic tests performed, treatments provided, referral diagnosis and the diagnosis after interdisciplinary team evaluation from patient charts. We evaluated MRN and electrodiagnostic studies (EDX) ability to identify injured nerves. We compared abnormal findings from these diagnostics to patient reported outcome after ultrasound-guided nerve block. A total of 58 patients, 17 males and 41 females, were identified. The majority of patients presented with lower extremity pain (75%) and had prior surgery (43%). The most commonly identified abnormality on MRN was nerve signal alteration on fluid sensitive sequences, followed by caliber change and impingement. Comparing the outcome of diagnostic nerve blocks with abnormal nerve findings on MRN or EDX, we found that MRN had a sensitivity of 67% and specificity of 100% while for EDX it was 45 and 0%, respectively. After interdisciplinary discussion and imaging review, a more specific diagnosis was produced in 78% of evaluated cases opening up additional treatment pathways such as nerve-targeted surgery, which was performed in 36% cases. This descriptive case series demonstrates that a majority of patients evaluated by our team for complex limb pain were women with lower extremity pain resulting from surgery. In addition, an interdisciplinary team evaluation and the use of the moderately sensitive but highly specific MRN imaging modality resulted in a change in diagnosis for a majority of patients with complex limb pain. Future studies investigating patient outcomes after diagnosis change are currently underway based on the findings of this preliminary study.

scholarly journals Asymptomatic free gas post Endoscopic Mucosal Resection (EMR) - Is surgical intervention always necessary?

2020 ◽  
pp. 19-26
Author(s):  
Shafquat Zaman ◽  
Hayaka Amada ◽  
Pratik Bhattachayra ◽  
Stephen Stonelake ◽  
Mark Goldstein ◽  
...  
Keyword(s):  
Endoscopic Mucosal Resection ◽  
Surgical Intervention ◽  
Bowel Perforation ◽  
Case Series ◽  
Colonic Polyps ◽  
Cost Effective ◽  
Direct Result ◽  
Free Gas ◽  
Mucosal Resection ◽  
Emergency Surgical Intervention

Background& Objectives Endoscopic mucosal resection (EMR) is an efficient, cost-effective and minimally-invasive mode of treatment of colonic polyps. Colonic perforation post EMR is one of the potential complications associated with this procedure. Some patients may present with asymptomatic free gas on imaging and therefore not necessarily require intervention. Methods We present a case series of patients undergoing EMR who were found to have intra-abdominal free gas or ‘bowel perforation’ on imaging post procedure. They were all asymptomatic and did not warrant emergency surgical intervention. In addition, we aim to provide a review of the existing literature on ‘bowel perforation’ post EMR and discuss its management. Results & Conclusion Through this case series we highlight the importance of assessing patients clinically and not treating the radiological findings alone. Clinicians must be aware of the possibility of patients with asymptomatic free gas post EMR as a direct result of the injectate during the procedure or due to the passage of air or CO2 from the distended colon. As the popularity of this procedure increases, it is crucial that clinicians, surgeons and endoscopists are all aware of its associated complications.

scholarly journals Seatbelt Injury Causing Small Bowel Devascularisation: Case Series and Review of the Literature

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Vincent O'Dowd ◽  
Christine Kiernan ◽  
Aoife Lowery ◽  
Waqar Khan ◽  
Kevin Barry
Keyword(s):  
Small Bowel ◽  
Traffic Accidents ◽  
Surgical Intervention ◽  
Road Traffic ◽  
Case Series ◽  
Adverse Outcomes ◽  
Emergency Surgical Intervention ◽  
High Index Of Suspicion ◽  
Delays In Diagnosis ◽  
Public Health Strategies

The use of seatbelts has increased significantly in the last twenty years, leading to a decrease in mortality from road traffic accidents (RTA). However, this increase in seatbelt use has also led to a change in the spectrum of injuries from RTA; abdominal injuries, particularly intestinal injuries have dramatically increased with the routine use of seatbelts. Such intestinal injuries frequently result from improper placement of the “lap belt”. We present 3 cases in which passengers wearing a seatbelt sustained significant devascularisation injuries to the small bowel requiring emergency surgical intervention. A high index of suspicion is crucial in such cases to prevent delays in diagnosis that can lead to severe complications and adverse outcomes. It is evident that while advocating seatbelt use, the importance of education in correct seatbelt placement should also be a focus of public health strategies to reduce RTA morbidity and mortality.

scholarly journals Observational study of the suspected or confirmed cases of sars COV-2 infection needing emergency surgical intervention during the first months of the pandemic in a third level hospital: Case series

2020 ◽  
Vol 60 ◽  
pp. 149-154
Author(s):  
Dra Mariel González-Calatayud ◽  
Dr Benito Vargas-Ábrego ◽  
Dra Gabriela E. Gutiérrez-Uvalle ◽  
Dra Sandra C. López-Romero ◽  
Dr Luis Gabriel González-Pérez ◽  
...  
Keyword(s):  
Observational Study ◽  
Surgical Intervention ◽  
Case Series ◽  
Hospital Case ◽  
Emergency Surgical Intervention ◽  
Level Hospital

scholarly journals Button battery foreign body among children: a case series

2020 ◽  
Vol 6 (5) ◽  
pp. 978
Author(s):  
Gerald P. Sebastian ◽  
Rajinidevi Kaliyan ◽  
Pethuru Devadason
Keyword(s):  
Foreign Body ◽  
Foreign Bodies ◽  
Surgical Intervention ◽  
Case Series ◽  
Mucosal Surface ◽  
Common Occurrence ◽  
Button Battery ◽  
Emergency Surgical Intervention ◽  
Button Batteries ◽  
Nose And Throat

<p>In children the foreign bodies are a common occurrence which may be either accidental or self-induced as a matter of habit. Various materials like metal, plastic toy parts, food matters, etc have been reported as foreign bodies. Button batteries have been reported as foreign bodies in the ear, nose and throat are very relevant and practical, due to their early chemical disintegration in contact with mucosal surface; hence, need emergency surgical intervention to avoid complications. Here, we report five cases of button batteries in the ear nose and throat at various stages of presentation with their sequelae.</p>

scholarly journals MAGNETIC RESONANCE NEUROGRAPHY AND DIFFUSION TENSOR IMAGING

Neurosurgery ◽  
2009 ◽  
Vol 65 (suppl_4) ◽  
pp. A29-A43 ◽  
Author(s):  
Aaron Filler
Keyword(s):  
Diffusion Tensor Imaging ◽  
Magnetic Resonance ◽  
Diffusion Tensor ◽  
The Body ◽  
Diagnostic Methods ◽  
Outcome Studies ◽  
Clinical Indication ◽  
Magnetic Resonance Neurography ◽  
Data Set ◽  
And Diffusion

Abstract OBJECTIVE Methods were invented that made it possible to image peripheral nerves in the body and to image neural tracts in the brain. The history, physical basis, and dyadic tensor concept underlying the methods are reviewed. Over a 15-year period, these techniques—magnetic resonance neurography (MRN) and diffusion tensor imaging—were deployed in the clinical and research community in more than 2500 published research reports and applied to approximately 50 000 patients. Within this group, approximately 5000 patients having MRN were carefully tracked on a prospective basis. METHODS A uniform Neurography imaging methodology was applied in the study group, and all images were reviewed and registered by referral source, clinical indication, efficacy of imaging, and quality. Various classes of image findings were identified and subjected to a variety of small targeted prospective outcome studies. Those findings demonstrated to be clinically significant were then tracked in the larger clinical volume data set. RESULTS MRN demonstrates mechanical distortion of nerves, hyperintensity consistent with nerve irritation, nerve swelling, discontinuity, relations of nerves to masses, and image features revealing distortion of nerves at entrapment points. These findings are often clinically relevant and warrant full consideration in the diagnostic process. They result in specific pathological diagnoses that are comparable to electrodiagnostic testing in clinical efficacy. A review of clinical outcome studies with diffusion tensor imaging also shows convincing utility. CONCLUSION MRN and diffusion tensor imaging neural tract imaging have been validated as indispensable clinical diagnostic methods that provide reliable anatomic pathological information. There is no alternative diagnostic method in many situations. With the elapsing of 15 years, tens of thousands of imaging studies, and thousands of publications, these methods should no longer be considered experimental.

Neurological Recovery in Traumatic Spinal Cord Injury Patient with Delayed Surgical Intervention

2018 ◽  
Vol 1 (2) ◽  
pp. 34
Author(s):  
Mochamad Targib Alatas
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Surgical Intervention ◽  
Case Series ◽  
Spinal Cord Injury Patient ◽  
Traumatic Spinal Cord Injury ◽  
Best Interest ◽  
Score Improvement ◽  
Cord Injury ◽  
Injury Patient

Early surgical treatment for traumatic spinal cord injury (SCI) patients has been proven to yield better improvement on neurological state, and widely practiced among surgeons in this field. However, it is not always affordable in every clinical setting. It is undeniable that surgery for chronic SCI has more challenges as the malunion of vertebral bones might have initiated, thus requires more complex operating techniques. In this case series, we report 7 patients with traumatic SCI whose surgical intervention is delayed due to several reasons. Initial motoric scores vary from 0 to 3, all have their interval periods supervised between outpatient clinic visits. On follow up they demonstrate significant neurological development defined by at least 2 grades motoric score improvement. Physical rehabilitation also began before surgery was conducted. These results should encourage surgeons to keep striving for the patient’s best interest, even when the injury has taken place weeks or even months before surgery is feasible because clinical improvement for these patients is not impossible. 

Сauses of Dizziness in Patients with Suspected Stroke

2018 ◽  
Vol 7 (3) ◽  
pp. 217-221
Author(s):  
E. V. Shevchenko ◽  
G. R. Ramazanov ◽  
S. S. Petrikov
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Demyelinating Disease ◽  
Heart Rhythm ◽  
Diagnostic Methods ◽  
Deficiency Anemia ◽  
Resonance Imaging ◽  
Peripheral Vestibulopathy ◽  
Suspected Stroke ◽  
The Brain

Background Acute dizziness may be the only symptom of stroke. Prevalence of this disease among patients with isolated dizziness differs significantly and depends on study design, inclusion criteria and diagnostic methods. In available investigations, we did not find any prospective studies where magnetic resonance imaging, positional maneuvers, and Halmagyi-Curthoys test had been used to clarify a pattern of diseases with isolated acute dizziness and suspected stroke.Aim of study To clarify the pattern of the causes of dizziness in patients with suspected acute stroke.Material and methods We examined 160 patients admitted to N.V. Sklifosovsky Research Institute for Emergency Medicine with suspected stroke and single or underlying complaint of dizziness. All patients were examined with assessment of neurological status, Dix-Hollpike and Pagnini-McClure maneuvers, HalmagyiCurthoys test, triplex scans of brachiocephalic arteries, transthoracic echocardiography, computed tomography (CT) and magnetic resonance imaging (MRI) of the brain with magnetic field strength 1.5 T. MRI of the brain was performed in patients without evidence of stroke by CT and in patients with stroke of undetermined etiology according to the TOAST classification.Results In 16 patients (10%), the cause of dizziness was a disease of the brain: ischemic stroke (n=14 (88%)), hemorrhage (n=1 (6%)), transient ischemic attack (TIA) of posterior circulation (n=1 (6%)). In 70.6% patients (n=113), the dizziness was associated with peripheral vestibulopathy: benign paroxysmal positional vertigo (n=85 (75%)), vestibular neuritis (n=19 (17%)), Meniere’s disease (n=7 (6%)), labyrinthitis (n=2 (1,3%)). In 6.9% patients (n=11), the cause of dizziness was hypertensive encephalopathy, 1.9% of patients (n=3) had heart rhythm disturbance, 9.4% of patients (n=15) had psychogenic dizziness, 0.6% of patients (n=1) had demyelinating disease, and 0.6% of patients (n=1) had hemic hypoxia associated with iron deficiency anemia.Conclusion In 70.6% patients with acute dizziness, admitted to hospital with a suspected stroke, peripheral vestibulopathy was revealed. Only 10% of patients had a stroke as a cause of dizziness.

DUAL-ENERGY CT WITH XENON IN PATIENTS WITH LUNG PATHOLOGY. FIRST DATA

2018 ◽  
pp. 47-51
Author(s):  
O. E. Karpov ◽  
O. Yu. Bronov ◽  
V. M. Kitaev ◽  
P. S. Vetshev ◽  
D. A. Pikhuta ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Lung Ventilation ◽  
Dual Energy ◽  
Diagnostic Methods ◽  
Dual Energy Ct ◽  
Lung Pathology ◽  
Preoperative Preparation ◽  
Before And After ◽  
Pulmonary Pathology ◽  
Postoperative Lung Function

Routine diagnostic methods have limitations in terms of predicting the ventilation function of the lungs before and after surgery. It was decided to investigate the possibilities of dual-energy CT (DECT) using xenon in assessment of lung ventilation function.Objective: to master the methods of examination of patients with pulmonary pathology, evaluate the possibility of justifying the volume of operative intervention and prediction of postoperative lung function based on the hybrid images.Materials and methods. For the study, 12 patients with different pulmonary pathologies were selected (COPD – 5, lung cancer – 4, bronchiectasis – 3). Results. It was found that the use of DECT with xenon reflects the functional state of lung tissue.Conclusions. DECT with xenon have potential for planning surgical intervention and introducing the method into modern protocols of preoperative preparation.

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