Applicability of Magnetic Resonance Imaging for Early Diagnosis of Common Peroneal Neuropathy

Objective: This study aimed to assess the clinical applicability of magnetic resonance imaging (MRI) for the early diagnosis of common peroneal neuropathy (CPNe).Methods: Over three years, the authors have treated 58 patients with CPNe. All patients had clinical or neurophysiological confirmation of CPNe. Among them, 35 (60%) patients underwent axial knee MRI with a 1.5-Tesla scanner. These 35 patients were selected for study and were classified into three groups according to the time of examination after the occurrence of dropped foot―acute, subacute, and chronic onset groups. According to muscle appearances (normal, edematous change, and atrophy), we diagnosed them with CPNe, except for those with normal morphology. We evaluated the applicability of MRI in the diagnosis of CPNe compared to that of electromyography (EMG).Results: The 18, 11, and six cases were included in the acute, subacute, and chronic onset groups, respectively. In the acute onset group, three cases had normal muscle appearance, while 15 cases had edematous changes in the affected muscles. In the subacute onset group, eight cases had edematous changes, while three cases showed muscle atrophy. In the chronic onset group, six cases had muscle atrophy. CPNe could be diagnosed using MRI in about 91% (32/35) of all the cases. Excluding the chronologically chronic stage, diagnosis rate was approximately 89%(26/29) of all the cases. However, only in 27 cases (77%) denervation potentials were presented on EMG.Conclusion: According to our results, MRI is a helpful diagnostic modality, especially in the early stage of CPNe, and may lead to proper management.

Could a Simple Nerve Block be Considered as a Treatment Option for Occipital Neuralgia with Both Short-Term and Long-Term Effects?

Objective: The study aims to show both the short- and long-term treatment outcome of occipital nerve block (ONB) patients with occipital neuralgia (ON).Methods: Patients who visited our hospital between 2013 and 2020 were reviewed retrospectively. Patients were excluded if the medical records were incomplete, if they had received a cervical operation, if they had a traumatic event prior to the symptom onset, or if the follow-up period was less than 3 months. ONB targeted the greater occipital nerve, the lesser occipital nerve or both. Short term follow-up period was defined as 3 months and long term was defined as 12 months. Injection consisted of a mixture of triamcinolone acetonide, lidocaine, and normal saline. Visual analogue scale (VAS) was recorded and compared before and during the follow-up to period to assess treatment outcome.Results: Clinical charts of 309 candidates were reviewed and 72 patients were excluded, making it 237 patients. VAS scores significantly decreased in both 3-month follow-up (from 7.20±0.94 to 3.48 ±1.66, p<0.05) and after 1 year follow-up (from 7.20±0.94 to 2.71±1.07, p<0.05). Only 8 patients (3.3%) were refractory to ONB and the procedure was found to be relatively safe since only 2 patients (0.8%) showed transient side effects.Conclusion: There are many treatment options for ON. However, from the results of our study, conservative treatment via ONB may have sufficient effect in controlling symptoms of ON in both short and long term.

Subarachnoid Hemorrhage from Ruptured Aneurysm in the Middle Cerebral Artery and Anterior Cerebral Artery Trunk: A Single-Center Study

Objective: Ruptured anterior cerebral artery (ACA) trunk aneurysms and middle cerebral artery (MCA) trunk aneurysms are rare, and little is known about them. This study was conducted to determine the difference between these and other types of aneurysms.Methods: We performed a retrospective review of patients diagnosed with subarachnoid hemorrhage over an 8-year period at a single institution. We analyzed the characteristics, clinical factors, and radiological components of aneurysms at the trunk portion of A-1 and M-1. Descriptive analysis and univariate analysis for factors were performed to determine the differences of ACA A-1 portion trunk and MCA M-1 portion trunk aneurysms from other ACA and MCA aneurysms, respectively.Results: Univariate logistic regression modeling showed that trunk aneurysms in MCA M-1 had a smaller dome size (p=0.026) and dome/neck ratio (p=0.048) than other MCA aneurysms. Likewise, through univariate logistic regression modeling, the ACA group showed differences in dome size including age (p=0.001) as well as dome size (p=0.038) and dome neck ratio (p=0.041) in the A1 region.Conclusion: MCA M-1 and ACA A-1 trunk aneurysms are likely to have several different characteristics such as small in size and a lower dome/neck ratio. Also, due to their close locations to the perforator arteries, there is a high possibility of perforator artery injury when treating these aneurysms. Thus, careful attention is required when setting the treatment methods, and further studies about these aneurysms are needed.

Role of Supine and Standing Radiography in Vertebroplasty for Osteoporotic Compression Fractures"

Objective: To confirm the benefits of vertebroplasty (VP) in selected patients with acute vertebral compression fracture (VCF) and analyze whether the study of a weight dynamic plain lateral radiograph would help in making decisions to perform VP. Using retrospective analysis, we aimed to determine the radiological characteristics of patients benefiting from VP.Methods: Data were collected from 54 patients (age, 56-97 years) diagnosed with osteoporosis and compression fractures between December 2013 and January 2018. Each patient was hospitalized with ≥2 weeks of absolute bed rest (ABR) and treated for osteoporosis. Plain lateral supine radiography of the fractured spine was performed prior to diagnosis, and both supine and standing spinal radiographs were taken 1 and 2 weeks after ABR. Patients were categorized into the VP and non-VP groups 2 weeks after ABR.Results: Although patients with worse pain and functional progress were selected to undergo VP, patients in the VP group presented better outcomes in the fourth week of evaluation than those in the non-VP group. In a retrospective analysis of the radiographic study, changes in the compression rate between supine and standing (weight-bearing) X-rays (ΔCR), showed a statistically significant correlation with the patient’s outcome in the second week.Conclusion: VP was found to be an effective management option for patients with VCF. A weightbearing radiographic study of VCFs provided valuable information on patient selection for VP. Therefore, patient selection based on subjective surveys and radiological studies to determine the benefits of VP could be a beneficial management strategy.