Entrapment of the lateral cutaneous nerve of the calf.

Isolated lesion of lateral cutaneous nerve of the calf (LCNC), particularly due to entrapment, is rarely reported in the literature. Patients usually present with sensory symptoms in the lateral aspect of the calf. Treatment is usually by local applications or local steroid/anaesthetic injection. We report the first case of LCNC entrapment in a 35-year-old man which is documented by nerve conduction studies. The patient had a temporary improvement following a local anaesthetic/steroid injection. Owing to the recurrence of symptoms, the patient opted for surgery. About 1 year after surgery, the symptoms disappeared completely.

Expression of a latent ophthalmic artery collateral circulation after extracranial-intracranial bypass.

We present the case of an unexpected response by the cerebral vasculature to bypass surgery. A 66-year-old man sustained a subarachnoid haemorrhage and cerebral angiography showed a large fusiform anterior communicating artery (ACoA) aneurysm and an anomalous anterior circulation. The right A1 segment was hypoplastic and blood supply to the entire right A2 was from the left anterior circulation via the ACoA. The aneurysm was therefore not amenable to endovascular coiling or surgical clipping alone. An extracranial-intracranial bypass was performed to revascularize the territory of the right A2 independently of the ACoA to allow the latter vessel to be clipped. Although the bypass graft was patent on post-operative cerebral angiography, it was in fact only perfusing a limited, peripheral anterior cerebral artery territory. The bulk of the right anterior circulation was derived retrogradely by latent collaterals from the internal carotid and ophthalmic arteries via small dural vessels which were not apparent prior to surgery.

A novel approach to the diagnosis and management of meralgia paresthetica.

OBJECTIVE: To review the results of conservative and surgical treatment of meralgia paresthetica (MP), with particular reference to the use of a simple clinical test for diagnosing this condition and the outcome of primary nerve decompression surgery. METHODS: Records of all patients with a diagnosis of MP were reviewed. Information was obtained about clinical presentation and risk factors, diagnostic evaluation, management, and outcome. Actuarial analysis was used to determine the intervention-free interval after surgical decompression. RESULTS: Between 2000 and 2005, MP was diagnosed in 45 patients. There were 27 men and 18 women, and the average age at presentation and duration of symptoms were 47 and 1.9 years, respectively. The pelvic compression test had a sensitivity of 95% and a specificity of 93.3% for this condition. Twenty-five patients were managed conservatively and 20 required operative intervention, which was bilateral in two patients. The average follow-up period was 25 months, and the actuarial 2- and 5-year intervention-free rates were 91 and 78%, respectively, with no specific risk factors for revision surgery. CONCLUSION: The pelvic compression test is a sensitive and specific test for MP, helping to distinguish it from lumbosacral radicular pain. Most patients with this condition can be managed successfully with conservative measures, and those requiring surgery can be treated effectively with nerve decompression.