Assuntos
Nervo Mediano/anormalidades , Nervo Mediano/diagnóstico por imagem , Malformações do Sistema Nervoso/diagnóstico por imagem , Neoplasias do Sistema Nervoso Periférico/diagnóstico por imagem , Nervo Ulnar/anormalidades , Nervo Ulnar/diagnóstico por imagem , Idoso , Feminino , Humanos , Masculino , Malformações do Sistema Nervoso/complicações , Neoplasias do Sistema Nervoso Periférico/complicações , Ultrassonografia , Adulto JovemRESUMO
Bifid median nerve is an anatomic variation that occurs in about 18% of patients with symptoms suggestive of carpal tunnel syndrome and in about 15% of symptom-free subjects. Reversed palmaris longus is a rare anatomic muscular variation. The simultaneous presence of a bifid median nerve and a reversed palmaris longus has been very rarely described, usually during surgical exploration or in cadavers. We present two cases where ultrasound showed the presence of both abnormalities, allowing a correct diagnosis and influencing the treatment plan.
Assuntos
Síndrome do Túnel Carpal/diagnóstico por imagem , Síndrome do Túnel Carpal/cirurgia , Nervo Mediano/anormalidades , Músculo Esquelético/anormalidades , Descompressão Cirúrgica/métodos , Feminino , Seguimentos , Antebraço/diagnóstico por imagem , Humanos , Nervo Mediano/diagnóstico por imagem , Pessoa de Meia-Idade , Músculo Esquelético/diagnóstico por imagem , Recuperação de Função Fisiológica , Medição de Risco , Estudos de Amostragem , Resultado do Tratamento , Ultrassonografia Doppler/métodosRESUMO
Chronic immune-mediated neuropathies show high clinical variability. Diagnosis is based on clinical and neurophysiological studies, but recently ultrasound (US) of peripheral nerves has been shown to provide useful morphological information. US has already been shown to crucially influence diagnosis and clinical care in entrapment neuropathies, in traumatic nerve lesions and in tumors. The role of US in the evaluation of polyneuropathies is still not clearly defined, but increasing attention has recently been focused on the immune-mediated neuropathies and specific US measures (namely the intra- and inter-nerve cross-sectional area variability) have been developed. The aim of the current paper is to make a review of the available nerve US studies and provide data from personal observations in the most common chronic immune-mediated neuropathies.
Assuntos
Doenças Autoimunes do Sistema Nervoso/diagnóstico por imagem , Doenças do Sistema Nervoso Periférico/diagnóstico por imagem , Humanos , Nervos Periféricos/diagnóstico por imagem , UltrassonografiaRESUMO
OBJECTIVE: The possibility of depicting through ultrasound (US) the nerve and its surroundings should be very useful in traumatic nerve lesion (TNL) management. Our study aimed at evaluating the contribution of US as complementary tool in a neurophysiological laboratory for the diagnosis and management of TNL. METHODS: A total of 112 nerves from 98 consecutive patients with clinical suspicion of TNL were considered. Two independent and blinded clinicians, different from the examiners performing electrodiagnosis and US, classified clinical, neurophysiological and US findings and classified the contribution of US as follows: 'contributive' and 'non-contributive' if US confirmed the clinical and neurophysiological diagnosis or if US findings were unremarkable. RESULTS: US was 'contributive' (strongly modified the diagnostic and therapeutic path) in 58% of cases (n: 65) providing information on therapeutic approach (immediate or delayed surgery), diagnosis and follow-up. US specifically contributed to the (1) assessment of nerve continuity/discontinuity, hence neurotmesis/axonotmesis; (2) identification of aetiology; and (3) demonstration of multiple sites of damage. US was contributive mainly in cases with neurophysiological evidence of complete axonal damage. CONCLUSIONS: US should be used, when available, in all patients in whom TNL is suspected as it provides a more comprehensive diagnosis than neurophysiologic studies alone. Anatomical information is often crucial for choosing the most appropriate therapeutic strategies (and for surgical planning). SIGNIFICANCE: US can improve the outcome of TNL.
Assuntos
Traumatismos dos Nervos Periféricos/diagnóstico por imagem , Traumatismos dos Nervos Periféricos/terapia , Acidentes de Trânsito , Adolescente , Adulto , Idoso , Axônios/diagnóstico por imagem , Criança , Estudos Transversais , Lesão Axonal Difusa/diagnóstico por imagem , Eletrodiagnóstico , Eletromiografia , Fenômenos Eletrofisiológicos , Feminino , Fíbula/lesões , Humanos , Úmero/lesões , Traumatismos do Joelho/diagnóstico por imagem , Traumatismos do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Motocicletas , Condução Nervosa/fisiologia , Exame Neurológico , Procedimentos Neurocirúrgicos , Esqui/lesões , Futebol/lesões , Nervo Sural/cirurgia , Nervo Sural/transplante , Nervo Ulnar/diagnóstico por imagem , Nervo Ulnar/fisiopatologia , Ultrassonografia , Adulto Jovem , Lesões no CotoveloRESUMO
BACKGROUND: Primary hyperaldosteronism is an uncommon cause of hypertension in the general population. Given the mechanism of action of aldosterone clinical manifestations may not occur in the setting of end stage renal disease. However, if a successful renal transplant is performed clinical manifestations may occur. METHODS: We present a case of a patient with a preexisting adrenal adenoma who only presented with clinical signs of hyperaldosteronism after renal transplantation. Patients' work-up included plasma aldosterone, plasma renin activity, serum cortisol, and estimation of trans tubular potassium gradient. RESULTS: The patient's serum aldosterone was markedly elevated with a relatively suppressed plasma renin activity. Trans tubular potassium gradient was high in the presence of hypokalemia. CONCLUSION: Previously silent hyperaldosteronism may be unmasked by a successful renal transplant.
Assuntos
Hiperaldosteronismo/diagnóstico , Transplante de Rim , Adenoma/complicações , Adenoma/diagnóstico por imagem , Neoplasias das Glândulas Suprarrenais/complicações , Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Diagnóstico Diferencial , Humanos , Hiperaldosteronismo/etiologia , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Tomografia Computadorizada por Raios XRESUMO
Spontaneous bilateral rupture of the extensor mechanisms of the knees, without significant history of trauma, has been reported rarely, generally in association with chronic metabolic disorders, such as chronic renal failure and secondary hyperparathyroidism. We report spontaneous tendon rupture in two patients on chronic hemodialysis for 4 and 11 years, with documented severe secondary hyperparathyroidism. One patient had spontaneous bilateral rupture of his quadriceps and partial avulsion of the left triceps tendons. The other patient had spontaneous rupture of his right quadriceps tendon. Both patients had markedly elevated serum intact parathyroid hormone and moderately elevated serum beta 2-microglobulin levels. Pathologic examination revealed diffuse immunohistochemical staining for beta 2-microglobulin but negative Congo-red staining of the ruptured tendon specimens. These cases and the previous reports in the literature suggest that secondary hyperparathyroidism may play a role in the pathogenesis of this clinical entity.