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1.
World Neurosurg ; 135: 171-172, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31870821

RESUMO

Benign peripheral nerve sheath tumors are well known to neurosurgeons and a relatively commonly seen pathology. Intraneural ganglion cysts, once thought to be rare and poorly understood, are increasingly recognized in clinical practice and better understood based on the advent of high-resolution imaging. There are few reports of different nerve lesions in the same anatomic location appearing concurrently. Herein we present a patient with 2 distinct pathologies explaining 2 distinct symptom complexes-sensory changes in the superficial peroneal distribution (from a schwannoma of the superficial peroneal nerve) and mild motor weakness in the tibialis anterior (from an intraneural ganglion cyst arising from the superior tibiofibular joint affecting this motor branch). Recognition of the 2 pathologies allowed targeted surgical approaches, which led to resolution of the symptoms.


Assuntos
Cistos Glanglionares/diagnóstico por imagem , Neurilemoma/diagnóstico por imagem , Neoplasias do Sistema Nervoso Periférico/diagnóstico por imagem , Neuropatias Fibulares/diagnóstico por imagem , Idoso , Feminino , Cistos Glanglionares/complicações , Cistos Glanglionares/cirurgia , Humanos , Imagem por Ressonância Magnética , Neurilemoma/complicações , Neurilemoma/cirurgia , Neoplasias do Sistema Nervoso Periférico/complicações , Neoplasias do Sistema Nervoso Periférico/cirurgia , Nervo Fibular/diagnóstico por imagem , Nervo Fibular/cirurgia , Neuropatias Fibulares/complicações , Neuropatias Fibulares/cirurgia
2.
AANA J ; 87(2): 110-113, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31587723

RESUMO

A 31-year-old man scheduled for a fifth metatarsal head resection secondary to osteomyelitis presented to the preoperative holding area for placement of an ultrasound-guided popliteal nerve block as part of a multimodal pain management plan. During the preoperative evaluation, a medical history of CharcotMarie-Tooth disease was noted. The patient had decreased range of motion and neuropathy in both lower extremities and required an assistive device when ambulating. Before placement of the block, a pre-procedure scan of the popliteal fossa revealed abnormal sonoanatomy of the distal sciatic nerve as well as the proximal tibial and common peroneal nerve branches. The surgeon was consulted regarding the ultrasonography findings, and the proposed block was abandoned. A field block proximal to the surgical site was performed under monitored anesthesia care, with an understanding that the case would convert to general anesthesia using a laryngeal mask airway if the procedure was not tolerated. The surgery was performed as planned without any difficulties, and the patient was transferred to the postanesthesia care unit. The postoperative course was uneventful, and the patient was discharged home.


Assuntos
Doença de Charcot-Marie-Tooth , Dor Crônica/prevenção & controle , Bloqueio Nervoso , Nervo Fibular/diagnóstico por imagem , Ultrassonografia de Intervenção , Adulto , Doença de Charcot-Marie-Tooth/complicações , Doença de Charcot-Marie-Tooth/diagnóstico por imagem , Técnicas de Apoio para a Decisão , Humanos , Masculino , Bloqueio Nervoso/métodos , Enfermeiras Anestesistas
3.
Muscle Nerve ; 60(6): 757-761, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31520475

RESUMO

BACKGROUND: The objective of the study was to determine the reference values for cross-sectional area (CSA) of the nerves in healthy subjects between the age of 2 and 30 years. METHODS: High-resolution ultrasonography (HRU) of the median, ulnar, tibial, sural, peroneal and spinal nerves C5-C7 was performed in 72 healthy subjects. RESULTS: The CSA of peripheral nerves demonstrated an age-dependent increase in size at all measurement sites in children up to around 14 years of age. This was most pronounced for large lower limb nerves and least for small nerves. Intra-nerve and inter-nerve variability of nerve CSA did not change with age. CONCLUSIONS: This study provides normative values for HRU of peripheral nerves in children and young adults. Adult reference values should not be used for children under the age of 14 years.


Assuntos
Nervos Periféricos/diagnóstico por imagem , Ultrassonografia , Adolescente , Adulto , Fatores Etários , Vértebras Cervicais , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Nervo Mediano/anatomia & histologia , Nervo Mediano/diagnóstico por imagem , Tamanho do Órgão , Nervos Periféricos/anatomia & histologia , Nervo Fibular/anatomia & histologia , Nervo Fibular/diagnóstico por imagem , Valores de Referência , Nervos Espinhais/anatomia & histologia , Nervos Espinhais/diagnóstico por imagem , Nervo Sural/anatomia & histologia , Nervo Sural/diagnóstico por imagem , Nervo Tibial/anatomia & histologia , Nervo Tibial/diagnóstico por imagem , Nervo Ulnar/anatomia & histologia , Nervo Ulnar/diagnóstico por imagem , Adulto Jovem
4.
Muscle Nerve ; 60(6): 744-748, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31469427

RESUMO

INTRODUCTION: Nerve cross-sectional area (CSA) is larger than normal in Charcot-Marie-Tooth disease 1A (CMT1A), although to a variable extent. We explored whether CSA is correlated with CMT clinical severity measured with neuropathy score version 2 (CMTNS2) and its examination subscore (CMTES2) in CMT1A. METHODS: We assessed 56 patients with CMT1A (42 families). They underwent nerve conduction study (NCS) and nerve high-resolution ultrasound (HRUS) of the left median, ulnar, and fibular nerves. RESULTS: Univariate analysis showed NCS and HRUS variables to be significantly correlated with CMTNS2 and CMTES2 and with each other. Multivariate analysis showed that ulnar motor nerve conduction velocity (ß: -0.19) and fibular compound muscle action potential amplitude (-1.50) significantly influenced CMTNS2 and that median forearm CSA significantly influenced CMTNS2 (ß: 5.29) and CMTES2 (4.28). DISCUSSION: Nerve size is significantly associated with clinical scores in CMT1A, which suggests that it might represent a potential biomarker of CMT damage and progression.


Assuntos
Doença de Charcot-Marie-Tooth/fisiopatologia , Nervo Mediano/fisiopatologia , Condução Nervosa/fisiologia , Nervo Fibular/fisiopatologia , Nervo Ulnar/fisiopatologia , Adulto , Doença de Charcot-Marie-Tooth/diagnóstico por imagem , Doença de Charcot-Marie-Tooth/patologia , Feminino , Humanos , Masculino , Nervo Mediano/diagnóstico por imagem , Nervo Mediano/patologia , Pessoa de Meia-Idade , Tamanho do Órgão , Nervo Fibular/diagnóstico por imagem , Nervo Fibular/patologia , Índice de Gravidade de Doença , Nervo Ulnar/diagnóstico por imagem , Nervo Ulnar/patologia , Ultrassonografia
5.
Muscle Nerve ; 60(5): 544-548, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31361339

RESUMO

INTRODUCTION: Ultrasound (US) evaluation of peripheral nerves is a noninvasive, cost-effective approach to diagnosing focal mononeuropathies and guiding surgical management. We used the intranerve ratio to evaluate for possible cut-off values in diagnosis of fibular mononeuropathies (FNs). METHODS: A retrospective analysis of FN confirmed by electrodiagnosis (EDx) was performed to identify intranerve ratio values between affected and unaffected limbs at the fibular head and popliteal fossa. RESULTS: The optimal fibular head/popliteal fossa intranerve ratio to discriminate between limbs with and without disease was 1.25 (sensitivity, 51%; specificity, 71%). There was no statistically significant difference between affected vs unaffected limbs (ratio, 1.13; P = .15) nor in subgroup analyses. However, 25% of patients had structural lesions amenable to surgery. DISCUSSION: The utility of US in diagnosis of FN is limited using intranerve ratio data, but US has a distinct advantage over EDx for identifying treatable structural lesions.


Assuntos
Cistos Glanglionares/diagnóstico por imagem , Neoplasias da Bainha Neural/diagnóstico por imagem , Neoplasias do Sistema Nervoso Periférico/diagnóstico por imagem , Nervo Fibular/diagnóstico por imagem , Neuropatias Fibulares/diagnóstico por imagem , Eletrodiagnóstico , Feminino , Cistos Glanglionares/complicações , Cistos Glanglionares/cirurgia , Humanos , Joelho , Masculino , Pessoa de Meia-Idade , Neoplasias da Bainha Neural/complicações , Neoplasias da Bainha Neural/cirurgia , Condução Nervosa , Tamanho do Órgão , Neoplasias do Sistema Nervoso Periférico/complicações , Neoplasias do Sistema Nervoso Periférico/cirurgia , Nervo Fibular/patologia , Neuropatias Fibulares/etiologia , Neuropatias Fibulares/cirurgia , Estudos Retrospectivos
6.
JAMA Netw Open ; 2(5): e194798, 2019 05 03.
Artigo em Inglês | MEDLINE | ID: mdl-31150078

RESUMO

Importance: Lowering serum cholesterol levels is a well-established treatment for dyslipidemia in patients with type 2 diabetes (T2D). However, nerve lesions in patients with T2D increase with lower serum cholesterol levels, suggesting that lowering serum cholesterol levels is associated with diabetic polyneuropathy (DPN) in patients with T2D. Objective: To investigate whether there is an association between serum cholesterol levels and peripheral nerve lesions in patients with T2D with and without DPN. Design, Setting, and Participants: This single-center, cross-sectional, prospective cohort study was performed from June 1, 2015, to March 31, 2018. Observers were blinded to clinical data. A total of 256 participants were approached, of whom 156 were excluded. A total of 100 participants consented to undergo magnetic resonance neurography of the right leg at the Department of Neuroradiology and clinical, serologic, and electrophysiologic assessment at the Department of Endocrinology, Heidelberg University Hospital, Heidelberg, Germany. Exposures: Quantification of the nerve's diameter and lipid equivalent lesion (LEL) load with a subsequent analysis of all acquired clinical and serologic data with use of 3.0-T magnetic resonance neurography of the right leg with 3-dimensional reconstruction of the sciatic nerve. Main Outcomes and Measures: The primary outcome was lesion load and extension. Secondary outcomes were clinical, serologic, and electrophysiologic findings. Results: A total of 100 participants with T2D (mean [SD] age, 64.6 [0.9] years; 68 [68.0%] male) participated in the study. The LEL load correlated positively with the nerve's mean cross-sectional area (r = 0.44; P < .001) and the maximum length of a lesion (r = 0.71; P < .001). The LEL load was negatively associated with total serum cholesterol level (r = -0.41; P < .001), high-density lipoprotein cholesterol level (r = -0.30; P = .006), low-density lipoprotein cholesterol level (r = -0.33; P = .003), nerve conduction velocities of the tibial (r = -0.33; P = .01) and peroneal (r = -0.51; P < .001) nerves, and nerve conduction amplitudes of the tibial (r = -0.31; P = .02) and peroneal (r = -0.28; P = .03) nerves. Conclusions and Relevance: The findings suggest that lowering serum cholesterol levels in patients with T2D and DPN is associated with a higher amount of nerve lesions and declining nerve conduction velocities and amplitudes. These findings may be relevant to emerging therapies that promote an aggressive lowering of serum cholesterol levels in patients with T2D.


Assuntos
LDL-Colesterol/sangue , Diabetes Mellitus Tipo 2/complicações , Neuropatias Diabéticas/etiologia , Nervo Fibular/patologia , Nervo Tibial/patologia , Idoso , Estudos Transversais , Diabetes Mellitus Tipo 2/sangue , Neuropatias Diabéticas/sangue , Neuropatias Diabéticas/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Condução Nervosa/fisiologia , Nervo Fibular/diagnóstico por imagem , Estudos Prospectivos , Nervo Tibial/diagnóstico por imagem
7.
Arch Orthop Trauma Surg ; 139(7): 921-926, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30737594

RESUMO

INTRODUCTION: Injuries to the peroneal nerve are a common complication in operative treatment of proximal tibial or fibular fractures. To minimize the risk of iatrogenic injury to the nerve, detailed knowledge of the anatomy of the peroneal nerve is essential. Aim of this study was to present a detailed description of the position and branching of the peroneal nerve based on 3D-images to assist preparation for surgical approaches to the fibular head and the tibial plateau. METHODS: The common peroneal nerve, the deep and the superficial peroneal nerve were marked with a radiopaque thread in 18 formalin-embalmed specimens. Three-dimensional X-ray scans were then acquired from the knee and the proximal lower leg in full extension of the knee. In 3D-reconstructions of these scans, distances of the common peroneal nerve and its branches to clearly defined osseous landmarks were measured digitally. Furthermore, the height of the branching of the common peroneal nerve was measured in relation to the landmarks. RESULTS: The mean distance of the common peroneal nerve at the level of the tibial plateau to its posterior osseous limitation was 7.92 ± 2.42 mm, and 1.31 ± 2.63 mm to the lateral osseous limitation of the tibia. In a transversal plane, distance of the common peroneal nerve branching was 27.56 ± 3.98 mm relative to the level of the most proximal osseous extension of fibula and 11.77 ± 6.1 mm relative to the proximal extension of the tibial tuberosity. The deep peroneal nerve crossed the midline of the fibular shaft at a distance of 22.14 mm ± 4.35 distally to the most proximal extension of the fibula, the superficial peroneal nerve at a distance of 33.56 mm ± 6.68. CONCLUSION: As the course of the peroneal nerve is highly variable in between individuals, surgical dissection for operative treatment of proximal posterolateral tibial or fibular fractures has to be done carefully. We defined an area were the peroneal nerve and its branches are unlikely to be found. However, specific safe zones should not be utilized due to the individual anatomic variation.


Assuntos
Imagem Tridimensional/métodos , Perna (Membro) , Traumatismos dos Nervos Periféricos/prevenção & controle , Nervo Fibular , Radiografia/métodos , Idoso , Anatomia Regional/métodos , Cadáver , Feminino , Humanos , Complicações Intraoperatórias/prevenção & controle , Perna (Membro)/inervação , Perna (Membro)/cirurgia , Masculino , Procedimentos Ortopédicos/efeitos adversos , Procedimentos Ortopédicos/métodos , Traumatismos dos Nervos Periféricos/etiologia , Nervo Fibular/anatomia & histologia , Nervo Fibular/diagnóstico por imagem , Nervo Fibular/lesões
8.
Muscle Nerve ; 59(5): 587-590, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30680752

RESUMO

INTRODUCTION: Tangier disease (TD) is an autosomal recessive disorder characterized by severe reduction in high-density lipoprotein and accumulation of cholesterol esters in peripheral nerves and other tissues. The aim of this study was to evaluate whether nerve high-resolution ultrasonography (HRUS) can detect morphological nerve changes in TD. METHODS: Three related patients of a previously reported Italian family with Tangier disease, carrying the Y1698X mutation in ABCA1, underwent clinical, neurophysiological, and quantitative nerve HRUS evaluation. Nerve HRUS data were compared with normal controls. RESULTS: Despite neurophysiological abnormalities, no quantitative HRUS abnormality was detected in peripheral nerves. DISCUSSION: Normalcy of HRUS in neurophysiologically abnormal nerves suggests possible subtle abnormalities that escape quantitative HRUS detection. Systematic studies in larger TD cohorts with different mutations are needed to confirm our findings. Muscle Nerve 59:587-587, 2019.


Assuntos
Nervos Periféricos/diagnóstico por imagem , Doença de Tangier/diagnóstico por imagem , Transportador 1 de Cassete de Ligação de ATP/genética , Idoso , Plexo Braquial/diagnóstico por imagem , Plexo Braquial/fisiopatologia , Feminino , Humanos , Masculino , Nervo Mediano/diagnóstico por imagem , Nervo Mediano/fisiopatologia , Pessoa de Meia-Idade , Condução Nervosa , Nervos Periféricos/fisiopatologia , Nervo Fibular/diagnóstico por imagem , Nervo Fibular/fisiopatologia , Irmãos , Nervos Espinhais/diagnóstico por imagem , Nervos Espinhais/fisiopatologia , Doença de Tangier/fisiopatologia , Nervo Ulnar/diagnóstico por imagem , Nervo Ulnar/fisiopatologia , Ultrassonografia/métodos
9.
J Back Musculoskelet Rehabil ; 32(2): 361-365, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30664501

RESUMO

INTRODUCTION: Running is one of the most common sports practices in the world due to the beneficial impact on the health, despite the relatively high risk of getting injuries. In fact, running is one of the most common sports capable to induce overuse injuries of the lower back and leg. In previous studies, the symptoms in the lower limb have been attributed to lumbosacral degenerative pathology. When the symptoms are unclear, they must be studied with great attention by carrying out an accurate process of screening and differential diagnosis. MATERIALS AND METHODS: A 42-year-old non-competitive male runner who complained of left leg pain was referred to a physiotherapist. He reported a continuous, deep, sharp, shooting pain of the left leg. The symptoms began one year earlier. Symptoms worsened during prolonged driving and long distance running. The patient had been previously diagnosed with lumbar radicular irradiation in the leg by a general practitioner. Initial management, in another physical therapy outpatient setting, was without any improvement. RESULTS: After surgical excision, symptoms gradually regressed shortly and the patient was referred to a physiotherapist in order to fully recover and restore work and running activities. CONCLUSION: This case report describes the history, assessment and treatment of a runner with a rare cause of leg pain. After surgery excision, treatment focused on education and loading the tissues over many weeks through a graded program of loaded exercises and running retraining.


Assuntos
Neurilemoma/diagnóstico por imagem , Neoplasias do Sistema Nervoso Periférico/diagnóstico por imagem , Nervo Fibular/diagnóstico por imagem , Radiculopatia/diagnóstico , Adulto , Transtornos Traumáticos Cumulativos/diagnóstico , Exercício , Terapia por Exercício , Humanos , Região Lombossacral , Imagem por Ressonância Magnética , Masculino , Dor/etiologia , Corrida , Ultrassonografia
10.
Clin Anat ; 32(3): 390-395, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30536834

RESUMO

Regional anesthesia relies on a sound understanding of anatomy and the utility of ultrasound in identifying relevant structures. We assessed the ability to identify the point at which the superficial peroneal nerve (SPN) emerges through the deep fascia by ultrasound on 26 volunteers (mean age 27.85 years ± 13.186; equal male: female). This point was identified, characterized in relation to surrounding bony landmarks (lateral malleolus and head of the fibula), and compared to data from 16 formalin-fixed human cadavers (mean age 82.88 years ± 6.964; equal male: female). The SPN was identified bilaterally in all subjects. On ultrasound it was found to pierce the deep fascia of the leg at a point 0.31 (±0.066) of the way along a straight line from the lateral malleolus to the head of the fibula (LM-HF line). This occurred on or anterior to the line in all cases. Dissection of cadavers found this point to be 0.30 (±0.062) along the LM-HF line, with no statistically significant difference between the two groups (U = 764.000; exact two-tailed P = 0.534). It was always on or anterior to the LM-HF line, anterior by 0.74 cm (±0.624) on ultrasound and by 1.51 cm (±0.509) during dissection. This point was significantly further anterior to the LM-HF line in cadavers (U = 257.700, exact two-tailed P < 0.001). Dissection revealed the nerve to divide prior to emergence in 46.88% (n = 15) limbs, which was not identified on ultrasound (although not specifically assessed). Such information can guide clinicians when patient factors (e.g., obesity and peripheral edema) make ultrasound-guided nerve localization more technically challenging. Clin. Anat. 32:390-395, 2019. © 2019 Wiley Periodicals, Inc.


Assuntos
Tornozelo/inervação , Pé/inervação , Nervo Fibular/anatomia & histologia , Adulto , Idoso , Anestesia por Condução/métodos , Tornozelo/cirurgia , Cadáver , Dissecação , Fáscia/anatomia & histologia , Feminino , Fíbula/anatomia & histologia , Pé/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/prevenção & controle , Nervo Fibular/diagnóstico por imagem , Estatísticas não Paramétricas , Ultrassonografia , Adulto Jovem
11.
J Neurosurg ; 131(6): 1869-1875, 2018 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-30579281

RESUMO

The authors present the cases of 3 patients with severe injuries affecting the peroneal nerve combined with loss of tibialis posterior function (inversion) despite preservation of other tibial nerve function. Loss of tibialis posterior function is problematic, since transfer of the tibialis posterior tendon is arguably the best reconstructive option for foot drop, when available. Analysis of preoperative imaging studies correlated with operative findings and showed that the injuries, while predominantly to the common peroneal nerve, also affected the lateral portion of the tibial nerve/division near the sciatic nerve bifurcation. Sunderland's fascicular topographic maps demonstrate the localization of the fascicular bundle subserving the tibialis posterior to the area that corresponds to the injury. This has clinical significance in predicting injury patterns and potentially for treatment of these injuries. The lateral fibers of the tibial division/nerve may be vulnerable with long stretch injuries. Due to the importance of tibialis posterior function, it may be important to perform internal neurolysis of the tibial division/nerve in order to facilitate nerve action potential testing of these fascicles, ultimately performing split nerve graft repair when nerve action potentials are absent in this important portion of the tibial nerve.


Assuntos
Nervo Fibular/lesões , Nervo Fibular/cirurgia , Nervo Isquiático/lesões , Nervo Isquiático/cirurgia , Nervo Tibial/lesões , Nervo Tibial/cirurgia , Adulto , Humanos , Masculino , Músculo Esquelético/diagnóstico por imagem , Músculo Esquelético/inervação , Músculo Esquelético/cirurgia , Nervo Fibular/diagnóstico por imagem , Nervo Isquiático/diagnóstico por imagem , Nervo Tibial/diagnóstico por imagem , Adulto Jovem
12.
World Neurosurg ; 120: 112-116, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30172973

RESUMO

BACKGROUND: The purpose of this paper is to underline that the association of physical examination, electrophysiology, and ultrasound was crucial in identifying the correct disease and atypical characteristics of its presentation, in turn, providing proper information for both surgical treatment and a rehabilitation program. Fibular nerve compression is a common finding in the adult population, and it is more frequent at the fibular head. The clinical picture may be characterized by motor and/or sensory deficits. The same symptoms may sometimes be suggestive of root impairment. CASE DESCRIPTION: We report the case of a 39-year-old man who came to our laboratory with a diagnosis of multimetameric lumbosacral radiculopathy. The patient reported a history of ankle numbness and transient foot drop. Neurophysiologic examination showed peripheral axonal damage at tibialis anterior and lateral gastrocnemius muscles. A nerve ultrasound showed the presence of a conflict between a fibular exostosis and the fibular nerve. Furthermore, the fibular nerve presented an anatomic variation supplying the lateral gastrocnemius muscle. CONCLUSIONS: Ultrasound was crucial in recognizing the cause of the atypical presentation and avoiding a misdiagnosis. Also, it allowed the identification of the appropriate treatment and rehabilitation, as well as preventing irreversible nerve damage. As a result, critical information was presented to the surgeon for surgical treatment.


Assuntos
Eletromiografia , Síndromes de Compressão Nervosa/diagnóstico , Síndromes de Compressão Nervosa/etiologia , Nervo Fibular/patologia , Ultrassonografia , Adulto , Variação Anatômica , Humanos , Masculino , Síndromes de Compressão Nervosa/fisiopatologia , Síndromes de Compressão Nervosa/cirurgia , Nervo Fibular/diagnóstico por imagem , Nervo Fibular/fisiopatologia
13.
Anaesthesia ; 73(11): 1361-1367, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30184254

RESUMO

The volume-duration relationship using low concentrations of ropivacaine for peripheral nerve blocks is unknown, even though low concentrations of ropivacaine are increasingly used clinically. We investigated the effect of ropivacaine 0.2% on common peroneal nerve block duration. With ethical committee approval, 60 consenting, healthy volunteers were randomly allocated to receive one of five volumes of ropivacaine 0.2% (2.5, 5.0, 10, 15 or 20 ml) administered by ultrasound-guided, catheter-based injection (at 10 ml.min-1 ) near the common peroneal nerve. Our primary outcome was duration of sensory block, defined by insensitivity to a cold stimulus. Our secondary outcome was duration of motor block. Outcomes were assessed every hour from onset of block to complete remission. Intergroup differences were tested using one-way ANOVA followed by regression analyses using the 20 ml intervention group as reference. Block durations varied significantly (p < 0.0001) between groups. Mean (SD) sensory block durations were 9.2 (3.3), 12.5 (3.0), 15.5 (4.4), 17.3 (3.5) and 17.3 (4.6) h. Mean (SD) motor block durations were 3.3 (2.1), 7.2 (2.5), 9.2 (2.2), 12.7 (2.5) and 12.5 (2.5) h. Regression analysis showed that the effect of volume on block duration was progressively smaller with increasing volume, reaching a threshold volume above which there was no effect on nerve block duration (10 ml for sensory block and 15 ml for motor block). We conclude that there is a ceiling effect of increasing volume of ropivacaine 0.2% on both sensory and motor block duration of the common peroneal nerve.


Assuntos
Anestésicos Locais/farmacologia , Bloqueio Nervoso/métodos , Nervo Fibular/efeitos dos fármacos , Ropivacaina/farmacologia , Adulto , Anestésicos Locais/administração & dosagem , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Humanos , Masculino , Nervo Fibular/diagnóstico por imagem , Valores de Referência , Ropivacaina/administração & dosagem , Fatores de Tempo , Ultrassonografia de Intervenção , Adulto Jovem
15.
AJR Am J Roentgenol ; 211(4): 872-879, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30063375

RESUMO

OBJECTIVE: The objective of this study was to review the anatomy of the superficial peroneal nerve (SPN) and describe the sonographic appearances of various abnormalities affecting it. We performed a retrospective chart review of ultrasound (US) examinations of the SPN performed from 2014 to 2016. CONCLUSION: SPN abnormalities are well shown on US. Of 181 patients examined with US, the most commonly detected abnormality was scar encasement and neuroma or laceration.


Assuntos
Nervo Fibular/anormalidades , Nervo Fibular/diagnóstico por imagem , Ultrassonografia/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
16.
Acta Neurochir (Wien) ; 160(8): 1597-1601, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29948301

RESUMO

BACKGROUND: In 1915, when Delorme described three general requirements for successful nerve repair-(1) resecting scar until a healthy bed is secured, (2) excising damaged nerve until healthy stumps are reached, and (3) placing tension-free sutures, either by adequately mobilizing adjacent joints or nerve grafting-his work was heavily criticized. One century later, history has vindicated all but one of these claims. Flexing adjacent joints to avoid nerve grafts remains controversial, though this practice has increased in recent years. METHODS: An 11-year-old male suffered a penetrating domestic accident that resulted in complete foot drop. At surgery, a 6-cm gap was treated with direct nerve sutures, for which the knee was maintained in 60° flexion in a cast. To avoid damage to the nerve sutures, ultrasound and an intense, though cautious physiotherapy program were employed to guide the progression of knee extension. RESULTS: The patient started to show clear signs of peroneal motor function recovery within 3 months of surgical repair, and almost complete recovery by 4 months postoperatively. CONCLUSIONS: Using physiotherapy and ultrasound might validate the classic joint-flexion technique in select patients with lower-limb nerve injuries.


Assuntos
Procedimentos Neurocirúrgicos/métodos , Neuropatias Fibulares/terapia , Modalidades de Fisioterapia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Ultrassonografia/métodos , Criança , Humanos , Masculino , Nervo Fibular/diagnóstico por imagem , Nervo Fibular/cirurgia , Neuropatias Fibulares/diagnóstico por imagem , Neuropatias Fibulares/cirurgia , Amplitude de Movimento Articular , Recuperação de Função Fisiológica
17.
Vet Anaesth Analg ; 45(4): 566-574, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29793780

RESUMO

OBJECTIVE: To evaluate an ultrasound-guided technique for adductor canal (AC) block by describing the distribution of methylene blue around the AC, popliteal fossa, saphenous, tibial and common fibular nerves in dog cadavers. STUDY DESIGN: Prospective experimental trial. ANIMALS: Ten mixed breed canine cadavers weighing 28.55 ± 3.94 kg. METHODS: Ultrasound scans of the AC were performed bilaterally in 10 canine cadavers. A high-frequency linear transducer was placed on the long axis of the pectineus muscle and using an in-plane technique, an insulated needle was introduced at a proximal to distal direction into the AC. Methylene blue 0.1% (0.3 mL kg-1) was administered followed by dissection. The presence of dye over the target nerves for ≥2 cm was considered successful distribution. Three of 10 cadavers were submitted to computed tomography (CT) and one of them to magnetic resonance (MR) evaluation. RESULTS: Methylene blue reached the AC in 20 (100%) and the popliteal fossa in 17 (85%) pelvic limbs. Staining was successful in the saphenous nerve (4.0 ± 1.57 cm) in 11 (55%) limbs, tibial nerve (2.65 ± 0.8 cm) in six (30%) and common fibular nerve (2.7 ± 0.9 cm) in four (20%). There was no evidence of staining around the motor branches of the femoral nerve. No intraneural or intravascular dye spread was found during dissections. Contrast distribution to the popliteal fossa was observed in three limbs (50%) in CT and in one (50%) MR image. CONCLUSIONS AND CLINICAL RELEVANCE: Although the tibial and common fibular nerves were not stained as often as the saphenous nerve, dye was encountered throughout the popliteal fossa near the nerves. The AC block may be useful for intra and postoperative analgesia in stifle surgery with minimal femoral motor dysfunction. However, further study is required to confirm its efficacy and safety in vivo.


Assuntos
Bloqueio Nervoso/veterinária , Ultrassonografia de Intervenção/veterinária , Animais , Cães , Feminino , Extremidade Inferior/diagnóstico por imagem , Extremidade Inferior/inervação , Masculino , Bloqueio Nervoso/métodos , Nervo Fibular/diagnóstico por imagem , Nervo Tibial/diagnóstico por imagem , Ultrassonografia de Intervenção/métodos
18.
Sci Rep ; 8(1): 7812, 2018 05 17.
Artigo em Inglês | MEDLINE | ID: mdl-29773868

RESUMO

The purpose of this study was to evaluate peripheral neural impairment in leprosy patients by ultrasonography (US). The cross-sectional areas (CSAs) of the median (M), ulnar (U) and common fibular (CF) nerves were compared in 71 leprosy patients and 29 healthy controls, and the data were analyzed between the leprosy, multibacillary (MB)/paucibacillary (PB), reaction (R)/no reaction (NR), disability (D)/no disability (ND), and longer/shorter duration groups after treatment. We found that for the nerves located in upper limbs, the CSAs were significantly increased in the leprosy patients vs the controls; the PB group vs the MB group; the R group vs the NR group; the ND group vs the D group; and the longer duration group vs the shorter duration group at some positions of the M nerve and U nerve. In contrast, for the nerves located in lower limbs, the CSAs were significantly reduced in the leprosy patients vs the controls and in the longer duration group vs the shorter duration group at some positions of the CF nerve. This result indicated that nerve enlargement and neuratrophy coexist in leprosy patients.


Assuntos
Hanseníase/diagnóstico por imagem , Doenças do Sistema Nervoso Periférico/diagnóstico por imagem , Nervos Espinhais/diagnóstico por imagem , Idoso , Feminino , Humanos , Hanseníase/complicações , Masculino , Nervo Mediano/diagnóstico por imagem , Pessoa de Meia-Idade , Doenças do Sistema Nervoso Periférico/complicações , Nervo Fibular/diagnóstico por imagem , Nervo Ulnar/diagnóstico por imagem
20.
Sci Rep ; 8(1): 3219, 2018 02 19.
Artigo em Inglês | MEDLINE | ID: mdl-29459701

RESUMO

Current neural interfaces are hampered by lack of specificity and selectivity for neural interrogation. A method that might improve these interfaces is an optical peripheral nerve interface which communicates with individual axons via optogenetic reporters. To determine the feasibility of such an interface, we delivered the genetically encoded calcium indicator GCaMP6f to the mouse peripheral nerve by intramuscular injection of adenoassociated viral vector (AAV1) under the control of the CAG (chicken beta actin- cytomegalovirus hybrid promoter). Small diameter axons in the common peroneal nerve were transduced and demonstrated electrically inducible calcium transients ex vivo. Responses to single electrical stimuli were resolvable, and increasing the number of stimuli resulted in a monotonic increase in maximum fluorescence and a prolongation of calcium transient kinetics. This work demonstrates the viability of using a virally-delivered, genetically-encoded calcium indicator to read-out from peripheral nerve axons.


Assuntos
Técnicas Biossensoriais/métodos , Fenômenos Eletrofisiológicos , Optogenética/métodos , Nervo Fibular/diagnóstico por imagem , Nervo Fibular/fisiologia , Animais , Sinalização do Cálcio , Dependovirus/genética , Fluorescência , Genes Reporter , Vetores Genéticos , Injeções Intramusculares , Camundongos , Transdução Genética
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