A bifid median nerve occurs relatively frequently in patients with CTS. It may facilitate compression of the median nerve in the carpal tunnel because of its relatively higher cross-sectional area compared with a nonbifid median nerve. The size criterion for CTS in patients with a bifid median nerve is slightly higher than in those with a nonbifid median nerve.

The aim of this study was to determine the diagnostic value of ultrasonographic measurements in ulnar neuropathy at the elbow (UNE) and to assess the relationship between the measurements and the electrophysiological severity. The largest anteroposterior diameter (LAPD) and cross-sectional area (CSA) measurements of the ulnar nerve were noted at multiple levels along the arm, and the distal-to-proximal ratios were calculated. Almost all of the measurements and swelling ratios between patients and controls showed statistically significant differences. The largest CSA, distal/largest CSA ratio, CSA at the epicondyle, and proximal LAPD had larger areas under the curve than other measurements. The sensitivity and specificity in diagnosing UNE were 95% and 71% for the largest CSA, 83% and 85% for the distal/largest CSA ratio, 83% and 81% for the CSA at the epicondyle, and 93% and 43% for the proximal LAPD, respectively. There was a statistically significant correlation between the electrophysiological severity scale score (ESSS) and the largest CSA, the CSA at the epicondyle and 2 cm proximal to the epicondyle, and the LAPD at the level of the epicondyle (P < 0.05). None of the swelling ratios showed a significant correlation with the ESSS. The largest CSA measurement is the most valuable ultrasonographic measurement both for diagnosis and determining the severity of UNE.

Our study shows that Doppler ultrasonography results strongly correlate with CTS severity. Hence, this is a useful method for diagnosing CTS and estimating its severity.

The purpose of this study was to document the ultrasonographic measurement differences in median nerve size between patients with carpal tunnel syndrome (CTS) and controls, and to correlate these findings with electrophysiological stage and motor unit number estimation (MUNE), thereby allowing us to test the validity of ultrasound as a diagnostic modality for assessing the severity of CTS. High-resolution sonography and electrophysiological studies were performed on 41 wrists of 27 patients and compared with findings on 40 wrists of 20 healthy individuals. On ultrasonographic views, cross-sectional area and flattening ratio in proximal, middle, and distal tunnel segments of the median nerve were measured both by calculating ellipsoid area by large and small cross-sectional diameters and by automated ellipsoid area calculation. We compared electrophysiological stage and MUNE with proximal, middle, and distal cross-sectional area and other ultrasonographic findings. All correlations between electrophysiological stage and cross-sectional areas in these different segments of the median nerve were significant with both measurement methods. Negative correlations were seen between MUNE and cross-sectional area in the proximal and middle segments, whereas no significant correlation was detected in the distal segment. Our results indicate that there are close correlations between the ultrasonographic findings and electrophysiological stage. Ultrasound also reflects the reduction in the number of axons estimated by the MUNE method. Therefore, we suggest that the ultrasonographic findings reflect the severity of disease in patients with CTS.

No abstract

The aim of this study was to determine the sensitivity of sympathetic skin response (SSR) in evaluating autonomic involvement in carpal tunnel syndrome (CTS) while simultaneously showing the axonal loss by motor unit number estimation (MUNE). Bilateral SSR were recorded by suprasternal stimulus in 50 hands of 31 patients and compared with 50 hands of 25 healthy volunteers. The groups were examined for sympathetic symptoms and sympathetic symptom scores (SSS) were determined. Axon count was performed on the abductor pollicis brevis (APB) muscle by using the MUNE method (with incremental technique) in both groups. There was no SSR difference between groups, although a significant difference was found for SSS. No relationships were found between SSR parameters and SSS or the electrophysiologic stage. MUNE of the APB muscle was significantly lower in CTS group and there was a negative correlation between MUNE and the electrophysiologic stage. The comparison of the MUNE and the amplitude of median compound muscle action potential indicated that MUNE is a highly sensitive method of determining severity in patients with CTS. In evaluating autonomic involvement in CTS, SSR does not seem to be a sensitive method. MUNE is a good indicator of motor reserve and can be helpful when following the treatment and prognosis of CTS in clinical practice.

Vincristine is a commonly used antineoplastic drug and frequently causes neurotoxicity. Here the authors report a 4-year-old boy with acute lymphoblastic leukemia in whom vincristine-induced peripheral and cranial neuropathy developed during remission induction therapy. The patient seemed to benefit from pyridoxine and pyridostigmine therapy greatly and this therapy is recommended in patients with severe vincristine-induced neuropathy.

Introduction Peroneal neuropathy is one of the most common mononeuropathies in the lower extremities and usually occurs at the fibular head where the nerve is superficial and vulnerable to injury. Peroneal neuropathy at the fibular head (PNFH) can result from a variety of conditions such as trauma, traction injuries, masses, entrapment, and external compression from prolonged immobilization. Patients with PNFH usually have weak toe and ankle dorsiflexion, weak foot eversion, and numbness over the lower lateral calf and the dorsum of the foot. Therefore, patients with sciatic neuropathy, lumbosacral plexopathy, or L5 radiculopathy may present a similar clinical pattern and differentiating PNFH from these conditions may sometimes be difficult (1,2). The diagnosis of PNFH is based on clinical findings and electrophysiological studies. Electrophysiological evaluation is usually adequate for the diagnosis of PNFH. However, additional tests may be required, especially in nonlocalizing peroneal nerve lesions with severe axonal loss. Although ultrasonography has proven to be useful in entrapment neuropathies of the upper extremities (3,4), there are few studies that investigated the validity of ultrasonography in the diagnosis of PNFH (5-8). In this study, we analyzed ultrasonographic findings in patients with PNFH and evaluated the efficiency of ultrasonography in the diagnosis of PNFH. 2. Materials and methods 2.1. Patients and controls This study included 15 peroneal nerves of 12 patients with PNFH and 24 peroneal nerves of 12 healthy controls. Three patients had PNFH bilaterally. The inclusion criteria were based on both clinical and electrophysiological findings. To make the clinical diagnosis, we looked for weak toe and ankle dorsiflexion, weak foot eversion, and sensory loss over the lateral calf and the dorsum of the foot. Local pain or Tinel's sign may also be present at the fibular head. Patients with any symptoms of polyneuropathy were excluded from the study. Patients with diseases related to polyneuropathy, hypothyroidism, diabetes mellitus, amyloidosis rheumatoid arthritis, or pregnancy were also excluded from the study. Histories of acute trauma, peroneal surgery, and duration of symptoms longer than Background/aim: Peroneal neuropathy at the fibular head (PNFH) is one of the most common entrapment neuropathies. Our aim in this study was to analyze the efficiency of ultrasonography in the diagnosis of PNFH. Materials and methods: The study included 15 peroneal nerves of 12 patients with PNFH and 24 peroneal nerves of 12 healthy controls. PNFH confirmation was based on clinical and electrophysiological findings. All patients and controls underwent ultrasonographic evaluations for peroneal nerves. The cross-sectional area (CSA) was measured. Echogenicity of the nerve was evaluated by comparing it with the adjacent connective tissue deep under the subcutaneous fat. Results: CSA measurement of the peroneal nerve is a valuable diagnostic tool in predicting PNFH (AUC: 0.87, 95% CI: 0.73-1.00, P < 0.01). The CSA ...