Acute Median Nerve Compression at the Distal Forearm Caused by a Thrombosed Aneurysm of an Epineural Vessel: Case Report

Abstract

The case of a patient with a 2-day history of symptoms suggesting acute carpal tunnel syndrome is presented. However, an urgent electroneurographic examination revealed median nerve compression at the forearm and magnetic resonance imaging confirmed compression by a mass proximal to the carpal tunnel. Surgical exploration showed a recently thrombosed aneurysm of an epineural vessel. Histological and, later, general and angiological investigations could not reveal the underlying cause of this aneurysm. Preoperative electrodiagnostic examination is recommended in acute peripheral nerve compression to prevent decompression at an incorrect site. If atypical nerve compression is suspected, magnetic resonance imaging may be indicated to detect localized nerve compression and its underlying cause.

Acute carpal tunnel syndrome from burns of the hand and wrist

“…Phelan contributed much to the present understanding of the etiology, diagnosis and management of this syndrome (2). Carpal tunnel syndrome is associated with acute pyogenic infection, Hansen's disease, spontaneous hemorrhage, thrombosis of persistent median artery, foreign body, gout, pseudogout and aneurysms of the epineural vessels (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). When intracarpal canal interstitial pressure rises above a critical threshold pressure, capillary blood flow is reduced below the level required for median nerve viability.…”

Compression neuropathy of the median nerve during tissue expansion of the forearm

“…When intra-compartmental pressure rises above a critical threshold pressure, capillary blood flow is reduced below the level required for median nerve viability. This can occur from bleeding, a foreign body in the compartment, or thrombosis of the median artery or epineural vessels (2)(3)(4)(5). Although several conditions are associated with compression neuropathy of the median nerve, acute carpal tunnel syndrome is the most common neuropathy of the median nerve.…”

Compression Neuropathy of the Median Nerve During Tissue Expansion of the Forearm

“…When intra-compartmental pressure rises above a critical threshold pressure, capillary blood flow is reduced below the level required for median nerve viability. This can occur from bleeding, a foreign body in the compartment, or thrombosis of the median artery or epineural vessels (2)(3)(4)(5). Although several conditions are associated with compression neuropathy of the median nerve, acute carpal tunnel syndrome is the most common neuropathy of the median nerve.…”