Adult‐onset lower extremity weakness caused by venous malformation detected by magnetic resonance imaging

French, Kris F.; Sanders, Kent; Chin, Steve S.; Bromberg, Mark B.

doi:10.1002/mus.23359

Cited by 3 publications

(3 citation statements)

References 15 publications

(20 reference statements)

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“…Therefore, we advise that MRI findings of nerve involvement are an indication for additional neurological examination to prevent aggravation of pain or neurological deficits. Since multiple case reports indicate that nerve-associated vascular anomalies may have an effect on electromyographic findings 8 , 23 , we anticipate that further research in this field is necessary.…”

Section: Discussionmentioning

confidence: 99%

MR imaging of venous malformations: sciatic nerve infiltration patterns and involved muscle groups

Goldann

Helm

Uller

et al. 2020

Sci Rep

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The aim of this retrospective cross-sectional study was to provide an MRI-based examination framework of venous malformations (VMs) infiltrating the sciatic nerve and determine the frequency of nerve infiltration patterns and muscle involvement in correlation to the patients' quality of life. Pelvic and lower limb MR images of 378 patients with vascular malformations were examined retrospectively. Pain levels and restriction of motion were evaluated with a questionnaire. Crosssectional areas of affected nerves were compared at standardized anatomical landmarks. Intraneural infiltration patterns and involvement of muscles surrounding the sciatic nerve were documented. Sciatic nerve infiltration occurred in 23/299 patients (7.7%) with VM. In all cases (23/23; 100%), gluteal or hamstring muscles surrounding the nerve were affected by the VM. Infiltrated nerves were enlarged and showed signal alterations (T2-hyperintensity) compared to the unaffected side. Enlarged nerve cross-sectional areas were associated with elevated pain levels. Three nerve infiltration patterns were observed: subepineurial (12/23; 52.2%), subparaneurial (6/23; 26.1%) and combined (5/23; 21.7%) infiltration. This study provides a clinically relevant assessment for sciatic nerve infiltration patterns and muscle involvement of VMs, while suggesting that VMs in gluteal and hamstring muscles require closer investigation of the sciatic nerve by the radiologist. Abbreviations VM Venous malformation ISSVA International society for the study of vascular anomalies VMCM Cutaneomucosal venous malformation CLVM Capillary-lymphatic-venous malformation STIR Short tau inversion recovery TSE Turbo spin echo TWIST Time-resolved angiography with interleaved stochastic trajectories Vascular anomalies of the lower limb are an uncommon diagnosis, which begins with an early onset in childhood or adolescence. These anomalies are congenital, grow at the same rate as the child and do not regress over time 1. The diagnosis is primarily made based upon physical examination and the patient's history of malformations with subcutaneous parts. However, imaging with ultrasonography and magnetic resonance imaging (MRI) plays an important role in confirming the diagnosis, as well as evaluating the size and extent of the malformation, because physical examinations tend to underestimate these factors 2. Deeply seated malformations without subcutaneous portions may only be detectable in MR images.

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Section: Discussionmentioning

confidence: 99%

MR imaging of venous malformations: sciatic nerve infiltration patterns and involved muscle groups

Goldann

Helm

Uller

et al. 2020

Sci Rep

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“…18 French et al described a similar case who presented a several-year history of slowly progressive atrophy and weakness in the right lower extremity, which gradually increased to a limp without reporting pain. 25 Finally, MRI demonstrated a VM in the right gastrocnemius muscle.…”

Section: Possible Aetiology Of Equinus Associated With Vmsmentioning

confidence: 95%

Operative management of equinus associated with lower limb venous malformations

Chen

Yang

et al. 2021

Phlebology

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Objectives Functional impairment is a common complaint in patients with venous malformations. Equinus can occur when the venous malformation involves the lower limb, a challenging condition with only a few studies to guide treatment choices. This study was aimed to investigate the operative management of equinus associated with lower limb venous malformations. Method Between August 2015 and September 2017, a total of 12 patients presented with equinus associated with lower limb venous malformations and underwent surgical correction. Preoperative and postoperative clinical symptoms, physical examination and orthopaedic evaluation were retrospectively reviewed. 8 patients who experienced pain underwent percutaneous sclerotherapy prior to the operation. Surgical management included gastrocnemius intramuscular aponeurotic recession, Z-lengthening of the Achilles tendon, Hoke technique and Taylor Spatial Frame external fixation. Results There were eight female and four male patients with a mean age of 14.3 ± 5.9 years. The mean follow-up period was 34.8 ± 9 months. The range of motion of ankle dorsiflexion (with knee extended) improved for each patient (mean, 25.4 degrees; standard deviation, 8.5 degrees). No neurovascular complications were observed. Conclusion Operative correction of equinus associated with lower limb venous malformations is safe and effective. Selective preoperative sclerotherapy is necessary for optimal outcomes.

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“… 3 4 5 Moreover, some cases of intramuscular VM manifest as motor weakness and muscle atrophy. 6 However, these symptoms are also present in other diseases, such as musculoskeletal disease. These characteristics make it difficult to diagnose intramuscular VM in the absence of superficial lesions.…”

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confidence: 99%

A Case of Focal Myopathy With Neuropathy Caused by Intramuscular Vascular Malformation

et al. 2023

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Adult‐onset lower extremity weakness caused by venous malformation detected by magnetic resonance imaging

Abstract: This case represents a rare cause of atrophic weakness in adults, but muscle MRI should be considered when other tests are equivocal.

Cited by 3 publications

References 15 publications

MR imaging of venous malformations: sciatic nerve infiltration patterns and involved muscle groups

MR imaging of venous malformations: sciatic nerve infiltration patterns and involved muscle groups

Operative management of equinus associated with lower limb venous malformations

A Case of Focal Myopathy With Neuropathy Caused by Intramuscular Vascular Malformation

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