Median Nerve Compression Caused by Brachial Pseudoaneurysm: Report of Two Cases and Review of the Literature

Abstract

).Median nerve neurapraxia associated with direct traumatic vascular injury to the brachial artery is extremely low. Brachial pseudoaneurysm could result in compression and elongation of the nerve leading to an ischemic injury. An early diagnosis of these injuries is essential to avoid complications and an improved prognosis could be expected under the correct management.A 46-year-old man, who was initially admitted to a tertiary hospital with a metal splinter penetrating injury at the elbow, was referred to our clinic 2 weeks later with swelling in the elbow and hypoesthesia in the second and third fingers. Electromyography confirmed an incomplete neuropathy of the median nerve and Doppler study revealed a 6 Â 4 cm brachial artery pseudoaneurysm. Operative finding showed a 10 Â 8 mm defect on the posterior medial wall of the brachial artery, which communicated with a large cavity containing a hematoma where the median nerve was clearly compressed (►Fig. 1). The thrombus was evacuated with extraction of the metal fragment and the injured arterial segment resected. Arterial flow was restored through end-to-end anastomosis. Three months after surgery full recovery was noted.The second patient, a 36-year-old man developed tingling sensation and paraesthesias over the thumb and index finger 1 week after suffering a stab wound over the left mid-arm. Electromyography showed a partial axonal injury of the median nerve with denervation of the flexor digitorum profundus of the index finger and the flexor pollicis longus. A 7 Â 5 cm pseudoaneurysm communicating with the distal portion of the brachial artery with displacement of the median nerve was observed by color Doppler. The injured arterial wall was resected and end-to-end anastomosis was

Iatrogenic brachial artery pseudoaneurysm causing median nerve compression neuropraxia diagnosed and compression therapy ultrasonography: A rarest case image

“…MN neuropraxia associated with post iatrogenic vascular injury to the brachial artery is very low and is a degraded complication. Brachial PNA could result in compression of the MN in the arm leading to an ischemic injury [4]. In this case, the patient was presented with pain and erythema of the left upper arm.…”

Pseudoaneurisma traumático em artéria braquial após retirada de implante contraceptivo subdérmico

“…These complications can progress to conditions such as hemorrhagic rupture, compression of nerves and veins, formation of significant edema that restricts distal perfusion, and localized necrosis of the skin because of ischemia. 1,2,4,5 Pseudoaneurysms measuring 2 cm or less tend to be asymptomatic. The majority of symptomatic cases present with pulsating masses.…”

“…Other factors include advanced age, female sex, and elevated body mass index (BMI). 2,4,5 Implanting or explanting subdermal contraceptive devices can increase the frequency of vascular and neurological injuries. 3 Insertion and later removal of these implants is within the expertise expected of a specialist.…”

“…If presence of injury to the median nerve is confirmed, the patient should be operated on immediately, to avoid development of permanent neurological sequelae with consequent manual dysfunction. 2,4,5 The preference for local anesthesia and conscious sedation is because of the need to conduct an intraoperative neurological assessment, after decompression of the pseudoaneurysm, and also because of sufficient access to obtain proximal and distal control of the brachial artery in the arm, which would have enabled us to extent the approach if necessary.…”

Compressive median neuropathy caused by brachial artery pseudoaneurysm

“…[ 2 ] Although neurologic symptoms are common in patients undergoing hemodialysis, direct nerve compression by large PSA is rare. [ 3 - 10 ] We report a case of median nerve compression by a brachial artery PSA treated by PSA resection and distal nerve transfer.…”