Sciatic schwannoma of the thigh causing foot pain mimicking plantar neuropathy

Gominak, Stasha; Ochoa, José L.

doi:10.1002/(sici)1097-4598(199804)21:4<528::aid-mus12>3.0.co;2-t

Cited by 25 publications

(9 citation statements)

References 12 publications

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“…Partial traumatic lesions have been observed to cause a fascicular lesion pattern not affecting the entire nerve [22]. In individual cases, small intraneural nerve sheath tumors have been observed to mimic more distal lesions by selectively involving only one or a few fascicles [23], [24], [25]. Restricted affection of an individual fascicle by a more disseminated neuropathy has long been deduced by neurologists by clinical experience [7] but has to our knowledge previously not been confirmed by imaging.…”

Section: Discussionmentioning

confidence: 99%

MR Neurography in Ulnar Neuropathy as Surrogate Parameter for the Presence of Disseminated Neuropathy

et al. 2012

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PurposePatients with ulnar neuropathy of unclear etiology occasionally present with lesion extension from elbow to upper arm level on MRI. This study investigated whether MRI thereby distinguishes multifocal neuropathy from focal-compressive neuropathy at the elbow.MethodsThis prospective study was approved by the institutional ethics committee and written informed consent was obtained from all participants. 122 patients with ulnar mononeuropathy of undetermined localization and etiology by clinical and electrophysiological examination were assessed by MRI at upper arm and elbow level using T2-weighted fat-saturated sequences at 3T. Twenty-one patients were identified with proximal ulnar nerve lesions and evaluated for findings suggestive of disseminated neuropathy (i) subclinical lesions in other nerves, (ii) unfavorable outcome after previous decompressive elbow surgery, and (iii) subsequent diagnosis of inflammatory or other disseminated neuropathy. Two groups served as controls for quantitative analysis of nerve-to-muscle signal intensity ratios: 20 subjects with typical focal ulnar neuropathy at the elbow and 20 healthy subjects.ResultsIn the group of 21 patients with proximal ulnar nerve lesion extension, T2-w ulnar nerve signal was significantly (p<0.001) higher at upper arm level than in both control groups. A cut-off value of 1.92 for maximum nerve-to-muscle signal intensity ratio was found to be sensitive (86%) and specific (100%) to discriminate this group. Ten patients (48%) exhibited additional T2-w lesions in the median and/or radial nerve. Another ten (48%) had previously undergone elbow surgery without satisfying outcome. Clinical follow-up was available in 15 (71%) and revealed definitive diagnoses of multifocal neuropathy of various etiologies in four patients. In another eight, diagnoses could not yet be considered definitive but were consistent with multifocal neuropathy.ConclusionProximal ulnar nerve T2 lesions at upper arm level are detected by MRI and indicate the presence of a non-focal disseminated neuropathy instead of a focal compressive neuropathy.

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Section: Discussionmentioning

confidence: 99%

MR Neurography in Ulnar Neuropathy as Surrogate Parameter for the Presence of Disseminated Neuropathy

et al. 2012

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“…These cases were reported by Wiles et al in 1987 [13], Persing et al in 1988 [7] and Gominak and Ochoa in 1998 [3]. Many patients with tarsal tunnel syndrome do not have the subjective signs including electrodiagnostic studies, physical examinations, and radiographic findings, with the exception of a positive Tinel's sign [8].…”

Section: Letter To the Editorsmentioning

confidence: 92%

Tarsal tunnel syndrome caused by synovial sarcoma

Yamamoto¹,

Mizuno²

2001

Journal of Neurology

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“…Les déficits sensitifs et moteurs sont rares. Parfois, la douleur fait évoquer un tableau de compression du sciatique poplité externe ou un syndrome du tunnel tarsien, conduisant parfois à tort à la chirurgie [4]. Le délai entre le début des douleurs et le diagnostic est souvent long, variable en fonction de la localisation, jusqu'à une dizaine d'année, du fait de l'errance vers d'autres diagnostics plus fréquents, voire par l'évocation d'une douleur psychogène devant la normalité de l'ensemble des examens complémentaires.…”

Section: Les Commentairesunclassified

“…Dans une étude portant sur 25 schwannomes du nerf tibial, le délai diagnostique est en moyenne de 86 mois avec des extrêmes allant de 2 à 360 mois [5]. D'autres auteurs rapportent également deux patients ayant une douleur du pied évoluant respectivement depuis 4 et 5 ans avant le diagnostic de schwannome du nerf sciatique de la cuisse [4]. Concernant l'imagerie, l'échographie permet d'affirmer rapidement la présence d'une masse excentrée sur le trajet du nerf.…”

Section: Les Commentairesunclassified