Sep diagnosing neurophaty of the lateral cutaneous branch of the iliohypogastric nerve: case report

Abstract

-The article pertains to the uncommon clinical case of a patient with a proximal neuropathy of the lower extremity. It outlines the electrophysiological evaluation and reviews the medical literature. The electrophysiologic test that most accurately revealed the neuropathy was the segmental somatosensory evoked potential (SEP) of the lateral cutaneous branch of the iliohypogastric nerve. It showed well-defined and replicable cortical waveforms following the excitation of the lateral cutaneous branch of the iliohypogastric nerve in the asymptomatic lower extremity, but failed to present somatosensory evoked potentials arising from the excitation of the contralateral nerve in the symptomatic lower extremity. We did not find any previous reports diagnosing that particular pathology by the use of segmental SEP. In conclusion, it is important to remember that the accurate diagnosis of patients complaining of pain and dysesthesia in the proximal part of the lower extremities can possibly be achieved through the use of electrophysiologic tests such as the segmental SEP.KEY WORDS: neuropathy, nerve injury, nerve entrapment, iliohypogastric nerve, somatosensory evoked potential. Neuropatia do ramo cutâneo lateral do nervo ílio-hipogástrico diagnosticada por PES: relato de casoRESUMO -O presente artigo relata caso clínico incomum de neuropatia proximal de membro inferior, demonstra eletrofisiologicamente o comprometimento neural e revisa a literatura médica sobre o assunto. O teste neurofisiológico que demonstrou a patologia foi o potencial evocado somato-sensitivo (PES) segmentar do ramo cutâneo lateral do nervo ílio-hipogástrico. Ele revelou potenciais corticais bem definidos e replicáveis à estimulação do membro inferior assintomático, mas falhou em produzir respostas corticais do membro inferior sintomático. Na revisão da literatura não foi encontrado nenhum relato anterior de diagnós-tico dessa patologia por PES segmentar. Conclui-se que é importante ter em mente ao avaliar pacientes com queixas de dor e disestesia na base dos membros inferiores que o acometimento de pequenos ramos cutâneos, como o cutâneo lateral do ílio-hipogástrico, pode ter confirmação eletrofisiológica da patologia por testes neurofisiológicos como o potencial evocado somato-sensitivo segmentar.PALAVRAS-CHAVE: neuropatia, nervo ílio-hipogástrico, potencial evocado somato-sensitivo.Proximal neuropathies of the lower extremities, with the exception of the lateral femoral cutaneous neuropathy, are uncommon causes of pain and paresthesia 1 . As such, these pathologies can often present a diagnostic challenge for the physician. There are several proximal neural branches of the lower extremities that can suffer nerve entrapment: the cluneal, the lateral cutaneous branch of the iliohypogastric and the subcostal 2,3 . This paper references one specific neuropathy that affects the lateral cutaneous branch of the iliohypogastric nerve, as revealed by the segmental somatosensory evoked potential (SEP).Review of anatomy -The iliohypogastric nerve is...

Sensate superficial inferior epigastric artery flap innervated by the iliohypogastric nerve for reconstruction of a finger soft tissue defect

“…Although only the IHN was used for innervation of the SIEA flap, it would be theoretically possible for a SIEA flap to be innervated by the T12 nerve; since a skin flap had to be changed from a SCIP flap to a SIEA flap due to hypoplastic SIEA, only the IHN happened to be found and included during elevation of the SIEA flap, and the T12 nerve was not intended to be included in the flap . Although not entirely dissected to confirm the course, the IHN anterior branch included in the flap seemed to run through the rectus abdominis muscle horizontally to a medial and a lateral direction as shown in Figure , . As demonstrated in the postoperative sensory recovery, the IHN seemed to innervate only the proximal portion of the SIEA flap; sensory recovery of the proximal portion of the SIEA flap where the IHN was supposed to innervate was significantly better than that of the distal portion where the T12 nerve was supposed to innervate.…”

“…Since a SCIP flap has many advantages and is well investigated regarding its vascular anatomy, we think that a SCIP flap is the first choice to elevate a flap in the groin region . When a SCIP flap cannot be raised due to hypoplasia of the SCIA, a SIEA flap should be used not to add additional donor scar at another site, and a surgeon should try to include the IHN in a SIEA flap if a sensate flap is required …”

“…[1][2][3][4] When a SCIP flap cannot be raised due to hypoplasia of the SCIA, a SIEA flap should be used not to add additional donor scar at another site, and a surgeon should try to include the IHN in a SIEA flap if a sensate flap is required. 2,5,9 Since functional preservation and restoration is the most important for hand reconstruction, a surgeon should consider well which is better for hand function as a whole to reconstruct or to amputate the ring finger with severe soft tissue injury. In this case, only the volar aspect of the ring finger was completely necrotized, and functional recovery was expected after soft tissue reconstruction.…”

Syndromes canalaires des nerfs ilio-hypogastriques, ilio-inguinaux, génitofémoraux, obturateurs et pudendal

“…Toutefois la douleur peut aussi survenir des mois ou plusieurs années après la chirurgie [4] (dans 13/23 cas, dont neuf après un intervalle libre d'au moins quatre ans [7]). Le diagnostic peut être facilité par l'abolition des potentiels somatosensitifs évoqués à partir de la branche cutanée du nerf ilio-hypogastrique [8], technique qui pourrait être plus performante que l'EMG. En effet, chez 41 patients suspects d'un syndrome canalaire des nerfs ilio-hypogastriqueilioinguinaux, l'EMG n'était anormal que chez 15 des 25 patients chez qui le diagnostic était déjà certain (et a été confirmé par la chirurgie), et dans seulement 6/16 cas où le diagnostic était encore douteux [9].…”