Spontaneous intraneural hematoma of the common fibular nerve due to oral anticoagulation

Abstract

Compression syndromes affecting the common fibular nerve are common and frequently caused by direct pressure upon the fibular tip region. Here, we describe a case of a 50-year-old male presenting with sudden foot drop, which had developed spontaneously. He was on oral anticoagulants due to hereditary thrombophilia (factor-V-Leiden). Neurophysiology examination revealed a common peroneal nerve lesion at the fibular tip. T1-weighted magnetic resonance imaging (MRI) showed a not further classifiable hyperintensity within the common peroneal nerve. Surgical exploration revealed a diffuse intraneural hematoma, which was not evacuated. During follow-up, the nerve function recovered almost completely. In retrospect, MRI findings indicated a hematoma supported by the history of anticoagulant medication.

A Rare Atypical Case of Asymptomatic and Spontaneous Intraneural Hematoma of Sural Nerve: A Case Report and Literature Review

“…There are some case reports without surgical excision of intraneural hematoma. Schwab et al 15 reported surgical exploration of intraneural hematoma without evacuation, due to diffuse spreading of hematoma with no relevant thickening of nerve. However, in most of intraneural hematoma, surgical evacuation was performed with good neurological outcomes.…”

Ultrasonographic diagnosis of intraneural hemorrhage of the sciatic nerve

“…The scenario has been reported previously for different nerves due to either traumatic/ iatrogenic events (e.g., nerve injections) or in patients with underlying coagulopathy and antiplateletanticoagulant therapies. [1][2][3] The intraneural hemorrhage may be responsible for excessive pressure inside the epifascicular epineurium covering the sciatic nerve. Intra-neural high pressure leads to fascicular compression and progressive axonal injury diagnosed with electrodiagnostic tests.…”