Anita Csillik

Ultrasonographic identification of nerve pathology in neuralgic amyotrophy: Enlargement, constriction, fascicular entwinement, and torsion

The aim of this study was to characterize the ultrasonographic findings on nerves in neuralgic amyotrophy.

Ultrasonography in neuralgic amyotrophy: Sensitivity, spectrum of findings and clinical correlations

The aim of this study was to assess the value of ultrasonography in neuralgic amyotrophy.

The significance of ultrasonographic carpal tunnel outlet measurements in the diagnosis of carpal tunnel syndrome

OBJECTIVE A retrospective study to investigate the utility of ultrasonographic carpal tunnel outlet measurements in the diagnosis of carpal tunnel syndrome (CTS). METHODS 118 hands of 87 patients with electrophysiologically confirmed CTS and 44 control hands of 23 subjects were assessed. Cross-sectional areas (CSA) of the median nerve were measured at the tunnel inlet, outlet, and forearm. Longitudinal diameters (LAPD) were measured at the inlet, proximal tunnel, distal tunnel, and outlet. RESULTS CSA at the outlet (median: 18mm2) and its palm-to-forearm-ratio (median: 2.7) were significantly larger than CSA at the inlet (median: 15mm2) and its wrist-to-forearm-ratio (median: 2.2) (p<0.001). 27% of the hands showed enlargement only at the outlet versus 13% only at the inlet. LAPD jump was significantly greater, suggesting relief of higher pressure, at the outlet/distal tunnel versus inlet/proximal tunnel (p<0.001). CONCLUSION Median nerve enlargement in CTS is greater at the tunnel outlet than at the inlet. We postulate that this is explained by the progressive increase of pressure within the tunnel from proximal to distal. SIGNIFICANCE The addition of CSA outlet measurements to inlet measurements increased CTS ultrasonographic diagnostic sensitivity and accuracy by 15% and 10%, respectively.

Asymptomatic cerebellar atrophy after acute enteroviral encephalitis

We report on a 13-year-old male who had acute enteroviral encephalitis causing cerebellar symptoms at the age of 10 years. Magnetic resonance imaging (MRI) showed no abnormalities. Clinically he appeared to be recovered completely after 6 months. Twenty-three months after the recovery, MRI was performed because he presented with slight lower-limb and truncal ataxia experienced as lack of foot coordination while playing football or riding a bicycle. MRI demonstrated severe cerebellar atrophy. Clinically he recovered completely in 10 days. Only sophisticated electrophysiological methods revealed cerebellar dysfunction. The case provides evidence for the plasticity of cerebellar regulatory structures involved in the coordination of fine movements. It seems that in childhood the slow, isolated disintegration of cerebellar systems can be compensated for by upper thalamic or telencephalic connections, in a similar way to a congenital deficit of the cerebellum.

Ultrasonographic demonstration of intraneural neovascularization after penetrating nerve injury: Neovascularization after Nerve Injury

Introduction: Hypervascularization of nerves has been shown to be a pathological sign in some peripheral nerve disorders, but has not been investigated in nerve trauma. Methods: An observational cohort study was performed of the intraneural blood flow of 30 patients (34 nerves) with penetrating nerve injuries, before or after nerve reconstruction. All patients underwent electrophysiological assessment, and B‐mode and color Doppler ultrasonography. Results: Intraneural hypervascularization proximal to the site of injury was found in all nerves, which was typically marked and had a longitudinal extension of several centimeters. In 6 nerves, some blood flow was also present within the injury site or immediately distal to the injury. No correlation was found between the degree of vascularization and age, size of the scar / neuroma, or degree of reinnervation. Discussion: Neovascularization of nerves proximal to injury sites appears to be an essential element of nerve regeneration after penetrating nerve injuries. Muscle Nerve 57: 994–999, 2018