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      Ultrasonographic findings of proximal median neuropathy: A case series of suspected distal neuralgic amyotrophy.

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          Abstract

          Spontaneous anterior interosseous nerve (AIN) palsy develops following the resolution of nerve pain, which may be considered as distal neuralgic amyotrophy. NA is assumed to have a complex etiology, but an autoimmune mechanism is likely involved. However, precise assessment of the lesion is challenging. We examined five consecutive patients with suspected spontaneous AIN palsy using ultrasonography. On electromyography, all patients exhibited denervation potentials in the muscles, not only in the AIN territory, but also in the proximal median nerve territory (e.g., the flexor carpi radialis or pronator teres). Ultrasonography of the median nerve demonstrated neural swelling at the proximal side of the medial epicondyle in four patients and an hourglass-like constriction of the nerve fascicle in three patients. Four patients were diagnosed with distal neuralgic amyotrophy; of these, three received intravenous immunoglobulin administration, but only limited beneficial effect was achieved in one patient with early stage disease. One patient showed significant median nerve hypertrophy on ultrasonography and was diagnosed with neurolymphomatosis following the detection of malignant lymphoma during a systemic survey. Our experience demonstrates that ultrasonography for proximal median neuropathy presenting as AIN palsy may be useful for the accurate lesion assessment.

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          Author and article information

          Journal
          J. Neurol. Sci.
          Journal of the neurological sciences
          Elsevier BV
          1878-5883
          0022-510X
          Jun 15 2017
          : 377
          Affiliations
          [1 ] Division of Neurology, Kobe University Graduate School of Medicine, Japan.
          [2 ] Division of Neurology, Kobe University Graduate School of Medicine, Japan. Electronic address: sekiguch@med.kobe-u.ac.jp.
          [3 ] Department of Neurology, Kita-HARIMA Medical Center, Japan.
          Article
          S0022-510X(17)30206-X
          10.1016/j.jns.2017.03.037
          28477674
          565622ee-9911-46d6-9cd9-a0476edfe693
          History

          Anterior interosseous nerve palsy,Hourglass-like appearance,Neuralgic amyotrophy,Proximal median neuropathy,Ultrasonography

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