神经内神经节囊肿合并L5神经根病变导致的压迫性腓神经病变,Medicine

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神经内神经节囊肿合并L5神经根病变导致的压迫性腓神经病变
Medicine ( IF 1.3 ) Pub Date : 2019-11-01 , DOI: 10.1097/md.0000000000017865
Se-Heum Park ₁ , Hwan-Kwon Do , Geun-Yeol Jo

Affiliation

摘要理由：已知大多数足下垂病例是由下运动神经元病变引起的，特别是腰神经根病变和周围神经病变，包括常见的腓骨神经病变。为了改善足下垂的预后，快速准确地诊断病因并提供适当的治疗非常重要。患者关注点：一名 65 岁女性患者，有 L4-5 椎间盘突出病史，1 个月前出现右足下垂。诊断：电诊检查发现常见腓骨神经病变合并L5神经根病变，前者是足下垂的主要原因。对右膝进行 MRI 以确定腓神经损伤的原因，结果显示腓总神经中存在神经内神经节囊肿。干预：患者在超声引导下经皮囊肿抽吸，减压神经节内注射皮质类固醇，随后加强锻炼，电刺激治疗，并开具踝足矫形器。结果：我们在干预后 12 周的随访电诊断检查中证实了受伤的腓神经再生。此外，手动运动功率测试显示踝背屈肌功能评分提高了一级。经验教训：诊断足下垂的原因可能很困难，因为有多种并存的病理，考虑各种可能的病因是正确诊断和治疗的关键。除了 MRI 等成像方式外，电诊断检查还有助于提高诊断准确性。

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Compressive peroneal neuropathy by an intraneural ganglion cyst combined with L5 radiculopathy

Abstract Rationale: Most cases of foot drop are known to result from lower motor neuron pathologies, particularly lumbar radiculopathy and peripheral neuropathy, including common peroneal neuropathy. To improve the prognosis of foot drop, it is important to quickly and accurately diagnose the etiology and provide appropriate treatment. Patient concerns: A 65-year-old female patient with a history of L4-5 intervertebral disc herniation presented with right foot drop that had developed 1 month previously. Diagnosis: Electrodiagnostic examination revealed common peroneal neuropathy combined with L5 radiculopathy, with the former being the main cause of the foot drop. MRI of the right knee was performed to identify the cause of the peroneal nerve lesion, which revealed an intraneural ganglion cyst in the common peroneal nerve. Interventions: The patient was treated by ultrasound-guided percutaneous cyst aspiration and corticosteroid injection into the decompressed ganglion, followed by strengthening exercise, electrical stimulation therapy, and prescription of an ankle foot orthosis. Outcomes: We confirmed regeneration of the injured peroneal nerve at the follow-up electrodiagnostic examination 12 weeks after the intervention. In addition, the manual motor power test demonstrated an increase in the ankle dorsiflexor function score by one grade. Lessons: Diagnosing the cause of foot drop can be difficult with multiple co-existing pathologies, and consideration of various possible etiologies is the key for appropriate diagnosis and treatment. In addition to imaging modalities such as MRI, electrodiagnostic examination can help to improve diagnostic accuracy. Intraneural ganglion cyst of the common peroneal nerve is rare, but should be considered as a possible cause of foot drop.

更新日期：2019-11-01

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