記述言語：英語   掲載種別：研究論文（学術雑誌）  

Lower back and lower limb pain can hamper the rehabilitation of cerebral stroke patients. We report that peripheral nerve blocks enabled two patients to continue rehabilitation. Case 1 was an 83-year-old female with left hemiparesis due to cerebral infarction of the right basal ganglia. Rehabilitation started on the day after the stroke onset. On the 7th post-stroke day, she reported right buttock and dorsal thigh pain. Lumbar MRI demonstrated no lumbar spinal canal stenosis and no nerve impingement. The middle cluneal nerve block alleviated her buttock pain. On the 29th post-stroke day, she suffered severe pain on the medial side of the right knee. Blocking the infrapatellar branch of the saphenous nerve lessened that pain, she was able to walk without assistance, and rehabilitation was resumed. Case 2 was an 87-year-old female with sudden-onset left hemiparesis due to cardiogenic cerebral infarction. Intravenous thrombolysis and mechanical thrombectomy were performed. She presented with left hemiparesis due to infarcts at the right basal ganglia and the right temporal and parietal lobes. Her chronic low back pain worsened after admission and walking was difficult. Bilateral superior and middle cluneal nerve blocks improved her right lower back pain. Left low back pain was alleviated by sacroiliac joint blockage and rehabilitation was possible due to the absence of back pain. The strain on the lower back and lower limbs attributable to paresis due to stroke may lead to entrapment neuropathy. Peripheral nerve blockage is relatively simple and safe and may be useful in acute stroke patients whose rehabilitation is difficult due to pain.

DOI： 10.7759/cureus.68114

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Tarsal tunnel syndrome (TTS) is a common entrapment neuropathy that is sometimes elicited by ganglia in the tarsal tunnel. METHODS: Between August 2020 and July 2022, we operated on 117 sides with TTS. This retrospective study examined data from 8 consecutive patients (8 sides: 5 men, 3 women; average age 67.8 years) with an extraneural ganglion in the tarsal tunnel. We investigated the clinical characteristics and surgical outcomes for these patients. RESULTS: The mass was palpable through the skin in 1 patient, detected intraoperatively in 1 patient, and visualized on MRI scanning in the other 6 patients. Symptoms involved the medial plantar nerve area (n = 5), lateral plantar nerve area (n = 1), and medial and lateral plantar nerve areas (n = 2). The interval between symptom onset and surgery ranged from 4 to 168 months. Adhesion between large (≥20 mm) ganglia and surrounding tissue and nerves was observed intraoperatively in 4 patients. Of the 8 patients, 7 underwent total ganglion resection. There were no surgery-related complications. On their last postoperative visit, 3 patients with a duration of symptoms not exceeding 10 months reported favorable outcomes. CONCLUSIONS: Because ganglia eliciting TTS are often undetectable by skin palpation, imaging studies may be necessary. Early surgical intervention appears to yield favorable outcomes.

DOI： 10.1272/jnms.JNMS.2024_91-203

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Persistent primitive olfactory arteries (PPOAs) are a rare variant of the anterior cerebral artery (ACA). Cerebral aneurysms may arise in the PPOA; most are saccular and on the unilateral PPOA. We report a 66-year-old male with bilateral PPOAs and a fusiform aneurysm on the left side detected at a health check-up. A brain magnetic resonance imaging (MRI) scan revealed a fusiform dilation in the proximal portion of the left ACA on a brain MRI. Good surgical results were obtained by combining trapping-and bonnet bypass surgery. Brain MRI and cerebral angiograms showed bilateral PPOAs and a fusiform aneurysm with the pearl-and-string sign in the proximal portion of the left PPOA. The aneurysm was trapped and a bonnet bypass using a radial artery (RA) graft was placed between the left superficial temporal artery and the distal portion of the left PPOA. The postoperative course was uneventful and 30 months after surgery he had no neurological symptoms; MRA showed no recurrence. In this patient, aneurysmal trapping and an A3-A3 bypass were an option, however, it would have placed an additional load on the right PPOA. Our decision to trap the aneurysm and perform bonnet bypass surgery using an RA graft led to success.

DOI： 10.2176/jns-nmc.2024-0156

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The flexor digitorum accessorius longus muscle (ALM) can be overlooked as the eliciting factor in patients with tarsal tunnel syndrome (TTS), an entrapment neuropathy of the posterior tibial nerve that elicits sole numbness and pain. Most elicitations are idiopathic, however, mass lesions within the tarsal tunnel can be also implicated. We report an 80-year-old woman whose flexor digitorum ALM led to the onset of bilateral TTS. She had suffered numbness in both soles for 3 years. Magnetic resonance imaging (MRI) of the bilateral tarsal tunnel showed that the posterior tibial nerve was compressed by the arteriovenous complex and in contact with the flexor digitorum ALM. We diagnosed bilateral TTS based on her symptoms and imaging findings, and performed bilateral decompression surgery of the posterior tibial nerve under local anesthesia. The artery on both sides was dislocated for nerve decompression. Because the posterior tibial nerve on the right side was strongly compressed in ankle plantar flexion we excised a portion of the tendon compressing the nerve. Postoperatively her symptoms gradually improved and she reported surgical satisfaction 6 months after the operation. In patients with flexor digitorum ALM-related TTS, the effect of dynamic factors on MRI findings and on surgical treatment decisions must be considered. Intraoperatively, not only the flexor digitorum ALM, but also other potential etiologic factors eliciting TTS must be kept in mind.

DOI： 10.2176/jns-nmc.2023-0136

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記述言語：日本語   出版者・発行元：日本末梢神経学会  

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J-GLOBAL

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J-GLOBAL

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記述言語：日本語   出版者・発行元：日本末梢神経学会  

J-GLOBAL

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