Subscribe to RSS
DOI: 10.1055/a-2218-8461
A Rare Atypical Case of Asymptomatic and Spontaneous Intraneural Hematoma of Sural Nerve: A Case Report and Literature Review
Funding None.
Abstract
Intraneural hematoma is a rare disease that results in an impaired nerve function because of bleeding around the peripheral nerve, with only 20 cases reported. Trauma, neoplasm, and bleeding disorders are known factors for intraneural hematoma. However, here we report atypical features of asymptomatic and spontaneous intraneural hematoma which are difficult to diagnose.
A 60-year-old woman visited our clinic with the complaint of a palpable mass on the right calf. She reported no medical history or trauma to the right calf and laboratory findings showed normal coagulopathy. Ultrasonography was performed, which indicated hematoma near saphenous vein and sural nerve or neurogenic tumor. We performed surgical exploration and intraneural hematoma was confirmed on sural nerve. Meticulous paraneuriotomy and evacuation was performed without nerve injury. Histological examination revealed intraneural hematoma with a vascular wall. No neurologic symptoms were observed.
In literature review, we acknowledge that understanding anatomy of nerve, using ultrasonography as a diagnostic tool and surgical decompression is key for intraneural hematoma. Our case report may help establish the implications of diagnosis and treatment. Also, we suggested surgical treatment is necessary even in cases that do not present symptoms because neurological symptoms and associated symptoms may occur later.
Ethical Approval
All research protocols were performed in accordance with National Institutes of Health guidelines.
Patient Consent
Written informed consent was obtained from the patient for publication of this case presentation and any accompanying images.
Authors' Contributions
Conception and design: S.H.K., I.Y.A., T.H.B.
Acquisition of data: H.K.K., W.J.K., S.H.K.
Data analysis and interpretation: S.A.H.
Manuscript writing: All authors
Revising the content: T.H.B.
All authors have read and approved the final version of this manuscript.
Publication History
Received: 29 June 2023
Accepted: 24 November 2023
Accepted Manuscript online:
28 November 2023
Article published online:
24 January 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Richardson RR, Hahn YS, Siqueira EB. Intraneural hematoma of the sciatic nerve. Case report. J Neurosurg 1978; 49 (02) 298-300
- 2 Dingeman RD, Mutz SB. Hemorrhagic neuropathy of the sciatic, femoral and obturator nerves: case report and review of the literature. Clin Orthop Relat Res 1977; (127) 133-136
- 3 Rodríguez J, Taboada M, García F, Bermúdez M, Amor M, Alvarez J. Intraneural hematoma after nerve stimulation-guided femoral block in a patient with factor XI deficiency: case report. J Clin Anesth 2011; 23 (03) 234-237
- 4 Chuang YM, Luo CB, Chou YH, Cheng YC, Chang CY, Chiou HJ. Sonographic diagnosis and treatment of a median nerve epineural hematoma caused by brachial artery catheterization. J Ultrasound Med 2002; 21 (06) 705-708
- 5 Kokkinakis M, Hinsche A, Rajeev A. Spontaneous intraneural haematoma causing acute neuropathy of the median nerve. J Hand Surg Eur Vol 2009; 34 (02) 280-281
- 6 de Ruiter GC, Prasad NK, Spinner RJ, Maniker AH. Intraneural hematoma: a proposed anatomic classification with potential treatment implications. World Neurosurg 2015; 84 (06) 1977-1984
- 7 Richardson SS, McLawhorn AS, Mintz DN, DiCarlo EF, Weiland AJ. Spontaneous intraneural hematoma of the sural nerve. Skeletal Radiol 2015; 44 (04) 605-608
- 8 Bryan III BM, Lutz GE, O'Brien SJ. Sural nerve entrapment after injury to the gastrocnemius: a case report. Arch Phys Med Rehabil 1999; 80 (05) 604-606
- 9 Babwah T. Sural nerve injury in a footballer related to blunt leg trauma. Res Sports Med 2012; 20 (01) 70-73
- 10 Daoud A, Olivieri B, Feinberg D, Betancourt M, Bockelman B. Soft tissue hemangioma with osseous extension: a case report and review of the literature. Skeletal Radiol 2015; 44 (04) 597-603
- 11 Song HB, Lee YH, Kang UR, Lee SM, Chae SB. Ultrasound and MRI findings of intraneural capillary hemangioma of the median nerve mimicking traumatic neuroma: a case report. J Korean Soc Radiol 2018; 78 (02) 115-119
- 12 Padua L, Liotta G, Di Pasquale A. et al. Contribution of ultrasound in the assessment of nerve diseases. Eur J Neurol 2012; 19 (01) 47-54
- 13 Arányi Z, Csillik A, Dévay K, Rosero M. Ultrasonographic demonstration of intraneural neovascularization after penetrating nerve injury. Muscle Nerve 2018; 57 (06) 994-999
- 14 Rusu GM, Ciuce C, Fodor L, Manole S, Dudea SM. Ultrasonographic and imaging appearance of peripheral intraneural vascular anomalies: report of two cases and review of the literature. Med Ultrason 2018; 20 (02) 237-246
- 15 Schwab S, Kabbasch C, Grau SJ. Spontaneous intraneural hematoma of the common fibular nerve due to oral anticoagulation. J Surg Case Rep 2020; 2020 (08) rjaa207
- 16 Rayan GM, Pitha JV, Wisdom P, Brentlinger A, Kopta JA. Histologic and electrophysiologic changes following subepineurial hematoma induction in rat sciatic nerve. Clin Orthop Relat Res 1988; (229) 257-264
- 17 Scopel GP, Marques Faria JC, Orpheu SC, Alves HR, Dellon AL, Ferreira MC. Intraneural hematoma with extrinsic compression: experimental study in rats and therapeutic options. J Reconstr Microsurg 2007; 23 (05) 275-281