Kim Du Hwan, Sung Duk Hyun, Chang Min Cheol
Department of Physical Medicine and Rehabilitation, College of Medicine, Chung-Ang University, Seoul 06973, Korea.
Department of Physical Medicine and Rehabilitation, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.
Diagnostics (Basel). 2020 Apr 17;10(4):232. doi: 10.3390/diagnostics10040232.
Hourglass-like constriction neuropathy is a neurological condition caused by fascicular constriction of one or more peripheral nerves, unrelated to intrinsic or extrinsic compression. It is often neglected in clinical practice, and its diagnosis is challenging. Here, we report two cases of hourglass-like constriction neuropathy in the radial nerve diagnosed using high-resolution magnetic resonance neurography (MRN). Two men, aged 47 and 19 years, developed sudden weakness in the left wrist and finger extensors. They were diagnosed with radial neuropathy between the left mid-humerus level and the elbow joint, using the electrodiagnostic test. To evaluate the cause of the nerve lesion and the lesion location, high-resolution MRN was performed. Patient 1 showed an hourglass-like constriction of the left posterior interosseous nerve within the epineurium of the left radial nerve, 8.9 cm proximal to the lateral epicondyle. Patient 2 showed two focal constrictions of the left radial nerve, 8.0 and 6.9 cm proximal to the lateral epicondyle, respectively, and distal to the radial groove. Additionally, bull's eye signs were observed juxta-proximal to constrictions of the left radial nerve. The findings were indicative of hourglass-like constriction neuropathy. Both of the patients underwent surgery. However, at the 6-month follow-up, their motor weakness showed no improvement. MRN can be beneficial for diagnosing hourglass-like constriction neuropathy and locating the lesion.
沙漏样缩窄性神经病变是一种由一条或多条周围神经的束状缩窄引起的神经疾病，与内在或外在压迫无关。在临床实践中，它常常被忽视，其诊断具有挑战性。在此，我们报告两例经高分辨率磁共振神经成像（MRN）诊断为桡神经沙漏样缩窄性神经病变的病例。两名男性，年龄分别为47岁和19岁，出现左腕和手指伸肌突然无力。通过电诊断测试，他们被诊断为左肱骨中段水平与肘关节之间的桡神经病变。为评估神经病变的原因及病变位置，进行了高分辨率MRN检查。病例1显示在左桡神经神经外膜内，左骨间后神经在外侧髁近端8.9厘米处呈沙漏样缩窄。病例2显示左桡神经分别在外侧髁近端8.0厘米和6.9厘米处、桡骨沟远端有两个局灶性缩窄。此外，在左桡神经缩窄近端旁观察到靶征。这些发现提示为沙漏样缩窄性神经病变。两名患者均接受了手术。然而，在6个月的随访中，他们的运动无力并未改善。MRN有助于诊断沙漏样缩窄性神经病变并定位病变。
