Itani Sabine, Malick Hamza, Nangrani Priya C, Lai Tony, Sims Patrick
Medicine, Texas A&M College of Medicine, Bryan, USA.
Physical Medicine and Rehabilitation, Baylor University Medical Center, Dallas, USA.
Cureus. 2023 Sep 7;15(9):e44872. doi: 10.7759/cureus.44872. eCollection 2023 Sep.
Ulnar neuropathy commonly causes hand paresthesia, often associated with mechanical compression or repetitive movements across the elbow or wrist. There are a few cases that document ulnar nerve injury from rapid compression in the absence of trauma. We present a 30-year-old previously healthy male who developed bilateral hand and forearm swelling, numbness, and pain after an allergic reaction initially treated with epinephrine and steroids. Following treatment, swelling improved; however, paresthesia and weakness persisted. Electrodiagnostic studies performed two months later showed severe ulnar neuropathy prominent at the left proximal wrist, confirmed by ulnar motor inching studies. Signs of acute or subacute denervation and active reinnervation were noted in the left flexor digitorum profundus and abductor digiti minimi. Right-sided studies were unrevealing, although magnetic resonance imaging (MRI) showed an acute flexor pollicis longus tear. Given the timing of events, it was felt that the ulnar neuropathy and acute muscle tear were related to the rapid onset of angioedema. Further research should be conducted on how acute episodes of angioedema (allergy) can cause nerve compression in different extremities. There are very scant reports of different types of angioedema (such as vibratory or hereditary) associated with neuropathy; however, there are no reports of acute allergic angioedema associated with neuropathy. A more comprehensive understanding of the pathophysiology of neuropathy following acute angioedema will help guide treatment approaches both acutely and after symptom presentation.
尺神经病变通常会导致手部感觉异常，常与肘部或腕部的机械性压迫或重复性动作有关。有少数病例记录了在无外伤情况下因快速压迫导致的尺神经损伤。我们报告一名30岁既往健康的男性，在最初用肾上腺素和类固醇治疗过敏反应后，出现双侧手部和前臂肿胀、麻木及疼痛。治疗后，肿胀有所改善；然而，感觉异常和无力持续存在。两个月后进行的电诊断研究显示严重的尺神经病变，在左腕近端明显，经尺神经运动渐增检查证实。在左侧指深屈肌和小指展肌中发现了急性或亚急性去神经支配和活跃的再支配迹象。右侧检查未发现异常，尽管磁共振成像（MRI）显示拇长屈肌急性撕裂。鉴于事件发生的时间顺序，认为尺神经病变和急性肌肉撕裂与血管性水肿的快速发作有关。应进一步研究血管性水肿（过敏）的急性发作如何导致不同肢体的神经受压。关于与神经病变相关的不同类型血管性水肿（如振动性或遗传性）的报道非常少；然而，尚无急性过敏性血管性水肿与神经病变相关的报道。对急性血管性水肿后神经病变的病理生理学有更全面的了解将有助于指导急性发作期及症状出现后的治疗方法。
