Median Nerve Compression Caused by Brachial Pseudoaneurysm: Report of Two Cases and Review of the Literature (original) (raw)
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Pseudoaneurysm of brachial artery: A rare cause of median nerve compression
Trauma case reports, 2018
The authors present an unusual clinical case of high median nerve compression caused by an iatrogenic pseudoaneurysm of the brachial artery after an angiography with a follow up of 9 months. A 73-year-old male was seen with progressive numbness, loss of opponency and diminution of strength of finger flexion in the left hand after an angiography with direct puncture of the left humeral artery. Physical examination revealed a hard consistency internal distal arm swelling with the size of a walnut, non-pulsatile and with a Tinel sign on percussion. Upper extremity arterial Doppler ultrasonography and magnetic resonance imaging didn't point to a pseudoaneurysm. Given the persistence and progressive worsening of symptoms, the patient was operated at 4 months after the beginning of symptoms through an anterior approach of the left elbow. The tumefaction corresponded to a brachial artery pseudoaneurysm completely thrombosed causing severe compression of the median nerve. Microsurgical ...
High Median Nerve Palsy Caused by Pseudoaneurysm After Brachial Catheterization: Two Case Reports
Journal of Medical Cases, 2017
We here present two very rare cases of high median nerve palsy caused by pseudoaneurysm after brachial catheterization. A 71-yearold woman developed high median nerve palsy 2 weeks after brachial catheterization. She underwent pseudoaneurysm resection together with neurolysis 4 months after the onset of palsy. Surgical findings suggested that her palsy was caused by both severe compression by pseudoaneurysm and adhesion following hematoma after catheterization. Five months after the surgery, she only had slight sensory disturbance. A 48-year-old lady developed high median nerve palsy 1 week after the catheterization. Simple pseudoaneurysm resection was performed 2 weeks after the catheterization. Neurolysis was not performed. Seven months after the surgery, she still had severe sensory disturbance. Our cases suggested importance of secured astriction after catheterization, and recommended surgical procedure for this condition is combination of pseudoaneurysm resection and neurolysis by hand surgeons.
World Neurosurgery, 2016
Background: Complex regional pain syndrome (CRPS; formerly referred to as reflex sympathetic dystrophy, RSD) is a pain syndrome characterized by severe pain, altered autonomic and motor function in addition to trophic changes. CRPS is usually associated with soft tissue injury or trauma. It has also been described as a rare complication of arterial access for angiography secondary to pseudoaneurysm formation. Case description: A 73 year-old female underwent catheterization of the left brachial artery for an angiogram of the celiac artery. The following day, the patient noticed numbness and severe pain in the median nerve distribution of the left upper extremity. Over the course of the next six months, the patient developed CRPS in the left hand with pain and signs of autonomic dysfunction. Further workup revealed the formation of a left brachial artery pseudoaneurysm with impingement upon the median nerve. She underwent excision of the pseudoaneurysm with decompression and neurolysis of the left median nerve. Approximately six weeks from surgery, the patient had noticed significant improvement in her autonomic symptoms. Conclusion: This case represents a unique presentation of CRPS caused by brachial artery angiography and pseudoaneurysm formation. In addition, this case demonstrates the efficacy of pseudoaneurysm excision and median nerve neurolysis in the treatment of CRPS as a rare complication of arterial angiography.
Archives of Case Reports, 2019
Introduction: Peripherally inserted central venous catheters (PICCs) have been increasingly used as an alternative to conventional central venous catheters for long-term administration of chemotherapy, antibiotics, parenteral nutrition, and hydration in patients with diffi cult venous access. Traumatic complications to arteries and nerves adjacent to veins selected for PICC placement have been rarely described. Case presentation: We report the case of a PICC placement in the brachial vein of the right upper limb of a 78-year-old woman that resulted in brachial artery pseudoaneurysm and median nerve lesion. Discussion: The pseudoaneurysm was successfully repaired with thrombin injection, but neurological defi cits to the hand resulting from nerve injury persisted even four months after the procedure.
The median nerve in its normal course in the arm crosses the brachial artery from lateral to medial side. It then passes superficial to the brachialis muscle and then enters the cubital fossa. During routine cadaveric dissection of the right upper limb, an unusual variation in the course of the median nerve was observed. The median nerve in the arm crossed the brachial artery from medial to lateral side and passed deep to the brachialis muscle. It then emerged from beneath the brachialis muscle and entered the cubital fossa. In the cubital fossa, it ran medial to the brachial artery as the normal course of the nerve. Further distribution of median nerve in the forearm and hand was observed to be normal. The anomaly reported here may result in the compression of the median nerve deep to the brachialis and hence resulting in mechanical disadvantages in the flexion at the wrist joint.
Entrapment of Median Nerve by a muscular Branch of Brachial Artery: A Case Report
Variations in the arterial pattern of the upper limbs are commonly encountered in routine dissection. In-depth information of the vascular structure of the upper extremities is not only important for diagnostic interventions and surgical approaches, but has medico-legal implications. We report the unusual variation of an additional muscular branch of the brachial artery entrapping the median nerve in the middle of the arm. This anomaly was present in both upper extremities of an adult male Indo-Malaysian cadaver. The abnormality reported here might result in neurovascular compression symptoms in the upper limbs. Knowledge of the vascular dissimilarity of the brachial artery and its division, and possible neurovascular entrapment is important to surgeons and medical practitioners for anticipating nerve compression and for confirmation via motor and sensory examination.
Entrapment of the Median Nerve by a Muscular Branch of the Brachial Artery: A Case Report
Forensic Medicine and Anatomy Research, 2014
Variations in the arterial pattern of the upper limbs are commonly encountered in routine dissection. In-depth information of the vascular structure of the upper extremities is not only important for diagnostic interventions and surgical approaches, but has medico-legal implications. We report the unusual variation of an additional muscular branch of the brachial artery entrapping the median nerve in the middle of the arm. This anomaly was present in both upper extremities of an adult male Indo-Malaysian cadaver. The abnormality reported here might result in neurovascular compression symptoms in the upper limbs. Knowledge of the vascular dissimilarity of the brachial artery and its division, and possible neurovascular entrapment is important to surgeons and medical practitioners for anticipating nerve compression and for confirmation via motor and sensory examination.
Entrapment of Brachial Artery and Median Nerve within the Brachialis Muscle – A Case Report
Brachial artery and median nerve is the main neurovascular bundle of the arm. They have close relationship throughout the arm. Their entrapment may result in neurovascular symptoms in the distal part of the upper limb. We report a rare entrapment of these structures in the arm within the brachialis muscle. The brachial artery and median nerve entered the substance of brachialis at the junction of upper and middle thirds of the arm(after a course of about 8 cm). They came out through the tendon of brachialis in the cubital fossa.They coursed within the brachialis muscle for about 10 cm. There were no other variations in the arm. Knowledge of this entrapment may be useful for the orthopedic surgeons since there is a high chance of involvement of the artery and the nerve in the supracondylar fractures of the humerus.
Brachial artery pseudoaneurysm secondary to inadvertent arterial puncture
Revista argentina de cirugía, 2021
Brachial artery pseudoaneurysm secondary to inadvertent arterial puncture Los pseudoaneurismas de la arteria humeral son infrecuentes, pero pueden asociarse a complicaciones de alta morbilidad como la isquemia de miembro superior. Comunicamos un caso de pseudoaneurisma humeral en el pliegue del codo, que se presentó como tumor pulsátil con leve disminución de la temperatura y parestesias en la mano homolateral de un año de evolución, debido a una punción arterial inadvertida durante la venopunción para extracción de sangre. Se trató con éxito mediante resección quirúrgica más reconstrucción vascular con bypass húmero-cubital y bypass húmeroradial ambos con vena safena. Se discuten las diversas opciones terapéuticas disponibles para los pseudoaneurismas humerales considerando las características anatómicas y la sintomatología del paciente.
Delayed presentation of a traumatic brachial artery pseudoaneurysm
2009
Brakiyel arter psödoanevrizmasının penetran travma sonrası geç başvurusu nadiren bildirilmiştir. Bu yazıda, antekübital fossa bölgesine nafiz penetran bir travma ve arkasından da dirseğinde ani bir şişlik ve duyarlılık oluşmasından üç ay sonra başvuran 23 yaşında bir erkek olgu sunuldu. Doppler ultrasonografi ve bilgisayarlı tomografi anjiyografisi büyük bir psödoanevrizma varlığını doğruladı. Normal arteriyel dolaşımı sağlayacak şekilde araya yerleştirilen bir safen ven interpozisyon greftiyle cerrahi rekonstrüksiyon gerçekleştirildi. Anahtar Sözcükler: Brakiyel arter; gecikmiş başvuru; sahte anevrizma; penetran travma; psödoanevrizma; üst ekstremite. Delayed presentation of a brachial artery pseudoaneurysm following penetrating trauma is infrequently reported. We report the case of a 23-year-old male who presented three months following a penetrating trauma to his antecubital fossa with a sudden exacerbation of swelling and tenderness of his elbow. Doppler ultrasound and computed tomography arteriography confirmed the presence of a large pseudoaneurysm. Surgical reconstruction was performed using the long saphenous vein as an interposition vein graft, restoring normal arterial circulation.