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J Neurol Surg A Cent Eur Neurosurg 2021; 82(04): 392-396
DOI: 10.1055/s-0041-1724110
Case Report

Utility of Preoperative Electrodiagnosis Together with Peripheral Nerve High-Resolution Ultrasound: A Complex Case Report of Neurofibromatosis Type I

Federica Basaldella
1   Department of Neurology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Veneto, Italy
,
Andrea Rasera 
2   Department of Neuroscience, University of Verona, Verona, Italy
,
Giampietro Zanette
3   Department of Neurology, Ospedale P. Pederzoli Casa di Cura Privata SpA, Veneto, Italy
,
Fabio Moscolo
4   Department of Neurosurgery, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Veneto, Italy
,
Francesco Sala
4   Department of Neurosurgery, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Veneto, Italy
,
Bruno Bonetti
1   Department of Neurology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Veneto, Italy
,
Giovanna Squintani
1   Department of Neurology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Veneto, Italy
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Abstract

Our case report underscores the importance of electroneuromyography (ENMG) combined with peripheral nerve high-resolution ultrasound (HRUS) in the evaluation of neurofibromatosis type 1 (NF1). A 49-year-old woman affected by NF1 came to our attention because of new-onset left arm weakness and atrophy. Debulking of a cervicothoracic C7–T1 neurofibroma had been performed 8 years earlier. On current admission, magnetic resonance imaging disclosed increased lesion volume that was thought to cause the neurologic deficits by compressing the C8 root. Findings from intraoperative neurophysiologic monitoring during repeat debulking suggested that C8 root integrity had been compromised during the first operation and that the new-onset symptoms probably stemmed from peripheral nervous system damage distal to the cervical roots. Postoperative ENMG showed chronic denervation signs in the muscles innervated by C7–C8–T1 roots, moderate carpal tunnel syndrome (CTS), and ulnar nerve conduction block at the elbow. HRUS confirmed the CTS and revealed multiple neurofibromas involving the distal tract of the radial, ulnar, and median nerves. Surgical debulking was considered unnecessary in this case. ENMG combined with nerve and plexus HRUS evaluation may help identify the cause of neurologic deficits and choose the best surgical option in such complex clinical conditions as NF1.

Keywords

NF1 - nerve HRUS - neurofibroma - ENMG together with nerve imaging - case report


Publication History

Received: 05 May 2020

Accepted: 25 August 2020

Article published online:
12 April 2021

© 2021. Thieme. All rights reserved.

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