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Pronator syndrome and anterior interosseous nerve palsy due to neurolymphomatosis: a case report

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Abstract

Pronator syndrome is a median nerve entrapment neuropathy that can be difficult to diagnose due to its variable presentation and objective findings. Neurolymphomatosis is an uncommon disease in which malignant lymphocytes infiltrate central or peripheral nerve endoneurium and is often missed for prolonged periods prior to diagnosis. We present a rare case of pronator syndrome and anterior interosseous nerve palsy due to neurolymphomatosis that was occult on initial MRI in spite of the presence of a median nerve mass discovered intra-operatively during neurolysis. This case demonstrates the value of ultrasound for the examination of peripheral nerve pathology and illustrates its utility as an adjunct to MRI, in part due to the ability to screen a large region.

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References

  1. Presciutti S, Rodner CM. Pronator Syndrome. J Hand Surg. 2011;36(5):907–9.

    Article  Google Scholar 

  2. Adler JA, Wolf JM. Proximal median nerve compression: pronator syndrome. J Hand Surg. 2020;45(12):1157–65.

    Article  Google Scholar 

  3. Afshar A. Pronator Syndrome Due to Schwannoma. J Hand Microsurg. 2015;7(1):119–22.

    Article  PubMed  Google Scholar 

  4. Keddie S, Nagendran A, Cox T, Bomsztyk J, Jaunmuktane Z, Brandner S, et al. Peripheral nerve neurolymphomatosis: clinical features, treatment, and outcomes. Muscle Nerve. 2020;62(5):617–25.

    Article  PubMed  Google Scholar 

  5. Khurana A, Novo M, Nowakowski GS, Ristow KM, Spinner RJ, Hunt CH, et al. Clinical manifestations of, diagnostic approach to, and treatment of neurolymphomatosis in the rituximab era. Blood Adv. 2021;5(5):1379–87.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  6. Avila JD, Vivar C. Neurolymphomatosis: a review of 82 cases (P5.141). Neurology. 2017;88(16 Supplement):P5.141.

    Article  Google Scholar 

  7. Bourque PR, Sampaio ML, Warman-Chardon J, Samaan S, Torres C. Neurolymphomatosis of the lumbosacral plexus and its branches: case series and literature review. BMC Cancer. 2019;19(1):1149.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Shree R, Goyal MK, Modi M, Gaspar BL, Radotra BD, Ahuja CK, et al. The Diagnostic Dilemma of Neurolymphomatosis. J Clin Neurol. 2016;12(3):274–81.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Lagarde S, Tabouret E, Matta M, Franques J, Attarian S, Pouget J, et al. Primary neurolymphomatosis diagnosis and treatment: a retrospective study. J Neurol Sci. 2014;342(1):178–81.

    Article  PubMed  CAS  Google Scholar 

  10. Misdraji J, Ino Y, Louis DN, Rosenberg AE, Chiocca EA, Harris NL. Primary lymphoma of peripheral nerve: report of four cases. Am J Surg Pathol. 2000;24(9):1257–65.

    Article  PubMed  CAS  Google Scholar 

  11. Crush AB, Howe BM, Spinner RJ, Amrami KK, Hunt CH, Johnson GB, et al. Malignant involvement of the peripheral nervous system in patients with cancer: multimodality imaging and pathologic correlation. RadioGraphics. 2014;34(7):1987–2007.

    Article  PubMed  Google Scholar 

  12. Choi SJ, Ahn JH, Ryu DS, Kang CH, Jung SM, Park MS, et al. Ultrasonography for nerve compression syndromes of the upper extremity. Ultrasonography. 2015;34(4):275–91.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Linda DD, Harish S, Stewart BG, Finlay K, Parasu N, Rebello RP. Multimodality imaging of peripheral neuropathies of the upper limb and brachial plexus. RadioGraphics. 2010;30(5):1373–400.

    Article  PubMed  Google Scholar 

  14. Andreisek G, Crook DW, Burg D, Marincek B, Weishaupt D. Peripheral neuropathies of the median, radial, and ulnar nerves: MR imaging features. RadioGraphics. 2006;26(5):1267–87.

    Article  PubMed  Google Scholar 

  15. Brown JM, Yablon CM, Morag Y, Brandon CJ, Jacobson JA. US of the peripheral nerves of the upper extremity: a landmark approach. Radiographics. 2016;36(2):452–63.

    Article  PubMed  Google Scholar 

  16. Zaidman CM, Seelig MJ, Baker JC, Mackinnon SE, Pestronk A. Detection of peripheral nerve pathology: comparison of ultrasound and MRI. Neurology. 2013;80(18):1634–40.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Vijayan J, Chan YC, Therimadasamy A, Wilder-Smith EP. Role of combined B-mode and Doppler sonography in evaluating neurolymphomatosis. Neurology. 2015;85(9):752.

    Article  PubMed  CAS  Google Scholar 

  18. Tagliafico A, Succio G, Serafini G, Martinoli C. Diagnostic accuracy of MRI in adults with suspect brachial plexus lesions: a multicentre retrospective study with surgical findings and clinical follow-up as reference standard. Eur J Radiol. 2012;81(10):2666–72.

    Article  PubMed  Google Scholar 

  19. Leigheb M, Tricca S, Percivale I, Licandro D, Paladini A, Barini M, et al. Diagnostic accuracy of the magnetic resonance imaging in adult post-ganglionic brachial plexus traumatic injuries: a systematic review and meta-analysis. Brain Sci. 2021;11(2):173.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, NYU Langone Health, Langone Orthopedic Center, 333 E 38th St, 6th Floor, New York, NY, 10016, USA

    Sophie L. Leung, Steven P. Daniels & Ronald S. Adler

  2. Division of Hand Surgery, Department of Orthopedic Surgery; Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, 530 1st Avenue, Suite 8U, New York, NY, 10016, USA

    Jacques H. Hacquebord

  3. Department of Pathology, NYU Langone Health, 240 East 38th Street, 22nd Floor, New York, NY, 10016, USA

    Nicholas Ward

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  1. Sophie L. Leung
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  2. Steven P. Daniels
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  5. Ronald S. Adler
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Correspondence to Sophie L. Leung.

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Leung, S.L., Daniels, S.P., Hacquebord, J.H. et al. Pronator syndrome and anterior interosseous nerve palsy due to neurolymphomatosis: a case report. Skeletal Radiol 53, 577–582 (2024). https://doi.org/10.1007/s00256-023-04410-8

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  • DOI: https://doi.org/10.1007/s00256-023-04410-8

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