P605: Peroneal nerve damage after knee dislocation. Clinic, neurophysiology and ultrasound in diagnosis, prognosis, treatment and rehabilitation

s of Poster Presentations / Clinical Neurophysiology 125, Supplement 1 (2014) S1–S339 S213 P605 Peroneal nerve damage after knee dislocation. Clinic, neurophysiology and ultrasound in diagnosis, prognosis, treatment and rehabilitation D. Coraci1, V. Santilli1, G. Granata2, I. Paolasso2, H. Tsukamoto3, L. Padua2,4 1Sapienza University, Board of Physical Medicine and Rehabilitation, Rome, Italy; 2Universita Cattolica del Sacro Cuore, Institute of Neurology, Rome, Italy; 3Teikyo University, Institute of Neurology, Tokyo, Japan; 4Don Gnocchi ONLUS Foundation, Milan, Italy Question: Peroneal nerve palsy may occur after a close traumatic knee dislocation. Ultrasound shows its usefulness in traumatic nerve injures. Methods: We present 5 patients with a history of knee dislocation associated with peroneal nerve damage, evaluated by clinical, neurophysiologic and ultrasonographic (US) examination. All the patients were examined in follow-up. At the first evaluation, the patients presented a severe clinic and neurophysiologic damage of peroneal nerve. US showed an increase of the cross sectional area (CSA) of the involved peroneal nerve, between popliteal fossa and fibular head. Results: Among these, 4 subjects presented a CSA four-seven times larger than normal, while one subject had the damaged nerve CSA only double compared to the other side. The first 4 patients did not present improvement in clinical, neurophysiologic and ultrasonographic follow-up. The latter one showed a general improvement in the later evaluations. Conclusions: This observation let us consider that larger is the CSA of the involved peroneal nerve and worse is the prognosis for the patient. Associating neurophysiology to US evaluation, we can obtain a guide for diagnosis, treatment and rehabilitation. In fact this combined evaluation gives data about the specific details and the changes over the time of the condition. This allow us to perform the best management for every individual case. P606 Ultrasonic evaluation as a method for determining diagnosis underlying clinical symptoms of carpal tunnel syndrome N. Wolfram, U. van Deurs, M. Lauritzen Glostrup Hospital, Department of Clinical Neurophysiology, Glostrup, Denmark Background: High resolution ultrasound (HRUS) was used to differentiate carpal tunnel syndrome (CTS) from other pathologies in the media nerve. Materials and methods: Forty-one patients, referred for diagnosis of CTS, were examined with HRUS supplemental to electrodiagnostic (EDX) evaluation when the medical history gave suspicion of polyneuropathy, cervical root affection on MRI scans, trauma or EDX changes not typical for CTS. Results: Twelve patients showed CTS in both EDX (29%) and HRUS, two patients had a bifid median nerve, one was supplemental investigated for HNPP. Seventeen patients had normal EDX (42%). Eight had normal findings by HRUS, five had CTS in HRUS, whereas four patients showed other pathologies including neurovascular contacts, bifid median nerve, partial nerve compression under the flexor retinaculum, palmaris muscle contacts and arthritis. Twelve patients showed atypical changes in EDX (29%). In this group, eight patients showed CTS in HRUS, four patients showed other pathologies including fibrolipomatous harmatoma, intraneural venous congestion, partial traumatic neuroma and flexor muscle compression under the flexor retinaculum. Conclusion: HRUS is not only relevant in confirming the diagnosis of CTS but also to reveal other clinical relevant pathologies when electrodiagnostic evaluation is normal or atypical. P607 Intraneural collateral circulation in the median nerve after radiocephalic fistula N. Wolfram, U. van Deurs, M. Lauritzen Glostrup Hospital, Clinical Neurophysiology, Glostrup, Denmark Introduction: Carpaltunnel Syndrome (CTS) is a known complication to chronic renal failure and radiocephalic fistula for hemodialysis, but the cause of median nerve affection is unknown. Case report: A 61 year old male with chronic renal failure, hemodialysis and radiocephalic fistula in the left forearm was referred for CTS, because of pain in the left thumb, progressive in flexion of the wrist and parestesia in finger 1 + 2. Electrodiagnostic (EDX) evaluation showed normal distal motor latency and motor velocity in the forearm, but reduced motor amplitude from the elbow. Normal sensory velocity from finger 2 and palm to wrist, with reduced sensory amplitudes. High resolution ultrasound (HRUS) (Esaote MyLAb Twice, 6-18 MHz) revealed intraneural arterial blood flow, presumably located in the intraneural venous plexus of the left median nerve at the level of the radiocephalic fistula, as well as hypo-eccogenic changes in the nerve fascicles. Discussion: Clinically, CTS may be mimicked by proximal nerve damage followed by intraneural collateral circulation in patients with radiocephalic fistula. This condition can easily and non-invasively be visualized using HRUS of the median nerve. P608 Ultrasound as a novel instrument for tremor evaluation and intervention S. Kim1, S. Ahn2, J.-H. Shin2 1Hanyang University, Seoul, Republic of Korea; 2National Rehabilitation Center, Rehabilitation, Seoul, Republic of Korea Question: Tremor is a common movement disorder, as which a varied neurological disorders can be presented and pharmacological treatment was firstly tried. Botulinum toxin type A (BoNT-A) has been adopted as another treatment method, and recently ultrasonography-guided injection has been emphasized for accuracy. We hypothesized ultrasonography could takes another role as an objective indicator for tremor. Methods: We report two case studies in which tremor were the chief complaint. Case 1. A 29-year-old male patient with a postural and rest tremor of right hand consistent with Holmes tremor secondary to left pontine hemorrhage visited. His tremor gradually spread to wrist and elbow with the characteristics of 1.4-2 Hz, irregular flexion-extension oscillation being present at rest. Ultrasonography-guided BoNT-A injections were administered at extensor pollicis longus (40 U) muscles, and flexor digitorum superficialis 2nd, 3rd and 4th digits (20 U, each), which showed plainest contraction in real time ultrasonography. Ultrasonography revealed the frequency of tremor decreased from 1.4-2 Hz (baseline) to 0-0.5 Hz (2 weeks after injection), as calculated by each muscle contraction. Case 2. A 30-year-old female patient with bilateral tremor secondary to hypoxic brain damage visited. Her muscle contraction was 0.2-0.4 Hz at her left extensor carpi radialis, extensor policis longus, flexor carpi ulnaris muscles with the help of ultrasonography. BoNT-A injections were administered at extensor carpi radialis (20 U), extensor policis longus (15 U), and flexor carpi ulnaris (20 U) muscles with ultrasonography. The frequency of muscle contraction decreased to 0.1-0.2 Hz at 2 weeks after injection. Conclusion: Ultrasonography has an advantage of objective evaluation of tremor as well as selecting the target muscles. We regard ultrasonography as a novel tool in increasing the accuracy of evaluation and intervention. LP36 Intraoperative high-resolution ultrasound in the managment of traumatic nerve lesions: a new technique K. Scheglmann1, M.-T. Pedro2, R. Koenig2 1Klinikum Augsburg, Neurology, Augsburg, Germany; 2University Ulm, Neurosurgery, Guenzburg, Germany Introduction: Surgical treatment of nerve lesion in continuity remains difficult even in the most experienced hands. Their regenerative potential is evaluated either by intraoperative electrophysiology and/or intraneural dissection. The values of preoperative ultrasound is often hampered due to low tissue penetration and trauma related artifacts. Therefore the present study for the first time examines feasibility and value of intraoperative high-frequency ultrasound as an imaging tool in the management of traumatic nerve lesions in continuity. Material and methods: After development of intraoperative application of high-frequency ultrasound we examined 19 traumatic or iatrogenic nerve lesions of different extent. The information obtained was correlated to intraoperative electrophysiology, the findings of microsurgical intraneural dissection and histopathology of the resected nerve segments. Results: The intraoperative application of high-frequency ultrasound enabled morphological ultrastructural examination of traumatic nerve lesions with excellent imaging quality. The assessment of the severity of the