A case of foot drop secondary to a giant extraneural ganglion cyst close to the peroneal nerve Düşük ayağa yol açan, peroneal sinir komşuluğunda dev ekstranöral ganglion kisti olgusu
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Abstract:
Extraneural ganglion cysts of the peroneal nerve have rarely been reported in the literature. This paper reports a large extraneural ganglion cyst compressing the peroneal nerve and causing pain in the leg, and foot drop. Electromyographic study revealed a deep peroneal nerve lesion, but the superficial branch was spared. Magnetic resonance imaging showed a cystic tumor located below the superior tibiofibular joint. A complete surgical resection was undertaken. During surgery multimodal intraoperative neurophysiological monitoring was performed. An extraneural ganglion cyst should be considered in the differential diagnosis of painful foot drop. Electrophysiological and radiological studies should be carried to rule out other causes of foot drop.Keywords:
Foot drop
Ganglion cyst
Superficial peroneal nerve
Common peroneal nerve
Tibial nerve
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Ganglion cysts are fluid filled sacs which develop near joints and tendons and are usually asymptomatic. Lower limb ganglion cysts are rare occurrences especially those situated around joint spaces causing nerve compression. We present the case of a 68 year-old female with history of progressive swelling in the left antero-lateral leg, associated with pain, and neurological symptoms of peroneal nerve compression. Magnetic resonance imaging (MRI) revealed a large proximal tibiofibular joint ganglion cyst causing peroneal nerve compression. One year following the left sided presentation, the patient presented with similar but less severe symptoms in her right antero-lateral leg. MRI revealed a small juxta-articular ganglion cyst in the right proximal tibiofibular joint space. We discuss etiology, symptoms, and management of lower limb ganglion cysts.
Ganglion cyst
Common peroneal nerve
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We report a case of sudden onset of deep peroneal neuropathy resulting from a ganglion cyst. Electrophysiology demonstrated a severe deep peroneal neuropathy with axonal loss and probably proximal conduction block. Magnetic resonance imaging demonstrated a mass arising from the proximal tibiofibular joint extending along the peroneal nerve. Surgical resection of the ganglion resulted in gradual improvement of strength. Peroneal nerve ganglia should be considered in the evaluation of patients with sudden painless foot drop.
Foot drop
Ganglion cyst
Superficial peroneal nerve
Common peroneal nerve
Entrapment Neuropathy
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There are various causes of the common peroneal nerve palsy. However, common peroneal nerve palsy caused by ganglia are uncommon. We hereby present a case of a 55-year-old man with a 1 week history of foot drop and swelling in the region of the right leg. Physical examination and nerve conduction study studies confirmed a diagnosis of common peroneal nerve palsy. Magnetic resonance imaging (MRI) revealed a lobulated, elongated cystic-appearing mass anterior to the head of fibula. Surgical decompression of the nerve with removal of the mass was performed. Surgical pathology reports confirmed the diagnosis of a ganglion cyst. Findings on physical examination, nerve conduction study and MRI results of this interesting case are being discussed. We wish to highlight that even a tumour which is benign and within the nerve sheath can cause compression.
Foot drop
Ganglion cyst
Common peroneal nerve
Entrapment Neuropathy
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Citations (15)
International Journal of Case Reports and Images (IJCRI)International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations.
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Introduction : Intraneural ganglion cysts (INGCs) are an infrequent cause of foot drop. INGCs are benign mucinous cysts within the epineurium of peripheral nerves, which are usually observed in the peroneal nerve at the knee typically leading to symptoms and signs of peripheral neuropathy. Case Report : A 40-year-old man with foot drop who had undergone a spinal study for discopathy was examined in this study. The patient had peroneal nerve compression at the neck of the fibula resulting from an extra neural cyst. Surgical exploration revealed an intraneural cyst. Epineurium was incised and the cyst was evacuated. In a two-week post-surgery follow up, his foot drop had improved partially and the remainder of his symptoms resolved. Conclusion : Awareness of the intraneural cysts of peroneal nerve as a cause for foot drop is important because early surgical intervention could reverse the course of disease.
Epineurium
Foot drop
Ganglion cyst
Common peroneal nerve
Superficial peroneal nerve
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Abstract Rationale: Peroneal neuropathy is the most common type of peripheral neuropathy in the lower extremities. The peroneal nerve is usually compressed at the lateral aspect of the fibular head. Compression by ganglion cysts are one of the numerous underlying etiologies for peroneal nerve neuropathy and are most frequently located around the fibular neck and proximal tibiofibular joint. To the best of our knowledge, this is the first report of an extraneural ganglion cyst located at the level of the distal thigh that resulted in compressive peroneal neuropathy. Patient concerns: We report a case of a 56-year-old man with sudden onset of left foot drop and gait disturbance caused by an extraneural ganglion cyst located in the popliteal fossa. Diagnosis: Electrodiagnosis (EDX) suggested a peroneal nerve lesion. Subsequently, diagnostic ultrasonography (USG) revealed a cystic mass located within the left side of the supracondylar area of femur. Further magnetic resonance imaging confirmed that the mass was located at the proximal of popliteal fossa. Interventions: Surgical excision was performed using a direct posterior approach. The cystic mass was compressing the common peroneal nerve, and was carefully and completely removed ensuring that all nerve branches were protected. Outcomes: A histopathologic evaluation confirmed the diagnosis of a ganglion cyst. There were no postoperative complications. Two months after the surgery, follow-up USG revealed no evidence of cyst recurrence or residual lesions. Six months after the surgery, the ankle dorsiflexor motor power improved and he experienced less pain and hypoesthesia. Lessons: Physicians should bear in mind that the peroneal neuropathy can occur because of the ganglion cyst in the distal thigh. The thorough evaluation of EDX and USG is crucial for the early diagnosis and surgical intervention, although there is no abnormal finding around the fibular neck.
Ganglion cyst
Common peroneal nerve
Foot drop
Hypoesthesia
Popliteal fossa
Tibial nerve
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Foot drop
Common peroneal nerve
Ganglion cyst
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Case: A 14-year-old female presented with a profound foot drop after trauma to the right leg. Clinical examination and electrodiagnostic studies demonstrated a dense palsy of the common peroneal nerve. Magnetic resonance imaging revealed an intraneural peroneal ganglion cyst at the fibular neck. Surgical treatment included decompression and transection of the articular branch to the proximal tibiofibular joint. At the 1-year follow-up, the patient demonstrated complete recovery of peroneal nerve function. Conclusions: This case demonstrates a rare finding of a pediatric intraneural peroneal ganglion cyst. The presentation and treatment is well-documented and adds depth to the literature on a sparsely reported condition.
Ganglion cyst
Foot drop
Common peroneal nerve
Presentation (obstetrics)
Superficial peroneal nerve
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Ganglion cyst
Foot drop
Presentation (obstetrics)
Common peroneal nerve
Superficial peroneal nerve
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Citations (0)
Cysts are very common lesions around the knee although they seldom cause complications. Peripheral neuropathy caused by these structures most commonly occurs by compression of the common peroneal nerve and its branches, at the level of the fibular neck. We report a case of a 44-year-old male admitted to the emergency department with complaints of right foot drop and numbness on the lateral side of the right leg caused by an extraneural synovial cyst compressing the peroneal nerve. Ultrasonography and magnetic resonance aided on the diagnosis. The cyst was removed surgically. Three months after the procedure, the patient was without complaints, with full motor and sensory function.
Foot drop
Common peroneal nerve
Superficial peroneal nerve
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Citations (2)