Experience with peripheral nerve injury in lower extremities

This study reports the results of 43 operations performed on nerves of lower extremities of 43 patients during a period of 7 years from 1999 - 2005 in Mansoura University Hospital and Mansoura Emergency Hospital. There were 15 patients with isolated sciatic nerve injury, 24 with isolated peroneal nerve injury and 4 with isolated tibial nerve injury. All patients were treated with nerve exploration within 1 hour to 7 months after injury and were followed-up for 6 months to 4 years. There were 22 nerve lesions not in continuity [9 needed suture repair and 13 needed sural nerve graft repair], while 21 nerve lesions were in continuity [16 partial lesions needed neurolysis and 5 complete lesions needed neuroma excision and suture repair]. Analysis of the outcome of surgical treatment was performed with respect to the following parameters: period between the injury and operation, patient age, type of injured nerve, mechanism of injury and type of surgical intervention. Overall significant outcome [>/= 3 Louisiana State University Health Science grade] was obtained in 53.5% [sciatic nerve 46%, peroneal nerve 54% and tibial nerve 75%]. According to the type of intervention and lesion categories; lesions not in continuity had a significant outcome 41% [suture repair 55.5% while graft repair 31%], and lesions in continuity had a significant outcome 67% [lesions underwent neurolysis 75%, while lesions underwent suture repair 40%]. Useful function was achieved in 3 [43%] of 7 patients with grafts less than 6 cm in length and in only 1 [16%] of 6 patients with grafts greater than 6 cm in length. The mean time to recovery in patients who underwent surgery was 18 months [range: 1- 32/ ]. In conclusion, the most favourable outcome was obtained with lesions that result in partial lesion in continuity. Considering the rate of spontaneous recovery of post-injection nerve injuries of the sciatic nerve and early onset of skeletal deformities, a closed nerve injury of the lower limb with no recovery within 3 months should always undergo surgery, even if complete functional outcome is not always guaranteed

Spontaneous spinal epidural haematoma

Spinal epidural haematomas [SHE] is a potentially reversible cause of spinal cord and nerve root compression, may be acute or chronic; usually its occurrence may be associated with coagulation dysfunction from medications and disease states. Patients usually present with sudden onset of neurological dysfunction. The prompt diagnosis and treatment of this relatively rare condition, when attained rapidly requires surgical decompression and can result in satisfactory neurological recovery. In the period from 2001 - 2007, 7 patients were diagnosed as spontaneous SEH and managed by urgent spinal cord decompression, age from 12-44 years. Urgent magnetic resonance imaging [MRI] was done for all patients followed by urgent decompression according to the affected levels. Spontaneous spinal epidural haematomas are a rare spinal problem and need immediate diagnosis. Imaging study, mainly MRI according to the sensory level is the key for diagnosis and immediate surgical intervention is the cornerstone to get a good result