ABSTRACT
Intraneural cysts are benign lesions filled with mucinous content and located inside the epineurum of the peripheral nerves. Peroneal nerve is the most affected nerve. The entity is rare and its ethiopathology still remains to be definitely elucidated. In 2003 Spinner et al published their articular theory, implicated in the formation and frequent recurrence of these lesions after surgical treatment. The practical application of this theory, nowadays almost universally accepted, generated an important diminution in the recurrence rate after surgical evacuation of this lesions, previously very elevated. Most of the cases of this entity are described in adults. In the present paper we describe two pediatric cases and analyze the clinical aspects of these cysts in pediatric and adults patients. Peroneal intraneural cysts are one of the differential diagnoses in foot drop, and an adequate treatment concludes in a complete remission of the symptoms.
Subject(s)
Ganglion Cysts/pathology , Peroneal Nerve/pathology , Adult , Child , Female , Ganglion Cysts/surgery , Humans , Male , Treatment OutcomeABSTRACT
Los quistes intraneurales son lesiones benignas de contenido mucinoso que se ubican dentro del epineuro de algunos nervios periféricos. El ciático poplíteo externo es el nervio más afectado por esta entidad, de incidencia muy baja y cuya etiopatogenia ha sido motivo de controversia. Spinner et al. en el año 2003 publican su teoría articular, que explica la formación de estas lesiones y la causa de su recidiva frecuente tras su evacuación quirúrgica. Esta teoría, a día de hoy, es la más aceptada, y desde su aplicación ha demostrado ser importante en la reducción de las recidivas y la mejora de los resultados del tratamiento de los quistes intraneurales. La mayoría de las series de casos publicadas describen las características clínicas, radiológicas y el pronóstico de esta entidad en adultos. A través de la revisión de los casos pediátricos existentes en la literatura, y junto con 2 nuevos casos que presentamos, este trabajo revisa los aspectos clínicos de los quistes intraneurales en su presentación pediátrica y las diferencias con su presentación en adultos. Es importante conocer esta entidad ya que es uno de los diagnósticos diferenciales que deben ser tenidos en cuenta al estudiar un paciente con un pie caído, y su tratamiento correcto en tiempo y forma redunda muchas veces en una remisión completa de la sintomatología (AU)
Intraneural cysts are benign lesions filled with mucinous content and located inside the epineurum of the peripheral nerves. Peroneal nerve is the most affected nerve. The entity is rare and its ethiopathology still remains to be definitely elucidated. In 2003 Spinner et al published their articular theory, implicated in the formation and frequent recurrence of these lesions after surgical treatment. The practical application of this theory, nowadays almost universally accepted, generated an important diminution in the recurrence rate after surgical evacuation of this lesions, previously very elevated. Most of the cases of this entity are described in adults. In the present paper we describe two pediatric cases and analyze the clinical aspects of these cysts in pediatric and adults patients. Peroneal intraneural cysts are one of the differential diagnoses in foot drop, and an adequate treatment concludes in a complete remission of the symptoms (AU)
Subject(s)
Humans , Male , Female , Child , Cysts/diagnosis , Peroneal Nerve/pathology , Peripheral Nervous System Neoplasms/diagnosis , Ganglion Cysts/diagnosis , Diagnosis, DifferentialABSTRACT
We report, on two, school-age girls with clinical and electroencephalographic features of early onset childhood epilepsy with occipital paroxysms (CEOP) of the "Panayiotopoulos type" that showed atypical evolution. Neurological examination and brain imaging were normal in both. One child presented at age 2.5 years episodes of oculocephalic deviation, and ictal vomiting during nocturnal sleep. The EEG showed left occipital spikes during wakefulness and sleep. One year later, frequent inhibitory seizures appeared in the lower limbs causing, "pseudoataxic gait". At the same time she presented with behavioral disturbances and aphasia. EEG showed bilateral spike-waves while awake and continuous spike-waves during slow sleep (CSWSS). After switching AEDs to benzodiazepines, control of seizures along with improvement of behavior, and partial restoration of cognitive functions were achieved. The CSWSS disappeared and the last EEG at age 8 years only showed only isolated right occipital spikes. The other girl had a personal and familial history of febrile seizures. At 4 years of age she presented the first non-febrile seizures during sleep, with oculocephalic deviation and ictal vomiting, followed by a generalized tonic-clonic seizure. Partial control of seizures was obtained with antiepileptic drugs. At age 7, the child began to have weekly episodes of oculocephalic version, occasionally with secondary generalization. Repeated inhibitory seizures and absences also appeared. EEG showed frequent bilateral spikes occupying predominantly the posterior regions while awake, and CSWSS. At 7.5 years the same electro-clinical picture persisted. Ethosuximide was added to sodium valproate and clobazam. Fifteen days later, the seizures disappeared and the EEG showed less frequent bilateral occipital spikes. She is now 9 years old and she has been seizure-free for 18 months. Her present neuropsychological profile shows mild mental retardation. The two children with typical electroclinical features of "Panayiotopoulos Type" CEOP developed an atypical evolution which, to our knowledge, has not been described previously.
