| 제목 |
Compressive peroneal neuropathy by an intraneural ganglion cyst combined with L5 radiculopathy |
| 소속 |
Inje University Haeundae Paik Hospital, Department of Rehabilitation Medicine1 |
| 저자 |
Ji-Ho Park1,1*, Hwan-Kwon Do1,1†, Geun-Yeol Jo1,1, Hee-Eun Choi1,1, Se-Heum Park1,1 |
Introduction: Most cases of foot drop are known to result from lower motor neuron pathologies, especially lumbar radiculopathy and peripheral neuropathy, including common peroneal neuropathy. To improve the prognosis of foot drop, it is important to quickly and accurately diagnose the etiology and provide appropriate treatment.
Patient concerns: A 65-year-old female patient with a history of herniation of intervertebral disc on L4-5 presented with right foot drop starting 1 month previously.
Diagnosis: An electrodiagnostic examination confirmed that the patient had common peroneal neuropathy combined with L5 radiculopathy, with the former being the main cause of foot drop. The patient was further diagnosed with an intraneural ganglion cyst in the common peroneal nerve as determined by MRI of the knee.
Interventions: The patient was treated by ultrasound guided percutaneous cyst aspiration and corticosteroid injection into the decompressed ganglion, followed by strengthening exercise, electrical stimulation therapy, and prescription of an ankle foot orthosis.
Outcomes: We confirmed some regeneration of the injured peroneal nerve in a 12-week follow-up electrodiagnostic examination. Manual motor power test demonstrated an increase in ankle dorsiflexor function score by one grade.
Conclusion: Diagnosing the cause of foot drop can be difficult with multiple co-existing pathologies, and consideration of various possible etiologies is key for appropriate diagnosis and treatment. In addition to imaging modalities such as MRI, electrodiagnostic examination can help to improve diagnostic accuracy. Intraneural ganglion cyst of the common peroneal nerve is rare, but should be considered as a possible cause of foot drop. |
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Table 1. Results of Nerve Conduction Studies
Table 2. Results of needle electromyography
Figure 1. T2-weighted magnetic resonance imaging of the knee. (a) Axial image at the distal femur level, (b) coronal image of the popliteal fossa. Arrows indicate multiloculated cystic lesion in common peroneal nerve.
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