title: Spontaneous intraneural hematoma of the sural nerve.
abstract: Symptomatic intraneural hemorrhage occurs rarely. It presents with pain and/or weakness in the distribution following the anatomic innervation pattern of the involved nerve. When a purely sensory nerve is affected, the symptoms can be subtle. We present a previously healthy 36-year-old female who developed an atraumatic, spontaneous intraneural hematoma of her sural nerve. Sural dysfunction was elicited from the patient's history and physical examination. The diagnosis was confirmed with magnetic resonance imaging, and surgical decompression provided successful resolution of her preoperative symptoms. To our knowledge, this entity has not been reported previously. Our case highlights the importance of having a high index of suspicion for nerve injury or compression in patients whose complaints follow a typical peripheral nerve distribution. Prior studies have shown that the formation of intraneural hematoma and associated compression of nerve fibers result in axonal degeneration, and surgical decompression decreases axonal degeneration and aids functional recovery.
authors.affiliation: Orthopaedic Surgery Resident, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA, richardsons@hss.edu.
authors.forename: Shawn S
authors.initials: SS
authors.lastname: Richardson
authors.forename: Alexander S
authors.initials: AS
authors.lastname: McLawhorn
authors.forename: Douglas N
authors.initials: DN
authors.lastname: Mintz
authors.forename: Edward F
authors.initials: EF
authors.lastname: DiCarlo
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Weiland
mesh_terms: D000328:Adult; D003287:Contrast Media; D019299:Decompression, Surgical; D005260:Female; D019786:Gadolinium DTPA; D006406:Hematoma / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D007089:Image Enhancement; D008279:Magnetic Resonance Imaging; D010146:Pain / Q000209:etiology; D010523:Peripheral Nervous System Diseases / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D010808:Physical Examination; D020127:Recovery of Function; D013497:Sural Nerve / Q000473:pathology* / Q000601:surgery
chemical_list: D003287:Contrast Media; C064925:gadodiamide; D019786:Gadolinium DTPA