Teaching NeuroImages: Posttraumatic neuroma-in-continuity of the right tibial nerve
A 40-year-old man with a history of penetrating injury to the right lower leg complained of shooting pain along the distribution of the tibial nerve and the small nodule beneath the cutaneous scar. MRI demonstrated nonenhancing fusiform thickening of the tibial nerve, which was isointense to muscle with perineural scarring (figures 1 and 2). The features were characteristic of posttraumatic neuroma-in-continuity.
Axial T1-weighted (A) and T2-weighted (B) MRI of the right leg show thickened tibial nerve (arrow) isointense to muscles with perineural scarring (asterisk). Axial T1-weighted fat suppressed pregadolinium (C) and postgadolinium contrast images (D) reveal no significant enhancement of the lesion.
Sagittal T1-weighted precontrast without fat suppression (A) and T1-weighted postcontrast fat-suppressed (B) MRI show fusiform thickening of the tibial nerve with nerve continuity on either side without significant enhancement of the lesion.
Posttraumatic neuromas are divided into neuroma-in-continuity and end-bulb neuroma. Neuroma-in-continuity is fusiform thickening of nerve due to injury or chronic friction of intact nerve. End-bulb neuroma occurs in completely transected nerve, which is not in apposition with distal nerve.1
Perineural fibrosis, T2 hypointensity, and absence of contrast enhancement (figure 2) differentiate neuroma-in-continuity from nerve sheath tumors.2
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REFERENCES
1.
Mark D, Murphey MD, Smith WS, et al. Imaging of musculoskeletal neurogenic tumors: radiologic-pathologic correlation. Radiographics 1999;19:1253–1280.
2.
Chhabra A, Andreisek G, Soldatos T, et al. MR neurography: past, present, and future. AJR Am J Roentgenol 2011;197:583–591.
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© 2014 American Academy of Neurology.
Publication History
Published online: June 2, 2014
Published in print: June 3, 2014
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The authors report no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.
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No targeted funding reported.
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Sathya Narayanan: data acquisition, drafting of manuscript. Radha Sarawagi: data acquisition, drafting and revising of manuscript, concept of the manuscript.
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Cited By
- Tibial Neuropathy, Imaging in Neurology, (459), (2016).https://doi.org/10.1016/B978-0-323-44781-2.50354-5
- Tibial Neuropathy, Diagnostic Imaging: Spine, (1030-1033), (2015).https://doi.org/10.1016/B978-0-323-37705-8.50269-8
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