By Amgad S. Hanna
This booklet addresses the critical wisdom deficit in peripheral nerve among neurosurgeons, although this subject represents an essential component of the oral board exam. The booklet employs a case established method with the highest-yield situations for oral forums, essentially concentrating on nerve entrapments, trauma and tumors. because of its query and solution layout, the reader is inspired to contemplate the situations and questions as though taking the genuine examination earlier than they fee the solutions. The paintings additionally comprises universal pitfalls, a piece on nerve examinations together with video recordings, and a bit on vital medical findings that are supposed to be clinically determined from the image. The publication not just serves neurosurgeons, but in addition plastic surgeons, orthopedists, and neurologists.
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Additional info for Nerve Cases: High Yield Scenarios for Oral and Written Testing
What is the most likely diagnosis? 2. What tests would you order? 3. How would you treat this condition? Answers 1. The patient has a right foot drop. The differential diagnosis mainly includes an L5 radiculopathy or a peroneal neuropathy. 1. The patient is unable to dorsiflex on the right side. The pattern of sensory loss on the dorsum of the first web space (grey area) is typical for a deep peroneal neuropathy. The patient also lost eversion but is able to plantar flex and invert. Inversion is typically lost in L5 radiculopathy (or more rarely high sciatic injury affecting both peroneal and tibial components).
2. 3. 4. 5. 6. What Can Go Wrong? Missing the diagnosis. Wrong localization of the lesion at the lower incision. Not offering surgery. Not prepping the leg for a potential need for graft. Not recording NAPs. Not knowing where to harvest the sural n from. References 1. Zeidenberg J, Burks SS, Jose J, Subhawong TK, Levi AD (2015) The utility of ultrasound in the assessment of traumatic peripheral nerve lesions: report of 4 cases. Neurosurg Focus 39(3), E3 2. Park SH, Esquenazi Y, Kline DG, Kim DH (2015) Surgical outcomes of 156 spinal accessory nerve injuries caused by lymph node biopsy procedures.
On examination: left TA 2, EHL 2, eversion 3, inversion 2, plantar flexion 5, and toe flexion 5. The remaining muscle groups are normal. Sensation is diminished to light touch and pinprick over the left dorsum of the foot and the outer leg. DTRs: 2+ and symmetric. Straight leg raise test is positive at 30° on the left. There is tenderness over the lower back. A B Fig. S. 2 4 Case IV: Foot Drop 2 Questions 1. What is the differential diagnosis? What is the most likely diagnosis? 2. What tests do you want to order?