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  • Title: Misinterpretation of sural nerve conduction studies due to anatomical variation.
    Author: Tankisi H, Pugdahl K, Otto M, Fuglsang-Frederiksen A.
    Journal: Clin Neurophysiol; 2014 Oct; 125(10):2115-21. PubMed ID: 24618219.
    Abstract:
    OBJECTIVE: Anatomical variation of the sural nerve has been documented in numerous cadaver studies. The sural nerve conduction parameters can potentially be influenced by the sural nerve type A formation formed by the union of the medial sural cutaneous nerve (MSCN) and the peroneal communicating branch (PCB) and the type C formation with the sural nerve formed solely by the PCB. METHODS: In 17 out of 240 prospectively examined subjects referred for polyneuropathy a suspicion of an anatomical variation of the sural nerve was raised due to decreased amplitude or substantial side-to-side variation (>50%) of the sensory nerve action potential (SNAP) in disproportion to the clinical findings. To verify the variation the sural nerve was examined further with surface electrodes and near-nerve technique, including extra lateral and distal needle placements. RESULTS: In all 17 subjects an anatomical variation affecting the sural SNAP was confirmed as a normal sural SNAP could be obtained by changing the electrode placement. The most frequent variation, seen in 15 subjects, was a type A formation with union of the MSCN and the PCB distally at low calf, while a type C formation was seen in 2 subjects. CONCLUSIONS: In case of a decreased sural SNAP amplitude or substantial side-to-side variation in disproportion to the neurologic evaluation, an anatomical variation instead of pathology could be suspected and a different electrode placement be considered. SIGNIFICANCE: Neurophysiologists should be aware of different types of formations of the sural nerve which may cause misinterpretations of nerve conduction studies, especially when needle electrodes are used.
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