Delayed severe median nerve palsy due to undiagnosed brachial pseudoaneurysm

Abstract

Summary. Post-catheterization pseudoaneurysms are a well-known complication of many endovascular procedures at the site of arterial puncture. However, long-term neurological complications due to undiagnosed compression are rare. A 60-year-old man presented to our unit for round, non-pulsatile, painless swelling in the inner side of his upper arm. Clinical examination showed finger paralysis, associated with amyotrophy of the forearm. Large brachial pseudoaneurysm with median nerve compression was diagnosed. The patient underwent autologous vein bypass, with poor 6-month neurological recovery. Early diagnosis of pseudoaneurysms is paramount because, when associated with nerve compression, the longer the diagnostic delay, the poorer the neurological prognosis.

Anemia to Median Nerve Palsy

“…Although commonly caused by carpal tunnel syndrome, there have been instances in which brachial angiography has led to median nerve damage. 13 In our case, CTA revealed a traumatic pseudoaneurysm that compressed the median nerve at the antecubital fossa, leading to median nerve palsy. The radial aspect of the palm is innervated by sensory branches of the median nerve from the forearm.…”

“…Other risk factors include ages older than 50 years, diabetes mellitus, and thyroid disease. Although commonly caused by carpal tunnel syndrome, there have been instances in which brachial angiography has led to median nerve damage 13 . In our case, CTA revealed a traumatic pseudoaneurysm that compressed the median nerve at the antecubital fossa, leading to median nerve palsy.…”

“…This is considered a surgical emergency and prevents permanent damage. 13 Because the source of compression, the pseudoaneurysm, in our patient was identified, immediate surgery to decompress the median nerve was necessary to prevent further permanent disabling function or sensation of her hand.…”

“…The most common cause of median nerve palsy is carpal tunnel syndrome, which is also more common in women. 13 Other risk factors include ages older than 50 years, diabetes mellitus, and thyroid disease. Although commonly caused by carpal tunnel syndrome, there have been instances in which brachial angiography has led to median nerve damage.…”

“…The most common cause of median nerve palsy is carpal tunnel syndrome, which is also more common in women 13 . Other risk factors include ages older than 50 years, diabetes mellitus, and thyroid disease.…”