Differential diagnosis of peroneal nerve palsy – case presentation
Keywords:
hereditary neuropathy with pressure palsies, peroneal nerve palsy, n. peroneusAbstract
Peroneal nerve palsy is the most common form of compression neuropathy of the lower limb, presenting with limited dorsal flexion of the foot with or without sensory symptoms. The etiology is variable, with nerve compression being the leading cause. The most common cases of peroneal palsy happen after trauma, surgical interventions in the foot and knee area, as well as compression of the nerve after prolonged lying of the patient in one posture, after immobilization, or after prolonged kneeling or staying with crossed legs, especially after significant weight loss. Peroneal nerve palsy is seen in various polyneuropathies, with peroneal paresis being one of the most common initial presentations in hereditary neuropathy with pressure palsies (HNPP).
We present the cases of patients, that illustrate the different etiologies of peroneal nerve palsy – a case of a girl with peroneal paresis after trauma of the foot, a case of a boy with peroneal paresis after prolonged lying in one posture, leading to a compression of the nerve and a case of peroneal palsy in a girl with significant weight loss. In the last case, the positive family history, the slow improvement in the clinical picture, as well as the results of the electrophysiological study, which showed involvement of other nerves during the acute onset of the peroneal monoparesis, were suggestive for the diagnosis of HNPP.
References
Attarian, S., Fatehi, F., Rajabally, Y., Pareyson, D. Hereditary neuropathy with liability to pressure palsies. J Neurol, 2020, 267, 8, 2198-2206.
Collis, R., Gee, A., Dillon, P., Warwick, M. Slimmer's Palsy Following Weight Loss Associated With Metastatic Breast Cancer: A Case Report. Cureus, 2024, 18, 16, 1, е52519.
de Oliveira, A., Pereira, R., Onofre, P., Marques, V., de Andrade, G., Barreira, A., Marques Junior, W. Clinical and neurophysiological features of the hereditary neuropathy with liability to pressure palsy due to the 17p11.2 deletion. Arq Neuropsiquiatr, 2016, 74, 2, 99-105.
Elias, W., Pouratian, N., Oskouian, R., Schirmer, B., Burns, T. Peroneal neuropathy following successful bariatric surgery. Case report and review of the literature. J Neurosurg, 2006, 105, 4, 631-635.
Fortier, L., Markel, M., Thomas, B., Sherman, W., Thomas, B., Kaye, A. An Update on Peroneal Nerve Entrapment and Neuropathy. Orthop Rev (Pavia), 2021, 19, 13, 2, 24937.
Fusco, C., Spagnoli, C., Salerno, G., Pavlidis, E., Frattini, D., Pisani, F. Hereditary neuropathy with liability to pressure palsy (HNPP): report of a family with a new point mutation in PMP22 gene. Ital J Pediatr, 2017, 27, 43, 1, 97.
Güzel, Ş., Ozen, S., Coşar, S.. Bilateral peroneal nerve palsy secondary to prolonged sitting in an adolescent patient. Int J Neurosci, 2022, 132, 9, 885-887.
Karklinsky, S., Kugler, S., Bar-Yosef, O., Nissenkorn, A., Grossman-Jonish, A., Tirosh, I., Vivante, A., Pode-Shakked, B. Hereditary neuropathy with liability to pressure palsies (HNPP): Intrafamilial phenotypic variability and early childhood refusal to walk as the presenting symptom. Ital J Pediatr, 2022, 48, 1, 84.
Kim, K.E. Characteristic features of hereditary neuropathy with liability to pressure palsy (HNPP) presenting with brachial plexopathy in soldiers. J Neurol Sci, 2014, 346, 1-2, 174-177.
Mitsiokapa, E., Mavrogenis, A., Drakopoulos, D., Mauffrey, C., Scarlat, M. Peroneal nerve palsy after ankle sprain: an update. Eur J Orthop Surg Traumatol, 2017, 27, 1, 53-60.
Nascimento, O.. The broad clinical spectrum of hereditary neuropathy with liability to pressure palsy (HNPP). Arq Neuropsiquiatr, 2016, 74, 2, 91-92.
Oh, M., Gu, M., Kong, H. Bilateral common peroneal neuropathy due to rapid and marked weight loss after biliary surgery: A case report. World J Clin Cases, 2021, 16, 9, 8, 1909-1915.
Poage, C., Roth, C., Scott, B. Peroneal Nerve Palsy: Evaluation and Management. J Am Acad Orthop Surg, 2016, 24, 1, 1-10.
Saurabh, K., Ahmad, R. An Unusual Case of Hereditary Neuropathy With Liability to Pressure Palsy: A Diagnostic Challenge. Cureus, 2023, 15, 1, e33306.
van Paassen, B., van der Kooi, A., van Spaendonck-Zwarts, K., Verhamme, C., Baas, F., de Visser, M. PMP22 related neuropathies: Charcot-Marie-Tooth disease type 1A and Hereditary Neuropathy with liability to Pressure Palsies. Orphanet J Rare Dis, 2014, 9, 38
Yurrebaso, I., Casado, O., Barcena, J., Perez de Nanclares, G., Aguirre, U. Clinical, electrophysiological and magnetic resonance findings in a family with hereditary neuropathy with liability to pressure palsies caused by a novel PMP22 mutation. Neuromuscul Disord, 2014, 24, 1, 56-62.
Zhu, G., Nie, X., Qi, W., Ma, Y., Hao, L., Guo, X. Tibial neuropathy, a rare manifestation of hereditary neuropathy with liability to pressure palsy: A case report. Heliyon, 2023, 9, 7, e18340.
