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Year : 2016  |  Volume : 64  |  Issue : 5  |  Page : 1099--1100

Bilateral ulnar neuropathy at the elbow secondary to Charcot-joint associated with Chiari malformation and syringomyelia

Venkata R.C. Vemula, Chandramouliswara P Bodapati, Jayachandar Vuttarkar, Bala B Vosuri 
 Department of Neurosurgery, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India

Correspondence Address:
Venkata R.C. Vemula
Department of Neurosurgery, Sri Venkateswara Institute of Medical Sciences, Tirupati - 517 507, Andhra Pradesh
India




How to cite this article:
Vemula VR, Bodapati CP, Vuttarkar J, Vosuri BB. Bilateral ulnar neuropathy at the elbow secondary to Charcot-joint associated with Chiari malformation and syringomyelia.Neurol India 2016;64:1099-1100


How to cite this URL:
Vemula VR, Bodapati CP, Vuttarkar J, Vosuri BB. Bilateral ulnar neuropathy at the elbow secondary to Charcot-joint associated with Chiari malformation and syringomyelia. Neurol India [serial online] 2016 [cited 2019 Dec 14 ];64:1099-1100
Available from: http://www.neurologyindia.com/text.asp?2016/64/5/1099/190297


Full Text



Neuropathic joints (Charcot joints) are a chronic form of degenerative arthropathy caused by a loss of sensation in the joints so that the joints are severely damaged and disrupted.[1] There are two theories describing the pathogenesis of neuropathic arthropathy (NA), the more popular Neurotraumatic theory, and a lesser known, Neurovascular theory.[2] NA is most commonly caused by chronic neurologic illnesses such as syringomyelia, diabetes mellitus, and tabes dorsalis.[2] Other rare disorders associated with NA are leprosy, amyloidosis, peripheral nerve injury, myelomeningocele, spinal cord injury, familial dysautonomia, and congenital insensitivity to pain.[3] In syringomyelia, neuropathic changes are relatively more common at the shoulder joint, followed by the elbow and wrist.[4] There are very few cases reported in the literature of NA involving the elbow joint secondary to syringomyelia. NA of the elbow joint causing ulnar nerve palsy is even rarer.[5],[6],[7] We report a case of Chiari malformation with syringomyelia presenting with bilateral ulnar nerve palsy secondary to NA involving both the elbow joints.

A 55-year-old gentleman presented with a 4-year history of painless swellings of bilateral elbows (left more than the right), and a 6-month history of weakness, deformity of both hands, and sensory loss over his forearms and hands. Local examination revealed a boggy, nontender swelling of both the elbows (left more than the right) [Figure 1]a with crepitus and loose bodies. Neurological examination revealed reduced sensation to touch, pain, and temperature over the C5 to T1 dermatome, bilateral claw hands [Figure 1]b and weakness of hand grip secondary to bilateral ulnar nerve palsy. Radiological examination of the elbow joint [Figure 1]c was consistent with NA. The magnetic resonance imaging of the cervical spine [Figure 1]d] revealed Chiari malformation with syringomyelia. The patient underwent foramen magnum decompression with duraplasty.{Figure 1}

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References

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