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Images in Neurology |

Nocturnal Cramps:  A Nerve Problem

Marco Luigetti, MD; Fioravante Capone, MD; Massimo Del Bene, MD; Federico Ranieri, MD; Vincenzo Di Lazzaro, MD
JAMA Neurol. 2013;70(6):792. doi:10.1001/jamaneurol.2013.1943.
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A 43-year-old woman was admitted to our department to investigate a 6-month history of nocturnal cramps and pain in her left leg. She denied significant prior illness or medication use. The pain was intermittent, was exacerbated by a lying position, and radiated from the proximal posterior part of the left lower limb to the medial malleolus. Findings on neurological examination, including deep palpation of the posterior part of the left thigh, were unremarkable. Tinel sign was absent.

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Figure. Magnetic resonance imaging neurography of the left leg (A-C), clinical photograph from surgery (D), and histological analysis (E and F). Coronal T1-weighted magnetic resonance imaging neurography revealed an isointense (compared with skeletal muscle), 2.6 × 2.0-cm mass (arrow) (A) with uniform postgadolinium enhancement (arrow) (B). Axial fat-saturated T2-weighted magnetic resonance imaging showed the tumor to be hyperintense (arrow) (C). Surgery confirmed the presence of a capsulated tumor (D). Histological analysis of the benign Schwannoma showed nerve bundles (E, hematoxylin-eosin) positive for S-100 protein immunostaining (F) (original magnification ×20).

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