Fibrolipomatous hamartoma of the median nerve presenting with carpal tunnel syndrome.

Neurology India | May-Jun 2009 | Vol 57 | Issue 3 A 37-year-old gentleman presented with weakness, burning sensation, pain and a progressively increasing swelling in the volar aspect of the right palm and wrist for three years. On examination there was wasting of the thenar eminence with muscle power of MRC Grade II and decreased sensation in the median nerve distribution of the right hand. Nerve conduction study showed no response to stimulation of the right median motor and sensory components. Palmar conduction showed no response to stimulation in right median nerve. Magnetic resonance imaging (MRI) of the wrist and hand showed enlargement of the median nerve with hypointense linear serpentine fibers interspersed between hyperintense signal both in T1W, proton density and T2W [not shown in figure] images suggestive of fatty infiltration, giving the appearance of “coaxialcablefibers” in the axial plane [Figure 1] and a “spaghetti pattern” in the coronal plane [Figure 2]. The mass caused displacement of the flexor tendons and bulging of the flexor retinaculum. Nerve thickening was extending proximally within the forearm and distally involving the digital branches [Figure 3]. A diagnosis of fibrolipomatous hamartoma Fibrolipomatous hamartoma of the median nerve presenting with carpal tunnel syndrome