Abstract：
OBJECTIVE: Intraneural ganglionic cysts are non-neoplastic cysts that can cause signs and symptoms of peripheral neuropathy. However, the scarcity of such cases can lead to cognitive biases. Early surgical exploration of space occupying lesions plays an important role in identification and improving the outcomes for intraneural ganglionic cysts.
METHODS: This patient presented with loss of sensation on the right sole with tingling numbness for six months. A diagnosis of tarsal tunnel syndrome was made. Nerve conduction study revealed that the mixed nerve action potential (NAP) was absent in the right medial and lateral plantar nerves. The magnetic resonance imaging (MRI) found a cystic lesion measuring 1.4×1.8×3.8 cm as the presumed cause of the neuropathy. Surgical exploration revealed a ganglionic cyst traversing towards the flexor retinaculum with baby cysts. The latter finding came as a surprise to the treating surgeon and was confirmed to be an intraneural ganglionic cyst based on the histopathology report.
CONCLUSIONS: Through integrated commentary by a case discussant and reflection by an orthopedician, this case highlights the significance of the availability heuristic, confirmation bias, and anchoring bias in a case of rare disease. Despite diagnostic delays, a medically knowledgeable patient\'s involvement in their own care lead to a more positive outcome. A fish-bone diagram is provided to visually demonstrate the major factors that contributed to the diagnostic delay. Finally, this case provides clinical teaching points in addition to a pitfall, myth, and pearl related to availability heuristic and the sunk cost fallacy.
METHODS: This patient presented with loss of sensation on the right sole with tingling numbness for six months. A diagnosis of tarsal tunnel syndrome was made. Nerve conduction study revealed that the mixed nerve action potential (NAP) was absent in the right medial and lateral plantar nerves. The magnetic resonance imaging (MRI) found a cystic lesion measuring 1.4×1.8×3.8 cm as the presumed cause of the neuropathy. Surgical exploration revealed a ganglionic cyst traversing towards the flexor retinaculum with baby cysts. The latter finding came as a surprise to the treating surgeon and was confirmed to be an intraneural ganglionic cyst based on the histopathology report.
CONCLUSIONS: Through integrated commentary by a case discussant and reflection by an orthopedician, this case highlights the significance of the availability heuristic, confirmation bias, and anchoring bias in a case of rare disease. Despite diagnostic delays, a medically knowledgeable patient\'s involvement in their own care lead to a more positive outcome. A fish-bone diagram is provided to visually demonstrate the major factors that contributed to the diagnostic delay. Finally, this case provides clinical teaching points in addition to a pitfall, myth, and pearl related to availability heuristic and the sunk cost fallacy.
摘要：
目的：神经内神经节囊肿是非肿瘤性囊肿，可引起周围神经病变的体征和症状。然而,这种情况的稀缺性会导致认知偏见。早期手术探索占位性病变在识别和改善神经内神经节囊肿的预后中起着重要作用。
方法：该患者出现右侧鞋底感觉丧失，并伴有刺痛麻木6个月。诊断为tal管综合征。神经传导研究显示，右侧内侧和外侧足底神经中不存在混合神经动作电位（NAP）。磁共振成像（MRI）发现囊性病变，大小为1.4×1.8×3.8cm，是神经病变的可能原因。手术探查显示神经节囊肿向屈肌支持带延伸，并伴有婴儿囊肿。后者的发现令治疗外科医生感到惊讶，并根据组织病理学报告被确认为神经内神经节囊肿。
结论：通过案例讨论者的综合评论和骨科医生的反思，这个案例强调了可用性启发式的重要性，确认偏差，和锚定偏差在罕见疾病的情况下。尽管诊断延迟，一个有医学知识的患者参与他们自己的护理会导致更积极的结果。提供了鱼骨图，以直观地说明导致诊断延迟的主要因素。最后,这个案例除了陷阱之外，还提供了临床教学要点，神话,和珍珠与可用性启发式和沉没成本谬误有关。
方法：该患者出现右侧鞋底感觉丧失，并伴有刺痛麻木6个月。诊断为tal管综合征。神经传导研究显示，右侧内侧和外侧足底神经中不存在混合神经动作电位（NAP）。磁共振成像（MRI）发现囊性病变，大小为1.4×1.8×3.8cm，是神经病变的可能原因。手术探查显示神经节囊肿向屈肌支持带延伸，并伴有婴儿囊肿。后者的发现令治疗外科医生感到惊讶，并根据组织病理学报告被确认为神经内神经节囊肿。
结论：通过案例讨论者的综合评论和骨科医生的反思，这个案例强调了可用性启发式的重要性，确认偏差，和锚定偏差在罕见疾病的情况下。尽管诊断延迟，一个有医学知识的患者参与他们自己的护理会导致更积极的结果。提供了鱼骨图，以直观地说明导致诊断延迟的主要因素。最后,这个案例除了陷阱之外，还提供了临床教学要点，神话,和珍珠与可用性启发式和沉没成本谬误有关。
