FIGURE 1. (A) US scan of the AADM (large open arrow) in its maximum anteroposterior diameter in the forearm. (B) Relationship between the AADM muscle (large open arrow), the ulnar nerve (small filled arrows), and the ulnar artery (empty triangle) just proximal to the wrist on the US scan. (C) Neurophysiologic study of the AADM muscle. Recording was done by the negative electrode positioned on the muscle belly, as localized by US. The positive electrode was positioned on the flexor retinaculum. Stimulation was done on median and ulnar nerves at the elbow. (D) Intraoperative image of the AADM muscle (large open arrow) in situ (the small filled arrow indicates the ulnar nerve). Inset: Surgical specimen after removal of the AADM. 5. Cartwright MS, Walker FO. Neuromuscular ultrasound in common entrapment neuropathies. Muscle Nerve 2013;48:696–704. 6. Claassen H, Schmitt O, Schulze M, Wree A. Variation in the hypothenar muscles and its impact on ulnar tunnel syndrome. Surg Radiol Anat 2013;35:893–899. 7. Dodds GA III, Hale D, Jackson WT. Incidence of anatomic variants in Guyon’s canal. J Hand Surg Am 1990;15:352–355. 8. James MR, Rowley DI, Norris SH. Ulnar nerve compression by an accessory abductor digiti minimi muscle presenting following injury. Injury 1987;18:66–67. 9. Sheppard JE, Prebble TB, Rahn K. Ulnar neuropathy caused by an accessory abductor digiti minimi muscle. Wisc Med J 1991;90:628– 631. 10. Luethke R, Dellon AL. Accessory abductor digiti minimi muscle originating proximal to the wrist causing symptomatic ulnar nerve compression. Ann Plast Surg 1992;28:307–308. 11. Al-Qattan MM. Ulnar nerve compression at the wrist by the accessory abductor digiti minimi muscle: wrist trauma as a precipitating factor. Hand Surg 2004;9:79–82. 12. Spiess AM, Gursel E. Entrapment of the ulnar nerve at Guyon’s canal by an accessory abductor digiti minimi muscle. Plast Reconstr Surg 2006;117:1060–1061. 13. Dimitriou C, Natsis K. Accessory abductor digiti minimi muscle causing ulnar nerve entrapment at the Guyon’s canal: a case report. Clin Anat 2007;20:974–975. 14. Sano K, Aoki S, Kitta E, Hagiwara Y, Hyakusoku H. Atypical ulnar tunnel syndrome accompanied by sensory disturbance of the dorsal sensory branch of the ulnar nerve. Scand J Plast Reconstr Surg Hand Surg 2009;43:117–119.

Published online 25 March 2015 in Wiley Online Library (wileyonlinelibrary.com). DOI 10.1002/mus.24660

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ACUTE ATAXIC NEUROPATHY ASSOCIATED WITH HEPATITIS E VIRUS INFECTION Recent reports have shown an epidemiological association of Guillain-Barre syndrome (GBS),1 and neuralgic amyotrophy,2 with hepatitis E virus (HEV) infection. A population-based series in Belgium of 841 serum sam464

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ples tested for HEV discovered 35 patients with IgM and IgG antibodies. One patient presented with GBS.3 In another series of 106 patients, 7.5% presented with neurological syndromes.4 Acute ataxic neuropathy (AAN) characterized by ataxia and areflexia without substantial ophthalmoplegia is considered to be an incomplete form of Miller Fisher syndrome, a GBS variant.5 We describe a case of AAN associated with HEV. A 54-year-old man was admitted with icterus (bilirubin: 9.61 mg/dL [normal,