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Drakou A, Altsitzioglou P, Roustemis AG, Vourda E, Papakonstantinou ME, Sioutis S, Koulalis D. Parsonage-Turner Syndrome and SARS-CoV-2 Infection: A Literature Review With Case Presentation. Cureus 2024; 16:e63305. [PMID: 39070412 PMCID: PMC11283305 DOI: 10.7759/cureus.63305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2024] [Indexed: 07/30/2024] Open
Abstract
Neuralgic amyotrophy, also known as Parsonage-Turner syndrome (PTS), is characterized by severe pain and muscle wasting affecting the anterior body, including the head, shoulder, upper limb, and chest wall. Often triggered by an antecedent event, such as infection, PTS encompasses various conditions historically identified as separate entities. In 1948, Parsonage and Turner unified these conditions under the term neuralgic amyotrophy based on shared features of intense pain and muscular atrophy. Recent studies have highlighted PTS as a spectrum disorder with diverse manifestations, including pure sensory neuropathy, extensive neuropathy, spinal accessory nerve involvement, and diaphragmatic palsy. We reviewed 26 documented cases of PTS following SARS-CoV-2 infection, emphasizing the importance of considering PTS in individuals with a history of COVID-19 due to varied clinical presentations. Standardized diagnostic methods and comprehensive evaluations are crucial for accurate diagnosis and management. Future research should focus on consistent evaluation methods and employing a comprehensive differential diagnosis approach.
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Affiliation(s)
| | - Pavlos Altsitzioglou
- 1st Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, Attikon Hospital, Athens, GRC
| | - Anastasios G Roustemis
- 1st Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, Attikon Hospital, Athens, GRC
| | - Eleni Vourda
- Department of Allergy and Immunology, National and Kapodistrian University of Athens, Attikon Hospital, Athens, GRC
| | | | - Spyridon Sioutis
- 1st Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, Attikon Hospital, Athens, GRC
| | - Dimitrios Koulalis
- 1st Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, Attikon Hospital, Athens, GRC
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2
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Sun J, Mao J, Zhang F, Gui X, Liao J. A case report of neuralgic amyotrophy. Front Neurol 2024; 15:1392766. [PMID: 38846034 PMCID: PMC11153766 DOI: 10.3389/fneur.2024.1392766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 05/14/2024] [Indexed: 06/09/2024] Open
Abstract
Neuralgic muscular atrophy is not uncommon in clinical practice. Due to the different branches of brachial plexus involved in the lesion, the clinical symptoms are different, and there is a lack of clear imaging diagnostic criteria, so the diagnosis of this disease brings great challenges to clinicians. We have certain experience in the diagnosis and treatment of this disease, and hereby select a representative case of neuralgic muscular atrophy to share its diagnosis and treatment process, focusing on analyzing the characteristic symptoms of this disease, valuable imaging data and targeted treatment, so as to enable clinicians to better understand this disease.
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Affiliation(s)
- Jianfeng Sun
- Department of Rehabilitation Medicine, Southern Theater Command General Hospital of the People's Liberation Army, Guangzhou, China
| | - Ji Mao
- Department of Ultrasonography, Southern Theater Command General Hospital of the People's Liberation Army, Guangzhou, China
| | - Fengfei Zhang
- Department of Rehabilitation Medicine, Southern Theater Command General Hospital of the People's Liberation Army, Guangzhou, China
| | - Xi Gui
- Department of Rehabilitation Medicine, Southern Theater Command General Hospital of the People's Liberation Army, Guangzhou, China
| | - Junfeng Liao
- Department of Rehabilitation Medicine, Southern Theater Command General Hospital of the People's Liberation Army, Guangzhou, China
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3
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Srichawla BS, Manan MR, Kipkorir V, Dhali A, Diebel S, Sawant T, Zia S, Carrion-Alvarez D, Suteja RC, Nurani K, Găman MA. Neuroinvasion of emerging and re-emerging arboviruses: A scoping review. SAGE Open Med 2024; 12:20503121241229847. [PMID: 38711470 PMCID: PMC11072077 DOI: 10.1177/20503121241229847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 01/16/2024] [Indexed: 05/08/2024] Open
Abstract
Background Arboviruses are RNA viruses and some have the potential to cause neuroinvasive disease and are a growing threat to global health. Objectives Our objective is to identify and map all aspects of arbovirus neuroinvasive disease, clarify key concepts, and identify gaps within our knowledge with appropriate future directions related to the improvement of global health. Methods Sources of Evidence: A scoping review of the literature was conducted using PubMed, Scopus, ScienceDirect, and Hinari. Eligibility Criteria: Original data including epidemiology, risk factors, neurological manifestations, neuro-diagnostics, management, and preventive measures related to neuroinvasive arbovirus infections was obtained. Sources of evidence not reporting on original data, non-English, and not in peer-reviewed journals were removed. Charting Methods: An initial pilot sample of 30 abstracts were reviewed by all authors and a Cohen's kappa of κ = 0.81 (near-perfect agreement) was obtained. Records were manually reviewed by two authors using the Rayyan QCRI software. Results A total of 171 records were included. A wide array of neurological manifestations can occur most frequently, including parkinsonism, encephalitis/encephalopathy, meningitis, flaccid myelitis, and Guillain-Barré syndrome. Magnetic resonance imaging of the brain often reveals subcortical lesions, sometimes with diffusion restriction consistent with acute ischemia. Vertical transmission of arbovirus is most often secondary to the Zika virus. Neurological manifestations of congenital Zika syndrome, include microcephaly, failure to thrive, intellectual disability, and seizures. Cerebrospinal fluid analysis often shows lymphocytic pleocytosis, elevated albumin, and protein consistent with blood-brain barrier dysfunction. Conclusions Arbovirus infection with neurological manifestations leads to increased morbidity and mortality. Risk factors for disease include living and traveling in an arbovirus endemic zone, age, pregnancy, and immunosuppressed status. The management of neuroinvasive arbovirus disease is largely supportive and focuses on specific neurological complications. There is a need for therapeutics and currently, management is based on disease prevention and limiting zoonosis.
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Affiliation(s)
- Bahadar S Srichawla
- Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | | | - Vincent Kipkorir
- Department of Human Anatomy and Physiology, University of Nairobi, Nairobi, Kenya
| | - Arkadeep Dhali
- Department of Internal Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Sebastian Diebel
- Department of Family Medicine, Northern Ontario School of Medicine University, Sudbury, ON, Canada
| | - Tirtha Sawant
- Department of Neurology, Spartan Health Sciences University, Spartan Drive St, Saint Lucia
| | - Subtain Zia
- Department of Infectious Diseases, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | | | - Richard C Suteja
- Faculty of Medicine, Udayana University, Kampus Bukit, Jl, Raya Kampus Unud Jimbaran, Kec, Kuta Sel, Kabupaten Badung, Bukit Jimbaran, Bali, Indonesia
| | - Khulud Nurani
- Department of Human Anatomy and Physiology, University of Nairobi, Nairobi, Kenya
| | - Mihnea-Alexandru Găman
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, București, Romania
- Bucharest, Romania and Department of Hematology, Center of Hematology and Bone Marrow Transplantation, Fundeni Clinical Institute, București, Romania
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Vazquez Do Campo R, Dyck PJB. Focal inflammatory neuropathies. HANDBOOK OF CLINICAL NEUROLOGY 2024; 201:273-290. [PMID: 38697745 DOI: 10.1016/b978-0-323-90108-6.00009-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
This chapter focuses on neuropathies that present with focal involvement of nerve roots, plexus, and/or peripheral nerves associated with autoimmune and inflammatory mechanisms that present with focal involvement of nerve roots, plexus and/or peripheral nerves. The clinical presentation, diagnosis, and treatment of focal autoimmune demyelinating neuropathies, focal nonsystemic vasculitic disorders (diabetic and nondiabetic radiculoplexus neuropathies, postsurgical inflammatory neuropathy, and neuralgic amyotrophy), and focal neuropathies associated with sarcoidosis and bacterial and viral infections are reviewed.
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Affiliation(s)
- Rocio Vazquez Do Campo
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - P James B Dyck
- Division of Neuromuscular Medicine, Department of Neurology, Mayo Clinic, Rochester, MN, United States; Peripheral Neuropathy Research Laboratory, Mayo Clinic, Rochester, MN, United States.
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Chiang PI, Chen CM. Increased 18 F-FDG uptake in denervated muscles in a case of Parsonage-Turner syndrome. BMC Neurol 2023; 23:280. [PMID: 37495981 PMCID: PMC10369682 DOI: 10.1186/s12883-023-03328-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/12/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Parsonage-Turner Syndrome (PTS) is a rare brachial plexopathy characterized by the sudden onset of pain in the shoulder girdle followed by upper limb weakness. PTS is frequently under-recognized or misdiagnosed as other more common neurological disorders presenting in a similar fashion, such as cervical radiculopathy which may require surgical intervention. Accurate diagnosis and prompt management implicate a good prognosis. Although electrophysiological studies are considered the most important for evaluating peripheral nerve injuries, it usually takes time, up to 3 weeks after the initial insult of the nerve for electromyogram (EMG) and nerve conduction studies (NCS) to display abnormalities. In the cases of PTS, especially when initial EMG/NCS and magnetic resonance neurography (MRN) results are inconclusive, 18 F-FDG positron emission tomography and computed tomography (18 F-FDG PET-CT) may be useful in helping the early detection of muscle denervation. CASE PRESENTATION A 60-year-old right-handed Taiwanese woman presented with sudden onset of intense and sharp left shoulder girdle pain without radiating to the arm, followed by muscle weakness of her left arm in abduction and elevation 3 days after the onset of pain. A detailed neurological examination and EMG and NCS suggested the clinical diagnosis of left brachial plexopathy. MRN imaging revealed no significant abnormality. 18 F-FDG PET-CT showed increased uptake in denervated muscles (supraspinatus, deltoid, and biceps muscles). Treatment with oral prednisolone and physiotherapy significantly improved pain and muscle weakness. CONCLUSIONS We present increased 18 F-FDG uptake in denervated muscles detected by 18 F-FDG PET-CT. 18 F-FDG PET-CT may serve as an adjunct examination to evaluate PTS, which has been suggested previously but rarely reported.
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Affiliation(s)
- Ping-I Chiang
- Center for Medical Education in English, Poznan University of Medical Sciences, Poznan, 60-512, Poland
| | - Chiung-Mei Chen
- Linkou Medical Center, Department of Neurology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
- Department of Neurology, College of Medicine, Chang Gung University, Taoyuan County, 33305, Taiwan.
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Parsonage-Turner Syndrome Following SARS-CoV-2 Infection: A Systematic Review. Biomedicines 2023; 11:biomedicines11030837. [PMID: 36979815 PMCID: PMC10045449 DOI: 10.3390/biomedicines11030837] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 03/12/2023] Open
Abstract
Parsonage-Turner syndrome (PTS) is an inflammatory disorder of the brachial plexus. Hypothesized underlying causes focus on immune-mediated processes, as more than half of patients present some antecedent event or possible predisposing condition, such as infection, vaccination, exercise, or surgery. Recently, PTS was reported following the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We aimed to investigate data on PTS triggered by SARS-CoV-2 infection to provide an extensive perspective on this pathology and to reveal what other, more specific, research questions can be further addressed. In addition, we aimed to highlight research gaps requiring further attention. We systematically reviewed two databases (LitCOVID and the World Health Organization database on COVID-19) to January 2023. We found 26 cases of PTS in patients with previous SARS-CoV-2 infection. The clinical and paraclinical spectrum was heterogeneous, ranging from classical PTS to pure sensory neuropathy, extended neuropathy, spinal accessory nerve involvement, and diaphragmatic palsy. Also, two familial cases were reported. Among them, 93.8% of patients had severe pain, 80.8% were reported to present a motor deficit, and 53.8% of patients presented muscle wasting. Paresthesia was noted in 46.2% of PTS individuals and a sensory loss was reported in 34.6% of patients. The present systematic review highlights the necessity of having a high index of suspicion of PTS in patients with previous SARS-CoV-2 infection, as the clinical manifestations can be variable. Also, there is a need for a standardized approach to investigation and reporting on PTS. Future studies should aim for a comprehensive assessment of patients. Factors including the baseline characteristics of the patients, evolution, and treatments should be consistently assessed across studies. In addition, a thorough differential diagnosis should be employed.
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Restoring the function in neuralgic shoulder amyotrophy by modified Somsak nerve transfer. INTERDISCIPLINARY NEUROSURGERY 2023. [DOI: 10.1016/j.inat.2023.101745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
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8
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Janssen RMJ, Lustenhouwer R, Cup EHC, van Alfen N, Ijspeert J, Helmich RC, Cameron IGM, Geurts ACH, van Engelen BGM, Graff MJL, Groothuis JT. Effectiveness of an outpatient rehabilitation programme in patients with neuralgic amyotrophy and scapular dyskinesia: a randomised controlled trial. J Neurol Neurosurg Psychiatry 2023; 94:474-481. [PMID: 36697215 DOI: 10.1136/jnnp-2022-330296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 01/10/2023] [Indexed: 01/27/2023]
Abstract
BACKGROUND Neuralgic amyotrophy (NA) is an acute inflammation of nerves within the brachial plexus territory leading to severe pain and multifocal paresis resulting in >60% of patients having residual complaints and functional limitations correlated with scapular dyskinesia. Our primary aim was to compare the effects of multidisciplinary rehabilitation (MR), focused on motor relearning to improve scapular dyskinesia and self-management strategies for reducing pain and fatigue, with usual care (UC) on shoulder, arm and hand functional capability in patients with NA. METHODS In a non-blinded randomised controlled trial (RCT), patients with NA (aged≥18 years, scapular dyskinesia, >8 weeks after onset) were randomised to either an MR or an UC group. MR consisted of a diagnostic multidisciplinary consultation and eight sessions of physical and occupational therapy. Primary outcome was functional capability of the shoulder, arm and hand assessed with the Shoulder Rating Questionnaire-Dutch Language Version (SRQ-DLV). RESULTS We included 47 patients with NA; due to drop-out, there were 22 participants in MR and 15 in UC for primary analysis. The mean group difference adjusted for sex, age and SRQ-DLV baseline score was 8.60 (95%CI: 0.26 to 16.94, p=0.044). The proportion attaining a minimal clinically relevant SRQ-DLV improvement (≥12) was larger for the MR group (59%) than the UC group (33%) with a number needed to treat of 4. CONCLUSION This RCT shows that an MR programme focused on motor relearning to improve scapular dyskinesia, combined with self-management strategies for reducing pain and fatigue, shows more beneficial effects on shoulder, arm and hand functional capability than UC in patients with NA. TRIAL REGISTRATION NUMBER NCT03441347.
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Affiliation(s)
- Renske M J Janssen
- Rehabilitation, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Renee Lustenhouwer
- Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.,Department of Functional Genomics, Faculty of Science, Center for Neurogenomics and Cognitive Research, Vrije Universiteit, Amsterdam, The Netherlands
| | - Edith H C Cup
- Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Nens van Alfen
- Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Jos Ijspeert
- Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Rick C Helmich
- Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.,Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Ian G M Cameron
- Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Alexander C H Geurts
- Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Baziel G M van Engelen
- Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Maud J L Graff
- Rehabilitation, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan T Groothuis
- Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Carrier RE, Marchetti MP. Parsonage-Turner Syndrome of Unclear Causation: A Case Report. Cureus 2022; 14:e27244. [PMID: 36039255 PMCID: PMC9401638 DOI: 10.7759/cureus.27244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2022] [Indexed: 11/06/2022] Open
Abstract
Parsonage-Turner syndrome (PTS), also referred to as idiopathic brachial plexopathy or neuralgic amyotrophy, is a rare disorder that classically presents with abrupt, patchy, unilateral shoulder pain followed by varying degrees of weakness and atrophy of the upper extremity musculature. PTS is a serious diagnosis that can result in irreversible atrophy with delayed diagnosis and treatment. Since there currently is no gold standard for diagnosis and the syndrome can present as many other possible pathologies, careful clinical examination and thorough review of relevant imaging and diagnostic studies are critical for proper diagnosis. Here, we present a case of PTS diagnosed in a 67-year-old male with extensive overlapping cervical and rotator cuff pathology following an apparent orthostatic episode with no known mechanism of injury. This case report not only adds to the literature regarding the importance of close examination and plausible etiologies of PTS but also emphasizes close collaboration among specialties to avoid misdiagnosis.
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Voss TG, Stewart CM. Parsonage-Turner syndrome after COVID-19 infection. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:182-185. [PMID: 35039808 PMCID: PMC8755556 DOI: 10.1016/j.xrrt.2021.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Miller NJ, Hooper DR, Sharma A. Bilateral neuralgic amyotrophy in a patient with livestock-associated hepatitis E virus infection. CMAJ 2022; 194:E495-E499. [PMID: 35379662 PMCID: PMC8985903 DOI: 10.1503/cmaj.211679] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Nicholas J Miller
- Departments of Physical Medicine and Rehabilitation (Miller, Hooper) and Internal Medicine (Sharma), Faculty of Medicine, University of Manitoba, Winnipeg, Man.
| | - Davyd R Hooper
- Departments of Physical Medicine and Rehabilitation (Miller, Hooper) and Internal Medicine (Sharma), Faculty of Medicine, University of Manitoba, Winnipeg, Man
| | - Aditya Sharma
- Departments of Physical Medicine and Rehabilitation (Miller, Hooper) and Internal Medicine (Sharma), Faculty of Medicine, University of Manitoba, Winnipeg, Man
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12
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Campbell WW, Landau M. Treatment and Management of Segmental Neuromuscular Disorders. Neuromuscul Disord 2022. [DOI: 10.1016/b978-0-323-71317-7.00017-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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HEV-Associated Neuralgic Amyotrophy: A Multicentric Case Series. Pathogens 2021; 10:pathogens10060672. [PMID: 34070707 PMCID: PMC8230081 DOI: 10.3390/pathogens10060672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/22/2021] [Accepted: 05/25/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Neuralgic amyotrophy (NA) has been described as a possible extrahepatic manifestation of hepatitis E virus (HEV) infection. Usually, HEV-associated NA occurs bilaterally. The clinical characteristics determining the course of HEV-associated NA have still not been defined. Methods: In this retrospective multicentric case series, 16 patients with HEV-associated NA were studied and compared to 176 HEV patients without NA in terms of their age, sex, and ALT levels. Results: Neither gender distribution (75% vs. 67% male) nor age (47 vs. 48 years median) differed significantly between the NA patients and controls. Eight NA patients (50%) presented with bilateral involvement—seven of these had right-side dominance and one had left-side dominance. Thirteen cases (81%) were hospitalized. Eight of these patients stayed in hospital for five to seven days, and five patients stayed for up to two weeks. The time from the onset of NA to the HEV diagnosis, as well as the diagnostic and therapeutic proceedings, showed a large variability. In total, 13 (81%) patients received treatment: 1/13 (8%) received intravenous immunoglobulins, 8/13 (62%) received glucocorticoids, 3/13 (23%) received ribavirin, and 6/13 (46%) received pregabalin/gabapentin. Patients with ages above the median (47 years) were more likely to be treated (p = 0.001). Conclusion: HEV-associated NA causes a relevant morbidity. In our case series neither the type of treatment nor the time of initiation of therapy had a significant effect on the duration of hospitalization or the course of the disease. The clinical presentation, the common diagnostic and therapeutic procedures, and the patients’ characteristics showed large variability, demonstrating the necessity of standardized protocols for this rare but relevant disease.
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Farrell M, Mathew E, Weiss M, Dickerman R. Right hemidiaphragmatic paralysis after cervical transforaminal epidural steroid injection: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 1:CASE20113. [PMID: 35854830 PMCID: PMC9245767 DOI: 10.3171/case20113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 02/15/2021] [Indexed: 12/04/2022]
Abstract
BACKGROUND Cervical radiculopathy is a common cause of neck pain, with radiation into the upper extremity in a dermatomal pattern. Corticosteroid injection is a conservative management option with a low risk of major adverse events. No reviewed literature or case reports have implicated phrenic nerve injury secondary to cervical transforaminal epidural steroid injection (CTFESI). OBSERVATIONS A 45-year-old man with severe right C6 radiculopathy secondary to a large right-sided C5–6 herniated intervertebral disc presented to the pain management clinic, where he received a right-sided C6 CTFESI. An hour after injection, the patient experienced shortness of breath, which was found to be caused by right diaphragmatic paralysis. The patient underwent a C5–6 anterior cervical discectomy and fusion, which provided complete relief of his radicular symptoms. However, the right hemidiaphragmatic paralysis remained at the 1-year postoperative visit. LESSONS Thorough literature review showed no established explanations for phrenic nerve injury after CTFESI. In this study, the authors explored the suspected mechanisms of possible injury to the phrenic nerve. Epidural corticosteroid injection is considered to be a safe option for conservative management of cervical radiculopathy. This study unveiled a unique and important adverse event that should be considered before a patient receives CTFESI.
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Affiliation(s)
- Molly Farrell
- Texas College of Osteopathic Medicine, Fort Worth, Texas
| | - Ezek Mathew
- Texas College of Osteopathic Medicine, Fort Worth, Texas
| | - Martin Weiss
- Cardiology Department, Baylor Scott & White Medical Center, McKinney, Texas; and
| | - Rob Dickerman
- Department of Neurosurgery, Presbyterian Hospital, Plano, Texas
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Abstract
Neuralgic amyotrophy (NA) is markedly underdiagnosed in clinical practice, and
its actual incidence rate is about 1 per 1000 per year. In the current article,
we provide an overview of essential information about NA, including the
etiology, clinical manifestations, diagnostic investigations, differential
diagnosis, treatment, and prognosis. The causes of NA are multifactorial and
include immunological, mechanical, or genetic factors. Typical clinical findings
are a sudden onset of pain in the shoulder region, followed by patchy flaccid
paralysis of muscles in the shoulder and/or arm. A diagnosis of NA is based on a
patient’s clinical history and physical examination. Gadolinium-enhanced
magnetic resonance imaging and high-resolution magnetic resonance neurography
are useful for confirming the diagnosis and choosing the appropriate treatment.
However, before a diagnosis of NA is confirmed, other disorders with similar
symptoms, such as cervical radiculopathy or rotator cuff tear, need to be ruled
out. The prognosis of NA depends on the degree of axonal damage. In conclusion,
many patients with motor weakness and pain are encountered in clinical practice,
and some of these patients will exhibit NA. It is important that clinicians
understand the key features of this disorder to avoid misdiagnosis.
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Affiliation(s)
- Tae Uk Kim
- Department of Physical Medicine and Rehabilitation, College of Medicine, Dankook University, Cheonan, Republic of Korea
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Republic of Korea
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Firmino GF, Schulze ML, Schlindwein MAM, Rampeloti B, Gonçalves MVM, Maçaneiro CH, Dos Santos RA. Neuralgic Amyotrophy: Its Importance in Orthopedics Practice. Spine Surg Relat Res 2021; 5:232-237. [PMID: 34435146 PMCID: PMC8356235 DOI: 10.22603/ssrr.2021-0014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/17/2021] [Indexed: 11/23/2022] Open
Abstract
The present academic work aims to contribute to an early diagnosis of neuralgic amyotrophy (NA) because of its high prevalence in the population. This disease is a neuromuscular syndrome with unclear etiology; it affects mostly the brachial plexus, causing acute pain in the affected shoulder, paralysis, and disabilities. Considering the importance of an early treatment that can modify the prognosis of the patient, knowing the last updates about the syndrome as its clinical presentation is important. Data analysis was conducted through an online non-systematic review that indicated the epidemiology, pathophysiology, and differential diagnosis and prognosis of NA. Knowledge of the clinical features of NA is not common; however, it is important in orthopedic practice because it requires differentiation from spine pathologies.
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Affiliation(s)
- George Fagundes Firmino
- Medical Student at Department of Medicine, University of the Region of Joinville, Joinville, Brazil
| | - Milena Luisa Schulze
- Medical Student at Department of Medicine, University of the Region of Joinville, Joinville, Brazil
| | | | - Breno Rampeloti
- Medical Student at Department of Medicine, University of the Region of Joinville, Joinville, Brazil
| | | | - Carlos Henrique Maçaneiro
- Professor of Orthopedics and Traumatology, Department of Medicine, University of the Region of Joinville, Joinville, Brazil
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Pepin ME, Chan D. Applying a clinical decision-making model to a patient with severe shoulder pain ultimately diagnosed as neuralgic amyotrophy. Physiother Theory Pract 2020; 38:1078-1089. [PMID: 32892675 DOI: 10.1080/09593985.2020.1815260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE AND PURPOSE Shoulder symptoms are often encountered in physical therapy and a myriad of etiologies can cause these symptoms, either locally or remotely. The purpose of this case report is to describe the physical therapist's differential diagnostic process for a patient with acute and severe onset of shoulder pain. Case Description: The patient was a 37-year-old female with sudden onset of right shoulder pain that awakened her at night. Pain was associated with decreased range of motion and shoulder weakness. Faced with an uncertain diagnosis, the physical therapist followed a systematic approach to clinical decision-making. Outcomes: Neuralgic amyotrophy was the primary diagnostic hypothesis but other causes of shoulder pain could not be ruled out. Conclusion: The clinical decision-making process helped the physical therapist narrow down the differential diagnosis list and make a decision to send the patient for further testing. Magnetic resonance imaging and electromyogram confirmed the diagnosis of neuralgic amyotrophy.
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Affiliation(s)
- Marie-Eve Pepin
- Physical Therapy Program, Wayne State University, Detroit, MI, USA
| | - Derek Chan
- Center for Athletic Medicine, Henry Ford Health Care System, Detroit, MI, USA
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18
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Clinico-diagnostic features of neuralgic amyotrophy in childhood. Neurol Sci 2020; 41:1735-1740. [PMID: 32140911 DOI: 10.1007/s10072-020-04314-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 02/21/2020] [Indexed: 10/24/2022]
Abstract
Neuralgic amyotrophy (NA), even known as Personage-Turner's syndrome (PTS), is a neurologic condition, affecting the lower motor neurons of brachial plexus and/or individual nerves or nerve branches, characterized by pain, muscle weakness/atrophy, and sensory symptoms. NA has an acute/subacute onset, after an infection or vaccination; it is more common in male and is rare in the pediatric population. The etiology remains uncertain, being considered heterogeneous and multifactorial. A severe acute neurologic pain around the shoulder girdle is the classic presenting symptom at onset. As the pain subsides, weakness and paresis develop. NA is usually unilateral, but sometimes, a subclinical contralateral limb involvement could be present and bilateral affection has been described. The diagnosis is clinical, through a comprehensive history and neurological examination. However, electrophysiological testing and imaging are critical, because there is no diagnostic test for PTS and it remains a diagnosis of exclusion. Upper brachial plexus peripheral involvement with weakness of periscapular and perihumeral muscles is the classic presentation, associated with electrophysiological evidence of denervation in the affected muscles. Imaging, laboratory, and genetic testing can be useful for the differential diagnosis. NA is in most cases a self-limiting condition, and it is characterized by good recovery. Treatment of NA usually involves a combination of corticosteroids, analgesics, immobilization, and physical therapy, even if limited data are available in children. Physiotherapy is required to maintain muscle strength.
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Jahic D, Marjanovic B, Merkac J, Mirnik N, Babic N. Neuralgic Amyotrophy in a 66-year-old Hiker: a Case Report. Mater Sociomed 2019; 31:224-226. [PMID: 31762709 PMCID: PMC6853743 DOI: 10.5455/msm.2019.31.224-226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Introduction Neuralgic amyotrophy (NA) or Parsonage Turner syndrome is a clinical syndrome characterized by sudden attack of neuropathic pain, motor weakness and sensory loss that could be more or less clinically present. Different interpretations regarding the differential diagnosis, symptoms, cause and treatment were given till now. Aim We report our experience with a 66-year-old male who had a sudden pain attack and palsy in shoulder region, without sensory loss, and associated calcific tendinitis of rotator cuff and degenerative changes in cervical spine. Case report Patient came to our hospital with strong pain in shoulder area and signs of frozen shoulder. Active abduction and anteflexion was only to 30 degrees. He experienced the intense pain with visual analogue scale (VAS) 10/10 a night before, during his sleep. No trauma. Neurontin (gabapentin) was given to the patient. After 4 days, he felt better with abduction and anteflexion to 90 degrees. After 2 weeks VAS was 3/10, abduction and anteflection to 100 degrees. Conclusion Neuralgic amyotrophy (NA) is a self-limiting inflammatory disorder usually with idiopathic etiology. The condition can be challenging to treat since many associated symptoms and diagnostic tests and procedures may mimic NA. In that case, accurate differential diagnosis is essential.
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Affiliation(s)
- Dzenan Jahic
- Orthopaedics and Traumatology Clinic, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina.,Faculty of Sport and Physical Education, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | | | - Jakob Merkac
- Orthopedic hospital Valdoltra, Ankaran, Slovenia
| | - Nino Mirnik
- Orthopedic hospital Valdoltra, Ankaran, Slovenia
| | - Nermina Babic
- Department of Physiology, Faculty of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
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20
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Gaudio A, Murabito AR, Xourafa A, Patanè F, Rapisarda R, Bagnato S, Castellino P. A strange case of dyspnoea. Respir Med Case Rep 2019; 28:100913. [PMID: 31384549 PMCID: PMC6661411 DOI: 10.1016/j.rmcr.2019.100913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/21/2019] [Accepted: 07/21/2019] [Indexed: 11/28/2022] Open
Abstract
Acquired neuralgic amyotrophy, described for the first time by Parsonage and Turner, is a rare idiopathic disease that may occur in otherwise normal healthy individuals. It typically begins with sudden, unilateral shoulder pain that may also involve the neck and/or arm. Less frequently, the disease involves nerves other than those of the brachial plexus, such as phrenic nerves, resulting in dyspnoea. The diagnosis is based on the clinical presentation and is generally supported by electroneurography/electromyography. We report the case of a 45-year-old white man who was referred to our clinic for acute dyspnoea preceded by severe neck and right shoulder pain. Corticosteroid therapy ameliorated the clinical picture, but without a complete recovery.
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Affiliation(s)
- Agostino Gaudio
- Department of Clinical and Experimental Medicine, University of Catania, Italy
- Corresponding author. UO di Medicina Interna, Policlinico “G. Rodolico”, Via S. Sofia 78, 95123, Catania, Italy.
| | | | - Anastasia Xourafa
- Department of Clinical and Experimental Medicine, University of Catania, Italy
| | - Federica Patanè
- Department of Clinical and Experimental Medicine, University of Catania, Italy
| | - Rosario Rapisarda
- Department of Clinical and Experimental Medicine, University of Catania, Italy
| | - Sergio Bagnato
- Neurophysiology Unit, Department of Rehabilitation, Giuseppe Giglio Foundation, Cefalù, Italy
| | - Pietro Castellino
- Department of Clinical and Experimental Medicine, University of Catania, Italy
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21
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ASHRAFI shrafi MR, TAVASOLI A, GHAHVECHI AKBARI M. Neuralgic Amyotrophy with Cervical Root and Cranial Nerves Involvement in a Child. IRANIAN JOURNAL OF CHILD NEUROLOGY 2019; 13:185-191. [PMID: 31645878 PMCID: PMC6789089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 05/08/2018] [Accepted: 09/27/2018] [Indexed: 11/06/2022]
Abstract
Idiopathic neuralgic amyotrophy (INA) is a disorder presented with acute severe pain in the upper extremity, followed by muscle weakness, paralysis and atrophy. INA is rare in children and few reports are found in the literature. Here, we report a case of INA in an 8-yr old boy from Iran following pharyngitis.
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Affiliation(s)
- Mahmoud Reza ASHRAFI shrafi
- Pediatrics Center of Excellence, Department of Pediatric Neurology, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza TAVASOLI
- Pediatrics Center of Excellence, Department of Pediatric Neurology, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Masood GHAHVECHI AKBARI
- Physical Medicine and Rehabilitation Department, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
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22
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van Rosmalen M, Lieba-Samal D, Pillen S, van Alfen N. Ultrasound of peripheral nerves in neuralgic amyotrophy. Muscle Nerve 2018; 59:55-59. [PMID: 30107038 DOI: 10.1002/mus.26322] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 08/07/2018] [Accepted: 08/09/2018] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Neuralgic amyotrophy (NA) can often be difficult to diagnose. Nerve ultrasound (US) is potentially useful, but it is operator-dependent, especially for small nerves. METHODS Fifty-one consecutive patients with NA (mean duration 16 months) and 50 control subjects underwent US of the brachial plexus and major nerves of the upper extremity at predefined sites. We compared cross-sectional areas (CSAs) of affected and unaffected sides with controls and sides within patients. RESULTS The median nerve and radial nerve at the level of the upper arm were enlarged on the affected sides compared with controls and the unaffected sides of patients. Enlargement was most pronounced for affected sides vs. controls (median 44%, radial 67%). DISCUSSION NA patients showed increased CSAs, especially in the major nerves of the upper limb, even after longer disease duration. This could make US a useful adjunct in diagnosing NA. Muscle Nerve 59:55-59, 2019.
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Affiliation(s)
- Marieke van Rosmalen
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Doris Lieba-Samal
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Sigrid Pillen
- Kempenhaeghe Center for Sleep Medicine, Heeze, The Netherlands
| | - Nens van Alfen
- Department of Neurology and Clinical Neurophysiology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
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23
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Neubauer K, Boeckelmann D, Koehler U, Kracht J, Kirschner J, Pendziwiat M, Zieger B. Hereditary neuralgic amyotrophy in childhood caused by duplication within the SEPT9 gene: A family study. Cytoskeleton (Hoboken) 2018; 76:131-136. [PMID: 30019529 PMCID: PMC6585727 DOI: 10.1002/cm.21479] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 06/28/2018] [Accepted: 07/10/2018] [Indexed: 01/24/2023]
Abstract
Hereditary neuralgic amyotrophy (HNA) is an autosomal dominant disorder associated with episodic, recurrent, and painful neuropathies affecting the nerves of the brachial plexus. In this study, we report on a family of Lebanese descent with HNA onset in early childhood. The affected family members presented with platelet dysfunction. Platelet aggregation was reduced after stimulation with the agonists ADP and epinephrine in all affected family members. Flow cytometric analyses revealed impaired platelet δ‐secretion. The index patient and one brother suffered from kidney cysts. Molecular genetic analysis revealed a heterozygous duplication of exon 2 within the septin 9 (SEPT9) gene in all the affected family members. Such a young child with HNA (aged 2 years) caused by SEPT9 duplication has not been described so far.
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Affiliation(s)
- Katharina Neubauer
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, University Medical Center, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Doris Boeckelmann
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, University Medical Center, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Udo Koehler
- Department of Medical Genetics, MGZ - Medical Genetics Center, Munich, Germany
| | - Julia Kracht
- Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine, University Medical Center, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Janbernd Kirschner
- Department of Neuropediatrics and Muscle Disorders, University Medical Center, Faculty of Medicine, University of Freiburg, Germany
| | - Manuela Pendziwiat
- Department of Neuropediatrics, Christian-Albrechts-University of Kiel and University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Barbara Zieger
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, University Medical Center, Medical Faculty, University of Freiburg, Freiburg, Germany
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24
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Tulloch I, Ali R, Papadopoulos MC. Contralateral lumbosacral plexopathy following lumbar microdiscectomy. Br J Neurosurg 2018; 34:357-361. [PMID: 29373920 DOI: 10.1080/02688697.2018.1429568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We describe the unique case of a 51-year-old lady who developed a contralateral lumbosacral plexopathy two days after a lumbar microdiscectomy. This is the first report to date of this complication occurring following this procedure. We review the literature regarding lumbosacral plexopathy and discuss the evidence base behind investigating and managing this condition and the potential pathophysiological mechanisms which underlie its development. We draw comparisons with the more widely recognised post-operative brachial neuritis, characterised by delayed onset brachial plexopathy developing after cervical decompression, and propose an immune-mediated inflammatory mechanism linking the two conditions.
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Affiliation(s)
| | - Riaz Ali
- Neurosurgery, St George's Hospital, London, UK
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25
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Kassem MW, Iwanaga J, Loukas M, Stone JJ, Smith J, Spinner RJ, Tubbs RS. Accessory neuropathy after sternotomy: Clinico-anatomical correlation supporting an inflammatory cause. Clin Anat 2017; 31:417-421. [PMID: 29193420 DOI: 10.1002/ca.23026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 11/24/2017] [Indexed: 11/07/2022]
Abstract
Inflammatory etiologies are becoming increasingly recognized as explanations of some neuropathies, especially those occurring in the perioperative period. Although "brachial neuritis" is known to affect extraplexal nerves, accessory nerve palsy following median sternotomy has been attributed to stretch on the nerve. To better elucidate stretch as a potential cause, a cadaveric study was performed. Two patients who developed accessory nerve palsy following median sternotomy are presented to illustrate features consistent with the diagnosis of a perioperative inflammatory neuropathy. Five adult unembalmed cadavers underwent exposure of the bilateral accessory nerves in the posterior cervical triangle. A median sternotomy was performed and self-retaining retractors positioned. With the head in neutral, left rotation and right rotation, retractors were opened as during surgery while observing and recording any accessory nerve movements. The self-retaining sternal retractors were fully opened to a mean inter-blade distance of 13 cm. Regardless of head position, from the initial retractor click to maximal opening there was no gross movement of the accessory nerve on the left or right sides. Opening self-retaining sternal retractors does not appear to stretch the accessory nerve in the posterior cervical triangle. Based on our clinical experience and cadaveric results, we believe that inflammatory conditions, (i.e., idiopathic brachial plexitis) can involve the accessory nerve, and might be triggered by surgical procedures. Clin. Anat. 31:417-421, 2018. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
| | - Joe Iwanaga
- Seattle Science Foundation, Seattle, Washington
| | - Marios Loukas
- Department of Anatomical Sciences, St. George's University, Grenada
| | | | - Jay Smith
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota
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26
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Gliedt J, Goehl JM, Smith DP, Daniels CJ. Chiropractic management of a geriatric patient with idiopathic neuralgic amyotrophy: a case report. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2017; 61:45-52. [PMID: 28413223 PMCID: PMC5381487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The purpose of this paper is to describe chiropractic management of a patient with neuralgic amyotrophy (NA) and to provide discussion regarding presentation, differential diagnosis, management and prognosis of idiopathic NA. CASE PRESENTATION An 85 year old Caucasian male presented to a chiropractic clinic with right periscapular and lateral rib cage pain. The patient had previously sought evaluation and treatment from multiple health care providers and underwent multiple interventions without relief. INTERVENTION AND OUTCOME The patient was managed with a course of chiropractic care and an ongoing home exercise program was carried out. The patient reported spontaneous resolution of pain approximately 14 months post onset. SUMMARY NA is a poorly known clinical entity amongst health care providers and poses challenges in timely and proper diagnosis. Recognition of NA is important for patients to be best managed and for more optimal patient outcomes to be achieved.
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Affiliation(s)
- Jordan Gliedt
- Phoenix Veterans Affairs Health Care System
- Logan University College of Chiropractic
| | | | - Derek P. Smith
- Private Practice; Back in Motion Chiropractic, Pocahontas, AR, USA
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27
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Clarke CJ, Torrance E, McIntosh J, Funk L. Neuralgic amyotrophy is not the most common neurologic disorder of the shoulder: a 78-month prospective study of 60 neurologic shoulder patients in a specialist shoulder clinic. J Shoulder Elbow Surg 2016; 25:1997-2004. [PMID: 27282731 DOI: 10.1016/j.jse.2016.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 03/31/2016] [Accepted: 04/05/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Neuralgic amyotrophy (NA) was first described in 1948. Traditional literature describes a painful attack with sudden onset, followed by paresis, with varied outcomes. Recent studies have suggested NA is currently underdiagnosed. However, a large number of studies detailing NA originate from a small group of sources. Our study compared the onset, diagnosis, investigation, and treatment of all neurologic shoulder conditions to provide comparable data for these studies. METHODS Data were collected from 60 patients (81.6% male; median age, 41.5 years) during a 78-month period. Patients with a diagnosis of a neurologic disorder of the shoulder with confirmatory electromyogram (EMG) studies were included. RESULTS NA was diagnosed in 18 patients before the EMG investigation. Of the clinically diagnosed NA patients, only 5 (27.8%) had EMG findings supportive of NA. A further 5 patients with a clinical diagnosis other than NA were diagnosed with NA after EMG findings. Overall, 10 patients (16.6%) in our study were diagnosed with NA after EMG studies. Only 4 (40.0%) reported a sudden onset attack associated with NA. Supraspinatus and infraspinatus were involved in 9 patients (90.0%), suggesting a predictable distribution of muscle involvement. CONCLUSIONS These results suggest that NA is overdiagnosed and does not warrant the increased attention suggested by recent articles. The current study also highlights a necessity to perform EMG investigations in all cases of suspected NA because the accuracy of the clinical assessment is poor.
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Affiliation(s)
| | | | - Jerome McIntosh
- Manchester Medical School, University of Manchester, Manchester, UK
| | - Lennard Funk
- Wrightington Hospital, Appley Bridge, Lancashire, UK.
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28
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Lieba-Samal D, Jengojan S, Kasprian G, Wöber C, Bodner G. Neuroimaging of classic neuralgic amyotrophy. Muscle Nerve 2016; 54:1079-1085. [DOI: 10.1002/mus.25147] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 04/01/2016] [Accepted: 04/11/2016] [Indexed: 12/18/2022]
Affiliation(s)
- Doris Lieba-Samal
- Department of Neurology; Medical University of Vienna; Währinger Gürtel 18-20 1090 Vienna Austria
| | - Suren Jengojan
- Department of Radiology and Image-Guided Therapy; Medical University of Vienna; Vienna Austria
| | - Gregor Kasprian
- Department of Radiology and Image-Guided Therapy; Medical University of Vienna; Vienna Austria
| | - Christian Wöber
- Department of Neurology; Medical University of Vienna; Währinger Gürtel 18-20 1090 Vienna Austria
| | - Gerd Bodner
- Department of Radiology and Image-Guided Therapy; Medical University of Vienna; Vienna Austria
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Parsonage-Turner Syndrome: A Case of Idiopathic Upper Extremity Paresis Following Middle Cranial Fossa Resection of a Vestibular Schwannoma. Otol Neurotol 2016; 37:1195-8. [PMID: 27518132 DOI: 10.1097/mao.0000000000001153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE In this patient report, Parsonage-Turner syndrome (acute brachial neuropathy) developed in our patient 1 day after resection of a vestibular schwannoma by a middle cranial fossa approach. Aiming to increase awareness of this rare disorder among neurotologists, we describe differential diagnoses, work-up, and management strategies. PATIENT A 67-year-old man treated for vestibular schwannoma at a single tertiary referral center. INTERVENTION Surgery for vestibular schwannoma, electromyography for confirmation of diagnosis, and physical therapy. MAIN OUTCOME AND RESULTS After ruling out postoperative complications by intracranial imaging and physical examination, electromyography was confirmatory of the suspected diagnosis, Parsonage-Turner syndrome; steroids were not indicated. With physical therapy as treatment, our patient is experiencing gradual recovery of all neurologic deficits, including gross motor function. CONCLUSION As a rare condition reported only sporadically in the orthopedic and neurology literature, our patient with Parsonage-Turner syndrome represents (to our knowledge) the first within neurotology literature. This rare, idiopathic disease process is usually self-limiting, and may mimic cerebral-vascular accident or injury from surgical positioning. Its presentation is one of limited motor and sensory neuropathies of the brachial plexus distribution.
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30
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Seo TG, Kim DH, Kim IS, Son ES. Does C5 or C6 Radiculopathy Affect the Signal Intensity of the Brachial Plexus on Magnetic Resonance Neurography? Ann Rehabil Med 2016; 40:362-7. [PMID: 27152289 PMCID: PMC4855133 DOI: 10.5535/arm.2016.40.2.362] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 08/04/2015] [Indexed: 11/21/2022] Open
Abstract
Patients with C5 or C6 radiculopathy complain of shoulder area pain or shoulder girdle weakness. Typical idiopathic neuralgic amyotrophy (INA) is also characterized by severe shoulder pain, followed by paresis of shoulder girdle muscles. Recent studies have demonstrated that magnetic resonance neurography (MRN) of the brachial plexus and magnetic resonance imaging (MRI) of the shoulder in patients with INA show high signal intensity (HSI) or thickening of the brachial plexus and changes in intramuscular denervation of the shoulder girdle. We evaluated the value of brachial plexus MRN and shoulder MRI in four patients with typical C5 or C6 radiculopathy. HSI of the brachial plexus was noted in all patients and intramuscular changes were observed in two patients who had symptoms over 4 weeks. Our results suggest that HSI or thickening of the brachial plexus and changes in intramuscular denervation of the shoulder girdle on MRN and MRI may not be specific for INA.
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Affiliation(s)
- Tae Gyu Seo
- Department of Rehabilitation Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Du Hwan Kim
- Department of Rehabilitation Medicine, Keimyung University School of Medicine, Daegu, Korea.; Pain Research Center, Keimyung University School of Medicine, Daegu, Korea.; Institute for Medical Science, Keimyung University School of Medicine, Daegu, Korea
| | - In-Soo Kim
- Department of Neurosurgery, Keimyung University School of Medicine, Daegu, Korea
| | - Eun Seok Son
- Department of Orthopedic Surgery, Keimyung University School of Medicine, Daegu, Korea
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31
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Doneddu PE, Sechi E, Addis A, Fadda G, Fois C, Sechi G. Neuralgic amyotrophy mimicking Vernet syndrome. J Neurol Sci 2016; 362:230-1. [PMID: 26944154 DOI: 10.1016/j.jns.2016.01.064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 01/21/2016] [Accepted: 01/29/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Pietro E Doneddu
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy.
| | - Elia Sechi
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Alberto Addis
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Giulia Fadda
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Chiara Fois
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - GianPietro Sechi
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
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32
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Monteiro dos Santos RB, dos Santos SM, Carneiro Leal FJC, Lins OG, Magalhães C, Mertens Fittipaldi RB. Parsonage-Turner syndrome. Rev Bras Ortop 2015; 50:336-41. [PMID: 26229940 PMCID: PMC4519651 DOI: 10.1016/j.rboe.2015.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 06/05/2014] [Indexed: 11/26/2022] Open
Abstract
Objective To describe the clinical, electrophysiological and imaging findings from Parsonage–Turner syndrome and evaluate the results from conservative treatment. Methods Eight cases were studied between February 2010 and February 2012, with a minimum follow-up of one year (mean of 14 months). All the patients answered a clinical questionnaire and underwent functional evaluation using the Constant and Murley score. After clinical suspicion was raised, an electromyography examination was performed to confirm the diagnosis. Results Eight patients (mean age of 29 years) were evaluated. The right side was affected in 70% of the cases, and the dominant side in 80% of the cases. All the patients reported that their shoulder pain had started suddenly, lasting from one to five days in six cases and up to 15 days in two cases. In three cases, severe atrophy of the deltoid muscle was observed. Hypotrophy of the supraspinatus and infraspinatus muscles was observed in three cases. A winged scapula was observed in the two remaining cases. Electromyography demonstrated involvement of the long thoracic nerve in these last two cases and confirmed the involvement of the axillary and suprascapular nerves in the remaining six cases. The mean score on the Constant and Murley scale was 96 at the end of the conservative treatment with non-steroidal anti-inflammatory drugs and physiotherapy. Six of the eight patients presented good recovery of muscle strength. Conclusions In the majority of the cases, the functional recovery was good, although muscle strength was not completely restored in some of them.
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Wade J, Taylor T. Postpartum Idiopathic Brachial Neuritis in a Sport Medicine Physician. J Brachial Plex Peripher Nerve Inj 2015; 10:e50-e52. [PMID: 27917239 DOI: 10.1055/s-0035-1558424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 06/03/2015] [Indexed: 10/23/2022] Open
Abstract
Idiopathic brachial neuritis is a distinctive condition that occurs most often in healthy individuals. It characteristically starts with an acute unilateral shoulder pain followed by a complex of symptoms, including weakness, paresthesias, and numbness. The cause of this syndrome is unknown and difficult to diagnose in the initial phase but may occur postsurgery, postinfection, posttrauma, or postvaccination. In this case, the patient's inciting event appeared to be a cesarean section. There was no trauma to the shoulder or upper extremity by way of positioning during the procedure. Several months after denervation of the supraspinatus and infraspinatus muscles, electromyography revealed some improvement. The diagnosis was made through a combination of clinical evaluation, ultrasound, magnetic resonance imaging, and electromyography. With the exception of weakness, this patient experienced few symptoms. Treatment is symptomatic including anti-inflammatories, opiates, and neuroleptics for pain. There is some evidence that immunotherapy may help decrease the length of symptoms, but there is no strong evidence to support steroid use. Physical therapy, the foundation of therapy in this case, is a useful adjunct for rehabilitation. In general, this condition has a good prognosis for recovery, although often slow, even when there is complete denervation. This patient made a full recovery and has no lingering symptoms.
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Affiliation(s)
| | - Taryn Taylor
- Carleton Sport Medicine Clinic, Ottawa, Ontario, Canada
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Incidence of neuralgic amyotrophy (Parsonage Turner syndrome) in a primary care setting--a prospective cohort study. PLoS One 2015; 10:e0128361. [PMID: 26016482 PMCID: PMC4445915 DOI: 10.1371/journal.pone.0128361] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 04/26/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Neuralgic amyotrophy is considered a rare peripheral nervous system disorder but in practice seems grossly under recognized, which negatively affects care for these patients. In this study we prospectively counted the one-year incidence rate of classic neuralgic amyotrophy in a primary care setting. METHODS In a prospective cohort study during the year 2012 we registered all new cases of neck, shoulder or arm complaints from two large primary care centers serving a population of 14,118. Prior to study, general practitioners received a short training on how to diagnose classic neuralgic amyotrophy. Neuralgic amyotrophy was defined according to published criteria irrespective of family history. Only patients with a classic phenotype were counted as definite cases. After inclusion, patients with suspected neuralgic amyotrophy who had not yet seen a neurologist were offered neurologic evaluation for diagnostic confirmation. RESULTS Of the 492 patients identified with new onset neck, shoulder or arm complaints, 34 were suspected of having neuralgic amyotrophy. After neurologic evaluation the diagnosis was confirmed in 14 patients. This amounts to a one-year incidence rate for classic neuralgic amyotrophy of 1 per 1000. CONCLUSIONS Our findings suggest that neuralgic amyotrophy is 30-50 times more common than previously thought. Unawareness of the disorder and its clinical presentation seems the most likely explanation for this difference. An incidence rate of 1 per 1000 and the long-term sequelae many patients suffer warrant more vigilance in diagnosing the disorder, to pave the way for timely treatment and prevent complications.
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dos Santos RBM, dos Santos SM, Leal FJCC, Lins OG, Magalhães C, Fittipaldi RBM. Síndrome de Parsonage‐Turner. Rev Bras Ortop 2015. [DOI: 10.1016/j.rbo.2014.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Neuralgic amyotrophy associated with temporary vocal fold paralysis: successful treatment by vocal fold augmentation with hyaluronic acid. The Journal of Laryngology & Otology 2015; 129:e1. [DOI: 10.1017/s0022215115000468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackground:Neuralgic amyotrophy is a polyneuropathy that classically involves the brachial plexus. This paper reports an unusual clinical manifestation associated with vocal fold paralysis.Case report:A 36-year-old male presented with hoarseness and progressive weakness of the right shoulder and upper arm muscles. Laryngoscopy revealed a limited adduction of the right vocal fold.Results:Subsequent speech therapy did not improve the symptoms. Therefore, vocal fold augmentation by application of hyaluronic acid in the right vocal fold was performed.Conclusion:Vocal fold augmentation with resorbable material seems to be a more effective transient treatment than speech therapy alone for patients with neuralgic amyotrophy and laryngeal involvement.
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Intravenous corticosteroid therapy for bilateral parsonage-turner syndrome: a case report and review of the literature. Reg Anesth Pain Med 2015; 39:243-7. [PMID: 24694999 DOI: 10.1097/aap.0000000000000070] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Parsonage-Turner syndrome (PTS) is a distinct clinical disorder characterized by pain, sensory loss, and impaired mobility of the upper extremities and, less commonly, the lower extremities. Manifestations vary from minor to fairly extensive involvement of the brachial and/or lumbosacral plexus. No evidence-based treatment protocol exists, with only anecdotal support of varied palliative efforts. CASE REPORT We describe a case of PTS in an otherwise healthy 19-year-old man presenting with severe neuropathic pain in the right upper extremity progressing to include weakness and contralateral extremity involvement. Intravenous corticosteroids were initiated with resolution of the pain after the first day of therapy and improvement in muscular strength throughout his hospitalization. CONCLUSIONS This case supports the use of intravenous corticosteroids in the literature as a treatment option for PTS to ameliorate intractable pain as well as to impede the progression of motor dysfunction.
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Kim JH, Ha SW, Son BC. Spinal Cord Stimulation for Refractory Neuropathic Pain of Neuralgic Amyotrophy. Korean J Neurotrauma 2015; 11:162-6. [PMID: 27169086 PMCID: PMC4847503 DOI: 10.13004/kjnt.2015.11.2.162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 07/12/2015] [Accepted: 08/28/2015] [Indexed: 11/15/2022] Open
Abstract
The aim of this paper was to report the effect of temporary and chronic spinal cord stimulation for refractory neuropathic pain in neuralgic amyotrophy (NA). A 35-year-old female presented with two-months history of a severe, relentless neuropathic pain of the left shoulder, forearm, palm, and fingers. The neuropathic pain was refractory to various medical treatments, including nonsteroidal anti-inflammatory drugs, opiates, epidural and stellate ganglion blocks, and typically unrelenting. The diagnosis of NA was made with the characteristic clinical history and magnetic resonance imaging. The patient underwent a temporary spinal cord stimulation to achieve an adequate pain relief because her pain was notoriously difficult to control and lasted longer than the average duration (about 4 weeks on average) of a painful phase of NA. Permanent stimulation was given with paddle lead. The neuropathic pain in her NA persisted and she continued using the spinal cord stimulation with 12 months after development of NA. The temporary spinal cord stimulation was effective in a patient with an extraordinary prolonged, acute painful phase of NA attack, and the subsequent chronic stimulation was also useful in achieving an adequate analgesia during the chronic phase of NA.
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Affiliation(s)
- Jae-hun Kim
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang-woo Ha
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Byung-chul Son
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- The Catholic Neuroscience Institute, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Gupta A, Sundaram M, Winalski CS. MRI diagnosis of muscle denervation from herpes zoster with discordant distribution of the skin rash. Skeletal Radiol 2014; 43:1481-5. [PMID: 24880713 DOI: 10.1007/s00256-014-1905-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 04/23/2014] [Accepted: 04/28/2014] [Indexed: 02/02/2023]
Abstract
Herpes zoster is a common disorder characterized by a painful rash along a dermatome caused by reactivation of the varicella zoster virus (VZV). Muscle denervation injury from motor involvement is an uncommon phenomenon. Discordant distribution of the skin rash and motor nerve involvement, presenting as a skin rash in one body part and muscle weakness or pain from nerve involvement in another body part is an even more uncommonly reported finding. We present an unusual case of muscle denervation injury resulting from motor involvement of a peripheral nerve by VZV diagnosed by magnetic resonance imaging with cutaneous manifestations in a different dermatomal distribution. To the best of our knowledge, there has been no similar case reported in the English radiology literature. We suggest that whenever a radiologist notices MRI findings suggesting denervation injury and a cause not readily identified, VZV-related denervation injury should be included in the differential diagnosis, especially in an older immunocompromised patient.
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Affiliation(s)
- Amit Gupta
- Section of Musculoskeletal Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA,
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Fransz DP, Schönhuth CP, Postma TJ, van Royen BJ. Parsonage-Turner syndrome following post-exposure prophylaxis. BMC Musculoskelet Disord 2014; 15:265. [PMID: 25098693 PMCID: PMC4126347 DOI: 10.1186/1471-2474-15-265] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 07/14/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The 'Parsonage-Turner syndrome' (PTS) is a rare but distinct disorder with an abrupt onset of shoulder pain, followed by weakness and atrophy of the upper extremity musculature, and a slow recovery requiring months to years. To our best knowledge, this is the first case describing symptoms and signs of PTS following the administration of a post-exposure prophylaxis (PEP) regimen against possible human immunodeficiency virus (HIV) and hepatitis B virus (HBV) infection. CASE PRESENTATION A 25-year-old Caucasian man presented with pain and unilateral scapular winging following PEP against possible HIV and HBV infection. Although atrophy and weakness were observed for the right supraspinatus muscle, a full range of motion was achievable. Neurological examination, plain radiography of the right shoulder and electromyography showed no additional abnormalities. The patient was diagnosed with post-vaccination PTS and treated non-operatively. During the following 15 months the scapular winging receded and full muscle strength was regained. CONCLUSION Parsonage-Turner syndrome is a rare clinical diagnosis. The precise pathophysiological mechanism of PTS remains unclear, but it seems to involve an interaction between genetic predisposition, mechanical vulnerability and an autoimmune trigger. An immunological event, such as - in this case - a vaccination as part of PEP treatment, can trigger the onset of PTS. The clinical presentation is distinctive with acute severe pain followed by patchy paresis, atrophy and sensory symptoms that persist for months to years. No currently available tests can provide a definite confirmation or exclusion of PTS. Routine blood examination, electromyography (EMG), and computed tomography (CT) or magnetic resonance imaging (MRI) serve mainly to exclude other disorders. The recovery can be quite lengthy, non-operative treatment is the accepted practice. Supplementary administration of oral prednisolone could shorten the duration of pain. Although the outcome is typically preferable, a substantial amount of patients are left with some residual paresis and functional impairment.
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Affiliation(s)
| | - Casper P Schönhuth
- Department of Orthopaedic Surgery, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands.
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Subash M, Patel G, Welker J, Nugent K. Brachial Neuritis With Phrenic Nerve Involvement in a Patient With a Possible Connective Tissue Disease. J Investig Med High Impact Case Rep 2014; 2:2324709614535203. [PMID: 26425609 PMCID: PMC4528891 DOI: 10.1177/2324709614535203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background. Brachial neuritis (BN) is a rare inflammatory condition of peripheral nerves, usually involving the cervicobrachial plexus. These patients present with sudden onset of shoulder and arm pain that evolves into muscle weakness and atrophy.. Case Report. A 33-year-old woman presented with a 1-month history of diffuse pain in her thorax. She had no trauma or inciting incident prior to the onset of this pain and was initially treated for muscle spasms. The patient was seen in the emergency room multiple times and was treated with several courses of antibiotics for pneumonia on the basis of clinical symptoms and abnormal x-rays. The pleuritic chest pain persisted for at least 4 months, and the patient was eventually admitted for worsening pain and dyspnea. On physical examination, crackles were heard at both lung bases, and chest inspection revealed increased expansion in the upper thorax but poor expansion of the lower thorax and mild paradoxical respiration. “Sniff” test revealed no motion of the left hemidiaphragm and reduced motion on the right hemidiaphragm. Her computed tomography scan revealed bilateral atelectasis, more severe at the left base. She reported no symptoms involving her joints or skin or abdomen. Her presentation and clinical course are best explained by BN with a bilateral diaphragmatic weakness. However, she had a positive ANA, RF, anti-RNP antibody, and anti SS-A. Conclusion. Patients with BN can present with diffuse thoracic pain, pleuritic chest pain, and diaphragmatic weakness. Our patient may represent a case of connective tissue disease presenting with brachial plexus neuritis.
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Affiliation(s)
- Meera Subash
- Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Gaurav Patel
- Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - John Welker
- Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Kenneth Nugent
- Texas Tech University Health Sciences Center, Lubbock, TX, USA
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Robinson M, Fulcher M. Brachial neuritis following a corticosteroid injection. BMJ Case Rep 2014; 2014:bcr-2013-203126. [PMID: 24596414 DOI: 10.1136/bcr-2013-203126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This report presents a case of brachial neuritis following a subacromial corticosteroid injection. The patient developed an anterior interosseous neuropathy shortly after the injection, with no other trigger being identified. This neuropathy has unfortunately not shown any sign of recovery at 2 years. The authors propose that corticosteroid injection be added to the list of possible triggering events of brachial neuritis and highlight the frequent use of oral corticosteroids in its treatment. (1) The injection of local anaesthetic and corticosteroid should be considered as a potential trigger for brachial neuritis. (2) Brachial neuritis should be considered in the differential diagnosis for patients presenting with severe arm pain and weakness. (3) The nerves originating from the upper trunk of the brachial plexus are most commonly affected. (4) The anterior interosseous nerve is involved in one-third of cases.
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Ritter C, Wunderlich G, Macht S, Schroeter M, Fink GR, Lehmann HC. [Differential diagnostics of diseases of the brachial plexus]. DER NERVENARZT 2014; 85:176-188. [PMID: 24343110 DOI: 10.1007/s00115-013-3949-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Progressive, atrophic, asymmetrically distributed flaccid paresis of arm and hand muscles represents a frequent symptom of neuromuscular diseases that can be attributed to injury of the arm nerves, the plexus or the cervical roots. A timely and exact diagnosis is mandatory; however, the broad spectrum of differential diagnoses often represents a diagnostic challenge. A large variety of neuromuscular disorders need to be considered, encompassing autoimmune mediated inflammatory neuropathic conditions, such as multifocal motor neuropathy, as well as chronic degenerative and nerve compression disorders. This review provides an overview of the most frequent disorders of the upper plexus and cervical roots and summarizes the characteristic clinical features as well as electrodiagnostic and laboratory test results. In addition the diagnostic value of magnetic resonance imaging and sonography is discussed.
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Affiliation(s)
- C Ritter
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
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Rattananan W, Thaisetthawatkul P, Dyck PJB. Postsurgical inflammatory neuropathy: a report of five cases. J Neurol Sci 2013; 337:137-40. [PMID: 24332011 DOI: 10.1016/j.jns.2013.11.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Revised: 11/19/2013] [Accepted: 11/20/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Clinical and pathologic descriptions of postsurgical inflammatory neuropathy have been reported but this condition is still under recognized. METHODS We reviewed 5 cases of a biopsy-proven inflammatory neuropathy that occurred within 30 days after surgical procedures. These patients were seen at one center in a 2-year period. RESULTS All patients developed neuropathy symptoms with time delay between the surgery and the neuropathy onset. In all, the symptoms progressed up to the time of evaluation. Electrophysiological studies revealed mononeuropathy or asymmetrical polyneuropathy with active denervation. Nerve biopsies showed ischemic injury and perivascular inflammatory collections in all cases. All patients were treated with intravenous methylprednisolone and four of them showed clinical improvement. The non-responsive patient did not receive immunotherapy until 2 years after neuropathy onset. CONCLUSIONS The report illustrates that focal or asymmetrical neuropathy is typical of postsurgical inflammatory neuropathy and has a favorable outcome after intravenous corticosteroid treatment. The report underscores the importance for considering potentially treatable inflammatory neuropathies in the post-surgical setting.
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Affiliation(s)
- Watcharasarn Rattananan
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, United States
| | - Pariwat Thaisetthawatkul
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, United States.
| | - P James B Dyck
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
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Zuberbuhler P, León Cejas LV, Binaghi D, Reisin RC. Acute brachial plexus neuropathy with involvement of cranial nerves IX, X, XI and XII. J Neurol Sci 2013; 334:169-71. [PMID: 23953851 DOI: 10.1016/j.jns.2013.07.2515] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Revised: 06/25/2013] [Accepted: 07/22/2013] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Acute brachial plexus neuropathy is characterized by acute onset of shoulder girdle and arm pain, followed by weakness of the shoulder and arm muscles. It affects primarily nerves of the upper trunk of the brachial plexus and the long thoracic nerve. Cranial nerve involvement is an infrequent association and implies a diagnostic challenge. We report a unique case of acute brachial plexus neuropathy with involvement of the cranial nerves IX, X, XI and XII. CASE REPORT Fifty six year-old woman who developed acute dysphonia, dysphagia and left shoulder pain, followed, six days later, by left arm weakness. Needle examination showed only fibrillation potentials and positive sharp waves in the left deltoid muscle. MRI of the brachial plexus shows enlargement of the trunks, cords and terminal branches, with mild gadolinium enhancement. DISCUSSION This case illustrates the unique presentation of neuralgic amyotrophy with involvement of nerves outside the brachial plexus, and the importance of MRI for diagnosis, in the absence of electrophysiologic involvement.
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Affiliation(s)
- Paz Zuberbuhler
- Neurology Department, Hospital Álvarez, Buenos Aires, Argentina.
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Nociti V, Monforte M, Perna A, Madia F, Melchiorri G, Mirabella M. Case of postpartum Parsonage-Turner syndrome. Muscle Nerve 2013; 49:294-5. [PMID: 24037750 DOI: 10.1002/mus.24073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 08/26/2013] [Accepted: 09/03/2013] [Indexed: 11/11/2022]
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Twaij H, Rolls A, Sinisi M, Weiler R. Thoracic outlet syndromes in sport: a practical review in the face of limited evidence — unusual pain presentation in an athlete. Br J Sports Med 2013; 47:1080-4. [DOI: 10.1136/bjsports-2013-093002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Pareyson D, Marchesi C, Salsano E. Dominant Charcot-Marie-Tooth syndrome and cognate disorders. HANDBOOK OF CLINICAL NEUROLOGY 2013; 115:817-845. [PMID: 23931817 DOI: 10.1016/b978-0-444-52902-2.00047-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Charcot-Marie-Tooth neuropathy (CMT) is a group of genetically heterogeneous disorders sharing a similar phenotype, characterized by wasting and weakness mainly involving the distal muscles of lower and upper limbs, variably associated with distal sensory loss and skeletal deformities. This chapter deals with dominantly transmitted CMT and related disorders, namely hereditary neuropathy with liability to pressure palsies (HNPP) and hereditary neuralgic amyotrophy (HNA). During the last 20 years, several genes have been uncovered associated with CMT and our understanding of the underlying molecular mechanisms has greatly improved. Consequently, a precise genetic diagnosis is now possible in the majority of cases, thus allowing proper genetic counseling. Although, unfortunately, treatment is still unavailable for all types of CMT, several cellular and animal models have been developed and some compounds have proved effective in these models. The first trials with ascorbic acid in CMT type 1A have been completed and, although negative, are providing relevant information on disease course and on how to prepare for future trials.
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Affiliation(s)
- Davide Pareyson
- Clinics of Central and Peripheral Degenerative Neuropathies Unit, Department of Clinical Neurosciences, IRCCS Foundation, C. Besta Neurological Institute, Milan, Italy.
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Silbert BI, Kolm S, Silbert PL. Postprocedural inflammatory inferior alveolar neuropathy: an important differential diagnosis. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 115:e1-3. [PMID: 23217545 DOI: 10.1016/j.oooo.2011.08.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2011] [Revised: 08/21/2011] [Accepted: 08/23/2011] [Indexed: 02/01/2023]
Abstract
Lingual or inferior alveolar nerve (IAN) injury after dental procedures may result from direct trauma or local anesthetic agent and presents with immediate onset of typically nonprogressive symptoms, including pain and sensory changes. We report a case of delayed-onset pain and progressive sensory symptoms after IAN block for amalgam restoration. A 54-year-old man presented with progressive right-sided facial pain 48 hours after IAN block for amalgam restoration, followed 1 week later by hypoesthesia and allodynia in IAN distribution. The presentation is more consistent with inflammatory neuropathy, as is well recognized in brachial plexopathy. Imaging was used to exclude local and central causes, following which the clinical diagnosis was made. Inflammatory neuropathies may be distinguished from iatrogenic causes on the basis of delayed symptom onset, early severe pain, and progressive sensory symptoms. Awareness of this condition is important, because early steroid therapy followed by medications for neuropathic pain may provide benefit.
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