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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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Parsonage-Turner Syndrome After COVID-19 Vaccination in a Child. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202303000-00006. [PMID: 36893168 PMCID: PMC10005827 DOI: 10.5435/jaaosglobal-d-22-00156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 01/28/2023] [Indexed: 03/10/2023]
Abstract
Parsonage-Turner syndrome (PTS) is a peripheral neuropathy involving the brachial plexus very rare in childhood. To date, no cases of PTS after COVID-19 vaccination have been reported in children. We report a case of a 15-year-old boy affected by PTS after the second dose of the BNT162b2 (Comirnaty, Pfizer-BioNTech) COVID-19 vaccine.
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Abstract
PURPOSE OF REVIEW This review focuses on the current insights and developments in neuralgic amyotrophy (NA), an auto-immune multifocal peripheral nervous system disorder that leaves many patients permanently impaired if not recognized and treated properly. RECENT FINDINGS NA is not as rare as previously thought. The phenotype is broad, and recent nerve imaging developments suggest that NA is the most common cause of acute anterior or posterior interosseous nerve palsy. Phrenic nerve involvement occurs in 8% of all NA patients, often with debilitating consequences. Acute phase treatment of NA with steroids or i.v. immunoglobulin may benefit patients. Long-term consequences are the rule, and persisting symptoms are mainly caused by a combination of decreased endurance in the affected nerves and an altered posture and movement pattern, not by the axonal damage itself. Patients benefit from specific rehabilitation treatment. For nerves that do not recover, surgery may be an option. SUMMARY NA is not uncommon, and has a long-term impact on patients' well-being. Early immunomodulating treatment, and identifying phrenic neuropathy or complete nerve paralysis is important for optimal recovery. For persistent symptoms a specific treatment strategy aiming at regaining an energy balance and well-coordinated scapular movement are paramount.
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Hu X, Jing M, Feng J, Tang J. Four cases of pediatric neuralgic amyotrophy treated with immunotherapy: one-year follow-up and literature review. J Int Med Res 2021; 48:300060520912082. [PMID: 32228355 PMCID: PMC7132571 DOI: 10.1177/0300060520912082] [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] [Indexed: 11/17/2022] Open
Abstract
Neuralgic amyotrophy (NA) is a neurological disease that occurs across all age
groups, but its prognosis in children is controversial. The present report adds
to the knowledge about its prognosis by describing four cases of pediatric NA in
which the patients were treated with immunotherapy and followed up for 1 year.
We also present a summary of relevant cases of pediatric NA treated with
immunotherapy. The clinical features of the four present cases were similar to
those of previously reported cases, and their symptoms improved after
immunotherapy. At the 1-year follow-up, three of the children gained near
complete recovery, and their improvement was significantly better than that
observed at the 2-month follow-up. A review of the literature showed that most
previously reported children with NA showed improvement after immunotherapy, but
no more than half of the patients recovered fully. These findings indicate that
in children with NA, immunotherapy is fairly effective and its benefits improve
with time. Thus, long-term follow-up is needed in these patients to determine
their prognosis.
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Affiliation(s)
- Xiaoyue Hu
- Department of Neurology, Children's Hospital of Soochow University, Suzhou, Jiangsu Province, China.,Department of Neurology, Wuxi Children's Hospital, Wuxi, Jiangsu Province, China
| | - Miao Jing
- Department of Neurology, Wuxi Children's Hospital, Wuxi, Jiangsu Province, China
| | - Jun Feng
- Department of Neurology, Children's Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Jihong Tang
- Department of Neurology, Children's Hospital of Soochow University, Suzhou, Jiangsu Province, China
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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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Manfredi M, Gismondi P, Iuliano S, Maffini V, Scivales S, Gargano G. A rare presentation of neuralgic amyotrophy in a child and a review of recent literature. J Int Med Res 2019; 47:5817-5823. [PMID: 31526173 PMCID: PMC6862908 DOI: 10.1177/0300060519868632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Neuralgic amyotrophy (NA), also known as brachial neuritis and previously known as Parsonage–Turner Syndrome, has an unknown etiology. Patients with NA have a clinical pattern characterized by sudden and acute pain across the shoulder followed by flaccid paralysis. NA has an incidence of one new case per 1000 people per year with an onset of age ranging between 20 and 60 years. We describe a rare presentation of NA in a Caucasian boy who was 11 years old and did not have any other family members affected by NA. All diagnostic studies were normal and he had full recovery 5 months from the onset of symptoms. We revised the recent literature of NA. No specific diagnostic studies can confirm the diagnosis of NA, although magnetic resonance imaging or electrophysiological studies can highlight some special features. Treatment of NA is symptomatic and it is based on analgesic drugs and physical therapy, although early administration of steroids appears to improve the outcome. Prognosis of NA is generally favorable with full recovery usually within 2 years. This disease is typically an adult syndrome, but pediatricians should also be aware of this entity to avoid delays in diagnosis.
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Affiliation(s)
- Marco Manfredi
- Pediatric Unit, Maternal and Child Department, Azienda USL-IRCCS of Reggio Emilia, Sant'Anna Hospital, Castelnovo ne' Monti, Italy
| | - Pierpacifico Gismondi
- Department of Pediatrics, "Pietro Barilla" Children's Hospital, University Hospital, Parma, Italy
| | - Silvia Iuliano
- Department of Pediatrics, "Pietro Barilla" Children's Hospital, University Hospital, Parma, Italy
| | - Valentina Maffini
- Department of Pediatrics, "Pietro Barilla" Children's Hospital, University Hospital, Parma, Italy
| | - Sonya Scivales
- Pediatric Unit, Maternal and Child Department, Azienda USL-IRCCS of Reggio Emilia, Sant'Anna Hospital, Castelnovo ne' Monti, Italy
| | - Giancarlo Gargano
- Head of Maternal and Child Department, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
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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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Al-Ghamdi F, Ghosh PS. Neuralgic amyotrophy in children. Muscle Nerve 2018; 57:932-936. [DOI: 10.1002/mus.26060] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/03/2018] [Accepted: 01/06/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Fouad Al-Ghamdi
- Department of Neurology; Boston Children's Hospital, 300 Longwood Avenue; Boston Massachusetts 02115 USA
- Department of Neurology; King Fahad Specialist Hospital; Dammam Saudi Arabia
| | - Partha S. Ghosh
- Department of Neurology; Boston Children's Hospital, 300 Longwood Avenue; Boston Massachusetts 02115 USA
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Van Eijk JJJ, Groothuis JT, Van Alfen N. Neuralgic amyotrophy: An update on diagnosis, pathophysiology, and treatment. Muscle Nerve 2016; 53:337-50. [PMID: 26662794 DOI: 10.1002/mus.25008] [Citation(s) in RCA: 160] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2015] [Indexed: 12/21/2022]
Abstract
In this review we provide a current overview of the clinical features, pathophysiology, epidemiology, and diagnostic and therapeutic strategies in neuralgic amyotrophy (NA). The disorder has several phenotypic variations, with a classic form in 70% of the patients. It is not rare, with an incidence of 1 per 1,000 individuals, but it is still often missed. Recurrences are common, yet the proposed multifactorial etiology, which includes genetic, biomechanical, and immunologic factors, limits our capacity to predict or prevent them. NA is a clinical diagnosis, and ancillary studies serve to exclude infectious or malignant causes or to assess a differential diagnosis. If patients are seen early and are still in pain, a short trial of high-dose oral corticosteroids is advised, and adequate analgesia may require opioids and non-steroidal anti-inflammatory drugs. Persistent complaints are common, and a multidisciplinary rehabilitation approach focusing on scapular coordination, energy distribution strategies, and self-management is indicated.
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Affiliation(s)
- Jeroen J J Van Eijk
- Department of Neurology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands.,Department of Neurology and Clinical Neurophysiology, Donders Centre for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan T Groothuis
- Department of Rehabilitation, Donders Centre for Neuroscience, Radboud University Medical Center, P.O. Box 9101, 6500, HB Nijmegen, The Netherlands
| | - Nens Van Alfen
- Department of Neurology and Clinical Neurophysiology, Donders Centre for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
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Abstract
Not available.
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Jain S, Bhatt GC, Rai N, Bhan BD. Idiopathic brachial neuritis in a child: A case report and review of the literature. J Pediatr Neurosci 2015; 9:276-7. [PMID: 25624937 PMCID: PMC4302554 DOI: 10.4103/1817-1745.147593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Brachial neuritis is a rare disease in children, affecting mainly the lower motor neurons of the brachial plexus and/or individual nerves or nerve branches. We report a case of idiopathic brachial plexus neuritis in a 2½-year-old female child admitted with acute respiratory distress and given antibiotic therapy following which she developed weakness of the left hand. She was diagnosed as a case of idiopathic brachial plexus neuritis and was given supportive care. Although, the association with antibiotic therapy in this case could be incidental, indeed it is intriguing and requires further studies.
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Affiliation(s)
- Shikha Jain
- Department of Pediatrics, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Girish Chandra Bhatt
- Department of Pediatrics, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Nirendra Rai
- Department of Neurology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Bhavna Dhingra Bhan
- Department of Pediatrics, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
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Yamada K, Mano T, Toribe Y, Yanagihara K, Suzuki Y. MRI findings and steroid therapy for neuralgic amyotrophy in children. Pediatr Neurol 2011; 45:200-2. [PMID: 21824572 DOI: 10.1016/j.pediatrneurol.2011.05.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Accepted: 05/23/2011] [Indexed: 11/18/2022]
Abstract
Neuralgic amyotrophy is not uncommon in adults but is relatively rare in children. We recently encountered 2 cases of neuralgic amyotrophy in children. Patient 1 was a 7-year-old girl who developed a right leg paralysis after an epileptic seizure. Lumbar plexus T(2)-weighted magnetic resonance imaging (MRI) revealed a hyperintense and thickened portion extending from the root to the knee region of the right sciatic nerve, and T(1)-weighted conventional spin echo with gadolinium administration revealed enhancement. Patient 2 was a 4-year-old boy who experienced a sudden onset of severe right arm pain and paralysis. T(2)-weighted MRI with a short tau inversion recovery revealed a slightly thickened and high intensity region at the right C(6)-C(8) level. After high-dose methylprednisolone pulse therapy was performed in each case, patient 1 experienced complete recovery, whereas patient 2 experienced only amelioration of pain. A diagnosis of neuralgic amyotrophy in children was facilitated by an MRI study (T(2) weighed with short tau inversion recovery and T(1) weighted with gadolinium enhancement), and early steroid therapy might have improved the condition of these children.
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Affiliation(s)
- Keitaro Yamada
- Department of Pediatric Neurology, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan.
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