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Suroto H, Rahman A. Traumatic brachial plexus injury: proposal of an evaluation functional prognostic scoring system. Br J Neurosurg 2024; 38:643-647. [PMID: 34240686 DOI: 10.1080/02688697.2021.1947975] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/14/2021] [Accepted: 06/22/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Until now, a scoring system for determining functional prognosis in traumatic brachial plexus injury (TBPI) does not yet exist. MATERIALS AND METHODS This research is a retrospective study with analytic design to find data for each parameter that affect the functional prognosis in patients with TBPI and assess these factors for comparison using the DASH score. The parameters that are proven to affect the functional prognosis included in a scoring system that we have designed. RESULTS It resulted that the functional prognosis of TBPI patients can be determined based on the mechanism of injury, initial pain scale, pain time, level of injury, time of surgery, and initial electromyography (EMG) result. CONCLUSION Based on the scoring system created in this study, we can conclude that the total score <15 has a good functional prognosis, while a score of ≥15 has a bad functional prognosis, with sensitivity and specificity of 76.6% and 70.2% respectively. This research is categorized as level 3 of evidence.
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Affiliation(s)
- Heri Suroto
- Department of Orthopaedic and Traumatology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Ansari Rahman
- Department of Orthopaedic and Traumatology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
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2
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Aghtarafi N, Makhdoom N, Arnaout A, Wong KY. Brachial Plexus Injury Secondary to Spontaneous Upper Limb Haematoma. Cureus 2024; 16:e55693. [PMID: 38586769 PMCID: PMC10998644 DOI: 10.7759/cureus.55693] [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: 03/06/2024] [Indexed: 04/09/2024] Open
Abstract
Spontaneous upper limb muscle haematomas are rare clinical phenomenons, which often go under- or misdiagnosed. They can present management challenges in the context of anticoagulant therapy, especially in the presence of other medical conditions. We present the case of a 52-year-old male with an initially missed presentation of a spontaneous muscle haematoma that progressed and re-presented to the emergency department (ED) with signs of mixed upper limb neuropathy requiring surgical evacuation and an emergency fasciotomy. This case highlights the importance of prompt diagnosis and intervention. While brachial plexus injuries from haematoma compression are uncommon, in our case, we discuss the need for surgical intervention to relieve pressure and optimise patient outcomes when clinically concerned about compartment syndrome or progressive neuropathy.
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Affiliation(s)
- Natasha Aghtarafi
- Radiology, East Suffolk and North Essex NHS Foundation Trust, Ipswich, GBR
| | - Natalia Makhdoom
- General Surgery, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, GBR
| | - Ali Arnaout
- Plastic and Reconstructive Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, GBR
| | - Kai Yuen Wong
- Plastic and Reconstructive Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, GBR
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3
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Sharma M, Bohara S, Manandhar S, Manandhar L, Maharjan SK. Postoperative Acute Submandibular Sialadenitis: A Case Report. JNMA J Nepal Med Assoc 2023; 61:668-670. [PMID: 38289814 PMCID: PMC10566616 DOI: 10.31729/jnma.8238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Indexed: 02/01/2024] Open
Abstract
Acute postoperative sialadenitis is a rare complication usually after surgery involving extreme head and neck rotation, such as posterior fossa surgery. It is characterized by the development of swelling in the submandibular region, usually contralateral to the surgical side, either immediately or within hours post-operatively. We report a case of a 43-year-old woman who developed sialadenitis leading to upper airway obstruction in the postoperative period. Further, she developed bilateral neck and face swelling. Dexmedetomidine used as an infusion throughout the surgery could be an additional cause. Swelling without signs of inflammation is rapidly progressive and may cause airway obstruction. Therefore, awareness and recognition are important, as a delay in airway securement can cause a complete collapse of the airway. Keywords airway obstruction; case reports; sialadenitis.
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Affiliation(s)
- Mona Sharma
- Department of Anesthesia and Intensive Care, Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
| | - Sandeep Bohara
- Department of Neurosurgery, Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
| | - Stuti Manandhar
- Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
| | - Lumu Manandhar
- Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
| | - Shyam Krishna Maharjan
- Department of Anesthesia and Intensive Care, Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
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4
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Gül S, Ahmed AF, McGraw C, Nasany RA. Magnetic Resonance Imaging-Negative Varicella Zoster Virus Plexopathy in a Young Patient: A Case Report. Cureus 2023; 15:e39876. [PMID: 37404385 PMCID: PMC10315163 DOI: 10.7759/cureus.39876] [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: 06/02/2023] [Indexed: 07/06/2023] Open
Abstract
Varicella zoster virus (VZV)-associated plexopathy mainly occurs in patients over 60 years old. Postherpetic neuralgia is a well-known complication of herpes zoster (HZ); however, segmental zoster paresis secondary to HZ was reported in 1-20% of cases in the literature. Magnetic resonance imaging (MRI) findings may be positive in up to 70% of the patients. We describe a 43-year-old male patient with a history of grade two left frontal oligodendroglioma, which was treated with two partial resections, radiation treatment and procarbazine/lomustine, who presented with left upper extremity pain and developed a blistering rash in a dermatomal pattern in the left proximal upper extremity two weeks after the initial symptoms. He was diagnosed with shingles and treated with steroids and acyclovir with minimal improvement. Six weeks after the initial symptoms, a physical exam revealed left deltoid, supraspinatus and infraspinatus weakness with normal muscle stretch reflexes and decreased sensation on the C5 dermatome. Electromyography (EMG) revealed absent left lateral antebrachial cutaneous sensory nerve action potentials (SNAP) amplitude and a small left radial SNAP amplitude compared to the right side. Evidence of ongoing denervation with reinnervation was seen in the left upper trunk-supplied muscles. MRI of the brachial plexus was negative for any abnormalities. The patient was diagnosed with VZV-associated plexopathy, which improved with pregabalin and physical therapy. Our patient was significantly younger than expected in the HZ group. MRI usually shows T2 hyperintensities and thickening of the nerve roots in patients with VZV-associated plexopathy. However, the presentation, onset of symptoms, characteristics of the rash, and clinical course were diagnostic of HZ, and the weakness pattern, supported by the EMG findings, was diagnostic of VZV-associated plexopathy.
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Affiliation(s)
- Sedat Gül
- Neurology, State University of New York Upstate Medical University, Syracuse, USA
| | - Adeenah F Ahmed
- Neurology, State University of New York Upstate Medical University, Syracuse, USA
| | - Corey McGraw
- Neurology, State University of New York Upstate Medical University, Syracuse, USA
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5
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Ng GJ, Chiew YR, Kong Y, Koh JS. Neuralgic amyotrophy in COVID-19 infection and after vaccination. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2022; 51:376-377. [PMID: 35786759 DOI: 10.47102/annals-acadmedsg.2022106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Gee Jin Ng
- Department of Neurology, National Neuroscience Institute, Singapore
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6
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Zhao KL, Liu Y, Scherpelz KP, Kao DS, Friedrich JB. Occult primary breast cancer presenting with brachial plexopathy: A case report. SAGE Open Med Case Rep 2021; 9:2050313X20985646. [PMID: 34262768 PMCID: PMC8243102 DOI: 10.1177/2050313x20985646] [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: 10/09/2020] [Accepted: 12/14/2020] [Indexed: 11/17/2022] Open
Abstract
Breast cancer affects about one in eight women over the course of her lifetime. Occult breast cancer, in which primary breast cancer is detected without evidence of disease in the breast itself, comprises up to 1% of new diagnoses; this is typically detected from abnormal axillary lymph nodes, and distant metastases are rare. Here, we present an unusual case of occult breast cancer presenting as upper extremity pain, edema, and weakness, with a metastatic mass to the brachial plexus being the only site of disease.
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Affiliation(s)
- Karen L Zhao
- Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, WA, USA
| | - Yusha Liu
- Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, WA, USA
| | - Kathryn P Scherpelz
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Dennis S Kao
- Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, WA, USA
| | - Jeffrey B Friedrich
- Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, WA, USA
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7
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Jain D, Goyal T, Paswan AK, Verma N. Sequential Supraclavicular Brachial Plexus and Stellate Ganglion Neurolysis for Upper Limb Pain in Metastatic Breast Cancer. Indian J Palliat Care 2021; 27:180-182. [PMID: 34035637 PMCID: PMC8121234 DOI: 10.4103/ijpc.ijpc_89_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/01/2020] [Accepted: 10/02/2020] [Indexed: 11/25/2022] Open
Abstract
Neuropathic pain in cancer can result in severe debilitation to a patient with limited treatment options. Interventional modalities like nerve destruction can provide relief but at the expense of motor paralysis. Sympathetic pain is often an undiagnosed and undertreated condition that may accompany cases of chronic pain. We describe a case of severe neuropathic pain in brachial plexopathy in a middle-aged woman caused by metastatic breast cancer that was managed by chemical neurolysis of brachial plexus. Residual pain was treated by neurolysis of stellate ganglion due to the presence of sympathetic pain. This case report highlights the importance of the dual nature of pain and its management by chemical neurolysis in severe refractory neuropathic and sympathetic mediated pain.
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Affiliation(s)
- Dhruv Jain
- Department of Anaesthesiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Titiksha Goyal
- Department of Anaesthesiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Anil Kumar Paswan
- Department of Anaesthesiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Nimisha Verma
- Department of Anaesthesiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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8
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Brachial Plexopathy as an Unusual First Sign of a Head and Neck Cancer: Case Report. ACTA MEDICA MARTINIANA 2020. [DOI: 10.2478/acm-2020-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Malignancies in the ENT (Ear, Nose, and Throat) area are mostly manifested by dysphagia, dysphonia, dyspnea, throat swelling, and other “traditional” head and neck symptoms. Sporadically, a primary tumor or metastasis can reach such a size and it can be localized in such an area in which it can cause the pathology of the brachial plexus. If this appears first, differential diagnosis may be more difficult.
In this article the authors review current literature knowledge and present the case of this unusual sign of a head and neck cancer at the Clinic of Otorhinolaryngology and Head and Neck Surgery, Jessenius Faculty of Medicine, Comenius University, and Martin University Hospital, Martin, Slovakia.
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9
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Verma R, Sarkar S, Shettigar C. Zoster Brachial Plexopathy as a Presenting Manifestation of Human Immunodeficiency Virus Infection. Ann Indian Acad Neurol 2020; 23:804-807. [PMID: 33688132 PMCID: PMC7900725 DOI: 10.4103/aian.aian_158_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 04/15/2019] [Accepted: 04/18/2019] [Indexed: 11/28/2022] Open
Abstract
Brachial plexopathy is an uncommon neurologic complication of varicella-zoster virus (VZV) infection. VZV is not an acquired immunodeficiency syndrome-defining illness, but human immunodeficiency virus (HIV) infection is a risk factor for atypical and severe complications of VZV reactivation. Here, we present a 70-year-old male, who presented with left upper-limb weakness, preceded by painful dermatomal vesicular eruption, and was diagnosed to have zoster brachial plexopathy. This severe and atypical manifestation of VZV prompted HIV infection testing, leading to a new diagnosis of HIV infection.
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Affiliation(s)
- Rajesh Verma
- Department of Neurology, King George's Medical University, Lucknow, Uttar Pradesh, India,Address for correspondence: Prof. Rajesh Verma, Department of Neurology, King George's Medical University, Lucknow - 226 003, Uttar Pradesh, India. E-mail:
| | - Soumik Sarkar
- Department of Neurology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Chetan Shettigar
- Department of Neurology, King George's Medical University, Lucknow, Uttar Pradesh, India
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10
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Youngner JM, Matsuo K, Grant T, Garg A, Samet J, Omar IM. Sonographic evaluation of uncommonly assessed upper extremity peripheral nerves: anatomy, technique, and clinical syndromes. Skeletal Radiol 2019; 48:57-74. [PMID: 30033506 DOI: 10.1007/s00256-018-3028-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 06/13/2018] [Accepted: 06/17/2018] [Indexed: 02/02/2023]
Abstract
Targeted ultrasound of the median, ulnar, and radial nerves is a well-established technique for suspected upper extremity peripheral neuropathy. However, sonographic imaging of the brachial plexus and smaller peripheral nerve branches is more technically difficult and the anatomy is less familiar to many radiologists. As imaging techniques improve, many clinicians refer patients for imaging of previously less-familiar structures. In addition, some patients may present with injuries that could involve local neurovascular structures. Finally, patients presenting with isolated peripheral neuropathies may be referred for perineural injections with local anesthetic for diagnostic purposes, or steroid for therapeutic reasons. This requires sonologists to have a firm understanding of the courses of these nerves and the surrounding anatomic landmarks that can be used to accurately identify and characterize them. We discuss clinical syndromes referable to specific peripheral nerve branches in the upper extremity, the relevant anatomy, and sonographic technique.
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Affiliation(s)
- Jonathan M Youngner
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair St. Ste 800, Chicago, IL, 60616, USA.
| | - Kulia Matsuo
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair St. Ste 800, Chicago, IL, 60616, USA
| | - Tom Grant
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair St. Ste 800, Chicago, IL, 60616, USA
| | - Ankur Garg
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair St. Ste 800, Chicago, IL, 60616, USA
| | - Jonathan Samet
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair St. Ste 800, Chicago, IL, 60616, USA.,Department of Radiology, Lurie Children's Hospital, Chicago, IL, USA
| | - Imran M Omar
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair St. Ste 800, Chicago, IL, 60616, USA
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11
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Singh N, Ray S, Srivastava A. Clinical Mimickers of Amyotrophic Lateral Sclerosis-Conditions We Cannot Afford to Miss. Ann Indian Acad Neurol 2018; 21:173-178. [PMID: 30258257 PMCID: PMC6137639 DOI: 10.4103/aian.aian_491_17] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Giving a diagnosis of amyotrophic lateral sclerosis to a patient is akin to handing out a death certificate. However, not all patients presenting with the classical dysphagia, wasting, and weakness may have motor neuron diseases. In these cases, it is extremely important not to miss little cues which can suggest an alternative diagnosis and in many cases a lease of life in terms of a treatment option. In this review, we consider some clinical scenarios that can present with the same symptom complex as diseases involving motor neurons but have a different anatomical or etiopathological basis and in many cases even a therapeutic option.
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Affiliation(s)
- Nishita Singh
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Sucharita Ray
- Department of Neurology, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Achal Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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12
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Ganaha S, Lara-Velazquez M, Yoon JW, Akinduro OO, Clendenen SR, Murray PM, Pichelmann MA, Quinones-Hinojosa A, Deen HG. Challenges of Managing Patients with Symptomatic Large Traumatic Cervical Pseudomeningoceles. World Neurosurg 2018; 115:128-133. [PMID: 29654960 DOI: 10.1016/j.wneu.2018.04.017] [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: 02/05/2018] [Revised: 04/02/2018] [Accepted: 04/03/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND Traumatic cervical pseudomeningoceles (TCPs) occur secondary to traction of the cervical nerve roots resulting in violation of the dura. Surgical repair is not necessary in most cases because pseudomeningoceles have a high propensity to spontaneously resolve with conservative management alone. Currently, there are a limited number of cases of large TCPs (large is defined as ≥6 cm in greatest diameter), and there is no established guideline for the management of such lesions. CASE DESCRIPTION We describe the cases of 2 young men in their 20s who were involved in a motor vehicle accident. Both patients suffered a brachial plexus injury and developed large TCPs. Patient 1 was treated surgically for TCP using a combined intra-/extradural approach using a fascia lata graft. Patient 2 was ultimately treated nonsurgically because a spontaneous resolution of the pseudomeningocele was achieved over the period of 7 months after the accident. Both patients underwent brachial plexus repair surgery consisting of spinal accessory nerve transfer to the suprascapular nerve and intercostal nerve transfer to the musculocutaneous nerve. CONCLUSIONS Disease progression of TCPs is a dynamic process, and even large lesions may spontaneously resolve without surgical intervention. When surgery is indicated, a definitive dural repair using a fascia lata graft to cover the dural tear intra- and extradurally is an effective method. Surgery must be planned carefully on a case-by-case basis, and close follow-up with thorough physical examination and serial imaging is critical to monitor disease progression.
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Affiliation(s)
- Sara Ganaha
- Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Jang W Yoon
- Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA
| | | | | | - Peter M Murray
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | | | | | - H Gordon Deen
- Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA.
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13
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Rhabdomyolysis resulting in concurrent Horner's syndrome and brachial plexopathy: a case report. Skeletal Radiol 2017; 46:1131-1136. [PMID: 28321484 DOI: 10.1007/s00256-017-2634-5] [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: 02/07/2017] [Revised: 03/05/2017] [Accepted: 03/13/2017] [Indexed: 02/02/2023]
Abstract
This case report describes a 29-year-old male who presented with immediate onset of Horner's syndrome and ipsilateral brachial plexopathy after sleeping with his arm dangling outside a car window for 8 h. Outside workup and imaging revealed rhabdomyolysis of the left neck musculature. Subsequent electrodiagnostic testing and high-resolution brachial plexus magnetic resonance imaging at the authors' institution attributed the Horner's syndrome and concurrent brachial plexopathy to rhabdomyolysis of the longus colli and scalene musculature, which had compressed-and consequently scar tethered-the cervical sympathetic trunk and brachial plexus. This case of co-existent Horner's syndrome and brachial plexopathy demonstrates the role of high-resolution brachial plexus MRI in diagnosing plexopathy and the importance of being familiar with plexus and paravertebral muscle anatomy.
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14
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Cerrahoglu L, Erol O, Sirin TC. Idiopathic Brachial Neuritis in a Patient with Multiple Myeloma. J Clin Diagn Res 2017; 11:OD11-OD12. [PMID: 28764228 PMCID: PMC5535420 DOI: 10.7860/jcdr/2017/22426.10082] [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: 06/29/2016] [Accepted: 10/15/2016] [Indexed: 11/24/2022]
Abstract
Idiopathic Brachial Neuritis (IBN), is a rare brachial plexopathy with an unknown aetiology. Multiple myeloma is a neoplastic plasma cell disease characterised by bone lesions. In this article, we present the case of a 59-year-old male patient with IBN associated with multiple myeloma, who was admitted to our clinic with right shoulder pain and right arm weakness. He experienced muscle weakness and atrophy in his right arm after a sudden onset of pain attack in the shoulder. Plexus and cervical vertebral MRI showed no pathology. Electrodiagnostic studies showed upper and middle trunk plexopathies. Laboratory analysis revealed anaemia, hypercalcaemia, renal dysfunction and monoclonal gammopathy in immunoglobulin electrophoresis. A bone marrow biopsy established the diagnosis of IgG kappa multiple myeloma. This is the first case report that presents the association of multiple myeloma and IBN.
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Affiliation(s)
- Lale Cerrahoglu
- Department of Physical Medicine and Rehabilitation, School of Medicine, Celal Bayar University, Manisa, Turkey
| | - Ozlem Erol
- Department of Physical Medicine and Rehabilitation, School of Medicine, Celal Bayar University, Manisa, Turkey
| | - Tuba Cerrahoglu Sirin
- Department of Neurology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
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15
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Coulier B, Van Cutsem O, Mailleux P, Richelle F. Brachial metastatic plexopathy as the inaugural manifestation of lung cancer: multimodality imaging. BJR Case Rep 2016; 2:20150410. [PMID: 30460024 PMCID: PMC6243311 DOI: 10.1259/bjrcr.20150410] [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: 10/19/2015] [Revised: 04/17/2016] [Accepted: 04/25/2016] [Indexed: 11/05/2022] Open
Abstract
Metastatic infiltration of a peripheral plexus, also named metastatic plexopathy (MP), often results in severe pain and muscular weakness. This rather rare event may have a dramatic impact on the quality of life of patients affected by cancer. We hereby report a rare case of painful MP of the left cervicobrachial plexus presenting as the inaugural manifestation of poorly differentiated large-cell lung carcinoma in a 53-year-old patient. This responsible lung carcinoma was fortuitously diagnosed during MRI of the brachial plexus (BP). Complementary cancer staging was completed by contrast-enhanced multidetector CT, 18-fludeoxyglucose–positron emission tomography/CT and colour Doppler ultrasound of the BP. Although MRI remains the gold standard method for imaging the BP, our reported case emphasizes the alternative diagnostic capabilities of contrast-enhanced multidetector CT and ultrasound and confirms the high specificity of 18-fludeoxyglucose–positron emission tomography/CT in distinguishing brachial MP from secondary radiation plexopathy.
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Affiliation(s)
- Bruno Coulier
- Department of Diagnostic Radiology, Clinique St Luc, Namur, Belgium
| | | | - Patrick Mailleux
- Department of Diagnostic Radiology, Clinique St Luc, Namur, Belgium
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16
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Grisold W, Grisold A, Löscher WN. Neuromuscular complications in cancer. J Neurol Sci 2016; 367:184-202. [PMID: 27423586 DOI: 10.1016/j.jns.2016.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 05/08/2016] [Accepted: 06/01/2016] [Indexed: 12/11/2022]
Abstract
Cancer is becoming a treatable and even often curable disease. The neuromuscular system can be affected by direct tumor invasion or metastasis, neuroendocrine, metabolic, dysimmune/inflammatory, infections and toxic as well as paraneoplastic conditions. Due to the nature of cancer treatment, which frequently is based on a DNA damaging mechanism, treatment related toxic side effects are frequent and the correct identification of the causative mechanism is necessary to initiate the proper treatment. The peripheral nervous system is conventionally divided into nerve roots, the proximal nerves and plexus, the peripheral nerves (mono- and polyneuropathies), the site of neuromuscular transmission and muscle. This review is based on the anatomic distribution of the peripheral nervous system, divided into cranial nerves (CN), motor neuron (MND), nerve roots, plexus, peripheral nerve, the neuromuscular junction and muscle. The various etiologies of neuromuscular complications - neoplastic, surgical and mechanic, toxic, metabolic, endocrine, and paraneoplastic/immune - are discussed separately for each part of the peripheral nervous system.
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Affiliation(s)
- W Grisold
- Department of Neurology, Kaiser Franz Josef Hospital, Vienna, Austria.
| | - A Grisold
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - W N Löscher
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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17
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Abstract
The brachial plexus is a series of nerves formed by roots of cervical segments 5 to 8 (C5-C8) as well as the first thoracic nerve (T1). It functions to provide sensation and motor innervation to the skin and muscles of the chest and upper limb. It does so through different segments: roots, trunks, divisions, and cords. Injuries to the brachial plexus occur relatively frequently and are due mainly to traumatic accidents that lead to traction or compression of the nerve roots. When considering the etiology and treatment of such injuries, it is important to make a distinction between adult versus obstetric brachial plexus injury. Although several surgical treatment options are described and used for patients with brachial plexus injury, no perfect remedy currently exists. Prevention and safety should be the focus. At the same time, high-quality studies and new technology and techniques are needed to determine more effective treatments for this group.
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19
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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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