Diagnostics and treatment of hourglass-like nerve constrictions and torsions in neuralgic amyotrophy

Abstract

Neuralgic amyotrophy is adisease of the peripheral nervous system characterized by severe neuropathic pain followed by peripheral paralysis. Adistinction is made between ahereditary and an idiopathic form, which is assumed to have an autoimmunological origin. Conservative medicinal treatment mainly consists of nonsteroidal anti-inflammatory drugs (NSAID), opioids and glucocorticoids; however, despite treatment, symptoms in the form of pain or paralysis persist in over 50% of cases. Inflammation can lead to strictures and torsions of peripheral nerves, which can be visualized by imaging using nerve sonography or magnetic resonance (MR) neurography and confirmed intraoperatively during surgical exploration. Based on the currently available data, patients with strictures and torsions of peripheral nerves can benefit from neurosurgical treatment.