Bilateral Brachial Plexus Injury Research Articles

Двухсторонняя брахиплексопатия после коррекции деформации Шейерманна: клинический случай

Introduction The article presents a case report and a brief literature review of an adverse event of brachial plexus injury associated with prone positioning in spinal surgery. The purpose was to report a case of bilateral brachial plexus injury after correction of Scheuermann's kyphosis. Material and methods Reported is a case of brachial plexus injury in a patient with Scheuermann's kyphosis after surgical correction. Results The patient could completely regain motor function of the left limb at 6 months with palsy scored 3 proximally retained in the right hand. Discussion The literature describes three pathophysiological conditions that predispose to brachial plexus injury in the postoperative period: sprain, compression, and ischemia. The adverse event is reversible in most cases and recovery depends on the degree of neurological deficit at an early stage. Recommendations are offered for surgeons and anesthesiologists to avoid the occurrence of the complication or take timely measures to alleviate the consequences. Conclusion Upperlimb somatosensory evoked potentials, a part of neurophysiological monitoring can be practical for prevention of the complication. Prevention of brachioplexopathy should be part of perioperative care.

Motor recovery after bilateral brachial plexus injury using motor irradiation: a case report

Background/Aims Brachial plexus injuries impair functionality, interfere with the performance of activities and affect participation in social events, thus decreasing an individual's quality of life. In cases where there is a total loss of muscular strength, complete rehabilitation is challenging. Motor irradiation is a basic proprioceptive neuromuscular facilitation procedure that is used to activate weak muscles. It is a promising procedure for rehabilitation following brachial plexus injuries, mainly in those with total loss of muscle strength. Methods The patient in this case study had suffered bilateral brachial plexus injuries as a result of mechanical restraint during a psychiatric episode. He presented with decreased muscle strength in the proximal segments of the upper limbs, no movement of the wrists and fingers, tactile hypoesthesia and no pain sensation. Motor irradiation was the main intervention used to improve motor function. Findings At the end of treatment, complete and partial recovery of muscle strength was observed in the proximal and distal segments, respectively. Conclusions The efficacy of motor irradiation in improving muscle strength following brachial plexus injuries should be investigated in future clinical trials.

Adaptive backlash compensation in upper limb soft wearable exoskeletons

A new frontier of assistive devices aims at designing exoskeletons based on fabric and flexible materials for applications where kinematic transparency is the primary requirement. Bowden-cable transmission is the widely employed solution in most of the aforementioned applications due to advantages in durability, lightweight, safety, and flexibility. The major advantages of soft assistive devices driven by bowden-cable transmissions can be identified in the superior ergonomics and wearability, allowing users to freely move and allocating the actuation stages far from the end-effector. However, control accuracy in bowden-cable transmission presents some intrinsic limitation due to nonlinearities such as static and dynamic friction, occurring between the cables and the bowden sheaths, and backlash hysteresis. Friction and backlash effects are known to be related to the curvature of the flexible sheath, which is not directly measurable and can vary during human motion. In this paper we describe our new wearable exosuit for upper limb assistance and in particular we introduce a mathematical model for backlash hysteresis compensation. The implementation of a nonlinear adaptive controller is described in detail and experimentally tested on the proposed design as a backlash compensation strategy: results report that the adaptive controller improves the accuracy in position tracking (i.e. RMSE in trajectory tracking ≈1∘) by compensating for time-varying backlash and continuously updating the model parameters. The backlash hysteresis model and the proposed control scheme are validated first on a custom-designed test bench and then applied to control the soft exoskeleton worn by a subject affected by bilateral brachial plexus injury.

Bilateral brachial plexus injury following acute carbon monoxide poisoning

BackgroundCarbon monoxide (CO) intoxication is a leading cause of severe neuropsychological impairments. Peripheral nerve injury has rarely been reported. It consists usually in a demyelinating polyneuropathy or mononeuropathy affecting mainly the lower limbs. Isolated involvement of both upper extremities has been described in only 4 patients related to root damage. We report the first case of bilateral brachial plexus injury following CO poisoning and review all previous CO-induced neuropathy described in literature.Case presentationAfter being unconscious for three hours, a 42 years old man experienced bilateral brachial weakness associated with edema of the face and the upper limbs. Neurological examination showed a brachial diplegia, distal vibratory, thermic and algic hypoesthesia, deep tendon areflexia in upper limbs. There was no sensory or motor deficit in lower extremities. No cognitive disturbances were detected. Creatine kinase was elevated. Electroneuromyogram patterns were compatible with the diagnosis of bilateral C5 D1 brachial axonal plexus injury predominant on the left side. Clinical course after hyperbaric oxygen therapy was marked by a complete recovery of neurological disorders.ConclusionPeripheral neuropathy is an unusual complication of CO intoxication. Bilateral brachial plexus impairment is exceptional. Various mechanisms have been implicated including nerve compression secondary to rhabdomyolysis, nerve ischemia due to hypoxia and direct nerve toxicity of carbon monoxide. Prognosis is commonly excellent without any sequelae.

Bilateral Brachial Plexus Injury after a Hanging Suicide Attempt: A Case Report

Bilateral Brachial Plexus Injury after a Hanging Suicide Attempt: A Case Report

Bilateral obstetric brachial plexus injury: A case report

Our case report describes a bilateral obstetric brachial plexus injury in a 14-year-old boy. In the first years of his life, treatment was conservative. After a period of clinical improvement, spontaneous regeneration had stopped. At age two years and three months, neurotmesis with root avulsion was diagnosed, which was the grounds for microsurgery. Unilateral revision and external neurolysis were performed. Currently, we observed dysfunction of the upper limbs associated with paresis primarily of the shoulder flexors, abductors, external rotators, elbow flexors and abnormal posture as well.

Poster 113 Bilateral Brachial Plexus Injury After Spine Surgery

Poster 113 Bilateral Brachial Plexus Injury After Spine Surgery

Brachial plexus injury as an unusual complication after aortic stent implantation

Aorta catheterisation can serve both diagnostic and therapeutic purposes in patients with aortic coarctation, especially when non-invasive evaluation cannot define severity of the abnormality. We report a case of bilateral brachial plexus injury due to standard positioning of the patient's arms during non-complicated aorta catheterisation and aortic stent implantation under general anaesthesia. In discussion, we consider our patient's predisposing factors, the understanding of which may be helpful in avoiding this complication in the future.

Neonatal Spinal Cord Injury After an Uncomplicated Vaginal Delivery

Neonatal spinal cord injury has been reported after traumatic births and as a consequence of underlying lesions in the spinal cord. This report describes an infant who was born with bilateral flaccid paralysis of the upper extremities after an atraumatic, noninstrumented vaginal delivery. The infant was otherwise neurologically intact. The infant was initially thought to exhibit bilateral brachial plexus injury. However, magnetic resonance imaging demonstrated an upper cervical spinal cord hemorrhage, with no underlying lesions of the spinal cord or surrounding vasculature. This case highlights the importance of thoroughly evaluating any neurologic deficit in the newborn, and suggests that normal mechanical forces of labor and delivery may be sufficient to cause damage to the newborn spinal cord.

P095 Bilateral brachial plexus injury and diaphragmatic palsy in pre-term newborn

P095 Bilateral brachial plexus injury and diaphragmatic palsy in pre-term newborn

Bilateral brachial plexus injury after liver transplantation

We report a case of bilateral brachial plexus injury following living-donor liver transplantation. A 35-year-old man with hepatitis C cirrhosis underwent liver transplantation under general anesthesia, performed in the supine position with 90 degrees arm abduction. The surgery lasted for 14 h, and the anesthesia for 16 h. On postoperative day 1, it was noticed that he had brachial plexus injuries. We investigated the cause of the nerve injuries, in particular, the possible involvement of stretching, compression, or nerve ischemia, which can often result from excessive abduction, the use of shoulder braces, compression by the poles used in the operating theater or compression caused by surgeons leaning on the patient, or serious general status (e.g., hypotension or hypoxemia). Our findings were inconclusive, but we postulated that 90 degrees abduction of the arms per se may have resulted in excessive stretching of the brachial nerves, causing his injuries.

Anterior dislocation of the shoulders with bilateral brachial plexus injury

A case of bilateral anterior shoulder dislocation accompanied by bilateral brachial plexus injuries is presented. A 53-year-old man fell and landed on his chest and arms flexed at the elbows. The dislocations were satisfactorily reduced using the forward elevation, flexion maneuver. Electromyography and nerve conduction studies confirmed bilateral brachial plexus lesions. Arthrogram of the right shoulder demonstrated a rotator cuff tear. The patient is undergoing physical therapy and making a slow recovery.