Brachial Plexus Involvement Research Articles

Factors correlating with positive electrodiagnostic findings for neurogenic thoracic outlet syndrome

IntroductionDiagnosis of neurogenic thoracic outlet syndrome (nTOS) remains a challenge. The role of electrodiagnostic studies (EDX) in the workup of nTOS remains controversial. The aim of this study was to report EDX findings in a cohort of patients undergoing surgery for nTOS and also analyse patient related and intraoperative factors associated with positive EDX findings supportive of a diagnosis of NTOS. MethodsBaseline characteristics of patients including age, sex, duration of symptoms, type of nTOS, and pattern of brachial plexus involvement were gathered and analysed. All patients received a preoperative EDX evaluation and were divided into two groups based on positive or negative EDX results for comparison. ResultsA total of 30 consecutive patients were included in this study comprising 11 (36.7%) male and 19 (63.3%) female patients, with a mean age of 44.6 ± 17.6 years. When classified by type of nTOS, 22 (73.3%) patients had type 1 nTOS with muscle weakness and atrophy, followed by 7 (23.4%) patients with type 3, and one (3.3%) patient with type 2 nTOS. In terms of the pattern of nTOS, 26 (86.7%) patients had lower plexus pattern of involvement (C8-T1), followed by 17 (56.7%) with upper-middle plexus pattern (C6-C7), and 13 (43.3%) with upper plexus pattern (C5-dorsal scapular nerve (DSN)). When comparing the characteristics of patients with positive and negative EDX findings suggestive of nTOS, only older age and type 1 nTOS (P<0.05) were significantly associated with positive EDX findings. ConclusionsEDX assessment, at this point in time, may not be the best modality for diagnosis of nTOS. Interindividual variation in findings reported by different clinicians performing the EDX remains a significant limiting factor. Older patients and those with more severe nTOS (type 1) are more likely to have positive results with EDX.

Neuralgic amyotrophy: sensitivity and specificity of magnetic resonance neurography in diagnosis: A retrospective study.

Neuralgic amyotrophy (NA) is a clinically acute or subacute disease. To study the characteristics of brachial plexus magnetic resonance neurography (MRN) in patients with NA, and to explore the clinical application value of MRN combined with electromyography (EMG) in the diagnosis of NA. Brachial plexus MRN images of 32 patients with NA were retrospectively analyzed, and their characteristics were investigated. The accuracy, sensitivity and specificity of MRN, EMG, and the combination of the 2 methods for NA diagnosis were compared. Among the 32 patients with NA, 28 (87.5%) cases of unilateral brachial plexus involvement, 18 (56.3%) cases of multiple nerve roots involvement. In 10 cases, C5 nerve roots were involved alone, and in 9 cases, C5 to C6 nerve roots were involved together. The T2 signal intensity of the affected nerve increased, and 19 cases showed thickened and smooth nerve root edges. Twelve cases showed uneven thickening and segmental stenosis of the involved nerve roots. The diagnostic accuracy, sensitivity, and specificity of MRN for NA were higher than those of EMG. Combining MRN and EMG could improve the sensitivity and specificity of diagnosis. The main feature of MRN in patients with NA was that it was unilateral brachial plexus asymmetric involvement. The diagnostic effect of MRN was better than that of EMG. The combined diagnosis of MRN and EMG can help clinicians diagnose NA accurately.

A CASE REPORT OF ASYMMETRIC BRACHIAL PLEXUS INVOLVEMENT IN LEPROSY NEUROPATHY DEMONSTRATED BY MAGNETIC RESONANCE IMAGING

Leprosy is a is a chronic granulomatous disease primarily affects the peripheral nerves and skin .Sometimes, the disease has an unusual presentation, crippling complications, and can be contagious, so its timely diagnosis and management are extremely important. In this case report 29-years-old male a case of biopsy proven Hansens disease-borderline tuberculoid type on MDT. Patient with complains of weakness of left upper limb and pain in the neck radiating to left upper limb since 1 month . MRI is commonly used for evaluating the plexus,brain and spinal cord Brachial plexus involvement is commonly seen in borderline tuberculoid variant .Thickening may be due to cell mediated immune response. A possibility of drug resistant leprosy was considered and adviced to continue MDT.Patient was treated as a case of bilateral brachial plexitis and transverse myelitis secondary to IRIS .Patient was managed with medication then improved

The spectrum of brachial plexopathy from perineural spread of breast cancer.

Perineural spread of breast cancer to the brachial plexus can lead to pain, sensory alterations, and upper-extremity weakness. Although rare, perineural spread is an often-misdiagnosed long-term complication following breast cancer diagnosis. The objective of this study was to critically review the clinical, radiological, and pathological findings of biopsy-proven perineural spread of breast cancer to the brachial plexus. This is a retrospective study from a single institution in which a total of 19 patients with brachial plexus involvement from perineural spread of breast cancer who underwent fascicular biopsy between 1999 and 2021 were identified. Clinical, radiographic, and pathological data were retrospectively collected. Descriptive statistics were calculated for the cohort. The mean age of patients at the time of diagnosis of breast cancer perineural spread was 60.6 ± 11.5 years. The diagnosis of brachial plexopathy due to perineural spread was on average 12 years after the primary diagnosis of breast cancer. There was also a delay in diagnosis due to the rarity of this disease, with a mean time from initial symptom onset to diagnosis of perineural spread of 25 ± 30 months. All patients at the time of presentation had upper-extremity weakness and pain. Nearly all patients demonstrated T2 signal change and nodular so-called sugar-coating contrast enhancement on brachial plexus MRI. Similarly, all patients who underwent PET/MRI or PET/CT had increased FDG uptake in the involved brachial plexus. Breast cancer perineural spread has an overall poor prognosis, with 16 of 19 patients dying within 5.9 ± 3.0 years after diagnosis of perineural spread. Perineural spread should be considered in patients with a history of breast cancer, even 10 years after primary diagnosis, especially in patients who present with arm pain, weakness, and/or sensory changes. Further diagnostic workup with electrodiagnostic studies; brachial plexus MRI, PET/CT, or PET/MRI; and possibly nerve biopsy is warranted to ensure accurate diagnosis.

Neuralgic amyotrophy detected by magnetic resonance neurography: subclinical, bilateral, and multifocal brachial plexus involvement

ABSTRACT Introduction Neuralgic amyotrophy (NA) is a painful non-traumatic peripheral nervous system condition affecting the brachial plexus. Signal abnormalities in nerves and muscles have been detected in these patients using magnetic resonance neurography (MRN). Methods Electronic medical records and MRN images obtained in a 3 T scanner, in 14 adult patients diagnosed with NA at our Neurological institution (Neuromuscular Disorders Section), between December 2015 and December 2019 were retrospectively reviewed. The study was first approved by our Institutional Ethics Committee. Results Subclinical, multifocal, and bilateral nerve signal anomalies were recorded in the brachial plexus of these patients. We identified four different types of nerve constriction without entrapment, which we categorized as follows: incomplete focal (type I), complete focal or hourglass (type II), multifocal or string of pearls (type III) and segmental (type IV). Conclusions Given that MRN is an accurate diagnostic tool to detect nerve damage, we believe abnormal findings could improve early detection of NA patients.

ELECTRONEUROMYOGRAPHIC AND CLINICAL ASPECTS OF BRACHIAL PLEXUS INVOLVEMENT IN PANCOAST-TOBIAS SYNDROME: A CASE REPORT

Pancoast-Tobias syndrome is a rare entity, defined by a clinical triad of cervicobrachial neuralgia in the C8-D1 territory, hand amyotrophy and Claude-Bernard-Horner syndrome, secondary to a tumor of the pulmonary apex. However, there are incomplete or misleading forms that can lead to a wrong diagnosis. The purpose of our observation is to study the clinical and electroneuromyographic patterns of brachial plexus involvement in Pancoast-Tobias syndrome.

Central nervous system, spinal root ganglion and brachial plexus involvement in leprosy: A prospective study.

BackgroundLeprosy is primarily a disease of peripheral nerves. Some isolated case reports and case series have communicated imaging changes in the central nervous system (CNS) and brachial plexus in patients with leprosy.ObjectivesTo study the neuroimaging abnormalities in patients with lepra bacilli-positive neuropathy in the context of CNS, spinal root ganglion, and brachial plexus.DesignProspective observational studyMethodsWe screened newly-diagnosed patients with multibacillary leprosy presenting with neuropathy. Patients with bacilli-positive sural nerve biopsies were included in the study and subjected to magnetic resonance imaging (MRI) of the brain and spinal cord.ResultsA total of 54 patients with bacteriologically confirmed multibacillary leprosy were screened; Mycobacterium leprae was demonstrated in the sural nerve biopsies of 29 patients. Five patients (5/29; 17.24%) had MRI abnormalities in CNS, spinal root ganglion, and/or brachial plexus. Three patients had MRI changes suggestive of either myelitis or ganglionitis. One patient had T2/FLAIR hyperintensity in the middle cerebellar peduncle while 1 had T2/FLAIR hyperintensity in the brachial plexus.ConclusionCNS, spinal root ganglion, and brachial plexus are involved in patients with leprous neuropathy. Immunological reaction against M leprae antigen might be a plausible pathogenetic mechanism for brachial plexus and CNS imaging abnormalities.

Abstract ES9-2: Special indications where local therapy should be considered

Abstract Clarity for the clinical issue of which patients with metastatic breast cancer should undergo local/regional therapy (LRT) was provided by the recent presentation of the prospective randomized ECOG-ACRIN 2108 trial data. This study, which randomized Stage IV breast cancer patients (initially treated with optimal systemic therapy for 4-8 months) to early local therapy or to continued systemic therapy alone, failed to demonstrate an improvement in overall survival for patients who had early local therapy compared to continued systemic therapy alone. However, there are some special indications that fall outside of this trial, and which remain areas of controversy. For instance, the subset of patients with inflammatory breast cancer (IBC) were not included in the ECOG trial, and therefore there are no prospective randomized clinical trial data available to determine if LRT improves survival in de novo stage IV IBC patients. To further confound the issue, several retrospective studies show clear survival benefit for Stage IV IBC patients who complete LRT, versus those who do not. While we all recognize that some differences could be attributed to selection bias, the differences in outcome are so striking that we believe that it warrants further discussion of the possible value of LRT in the IBC group. Furthermore, patients with IBC are more likely to be found to have Stage IV disease at presentation, complicating the discussion of whether complete trimodal therapy (neoadjuvant chemotherapy, mastectomy, and post-mastectomy radiation therapy) should still be considered at initial treatment planning, or whether LRT should be omitted altogether. Finally, due to the skin involvement and rapid progression inherent to IBC, these patients often require LRT for palliation of advanced disease (to control fungating tumors, brachial plexus involvement, etc.), so palliative surgery plays an important role in the management of the patient with IBC. During this presentation, we plan to discuss the available data regarding optimal LRT decisions for patients with de novo Stage IV IBC. Beyond the subset of IBC patients, several studies have identified non-IBC patients with Stage IV disease who might benefit from LRT. We will also discuss subsets of Stage IV breast cancer patients, including those with HR+ tumors, those with bone-only oligometastasis, and younger age patients, where LRT has shown survival benefit, based mainly on longer follow-up data from the randomized MF07-01 trial. Our objective is to improve knowledge of the local/regional treatment recommendations of select subgroups of Stage IV patients, where the use of LRT could translate to not only improved local control, but possibly to improved survival in carefully selected patients. Citation Format: A Lucci. Special indications where local therapy should be considered [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr ES9-2.

Possible donor nerves for axillary nerve reconstruction in dual neurotization for restoring shoulder abduction in brachial plexus injuries: a systematic review and meta-analysis.

Restoring shoulder abduction is one of the main priorities in the surgical treatment of brachial plexus injuries. Double nerve transfer to the axillary nerve and suprascapular nerve is widely used and considered the best option. The most common donor nerve for the suprascapular nerve is the spinal accessory nerve. However, donor nerves for axillary nerve reconstructions vary and it is still unclear which donor nerve has the best outcome. The aim of this study was to perform a systematic review on reconstructions of suprascapular and axillary nerves and to perform a meta-analysis investigating the outcomes of different donor nerves on axillary nerve reconstructions. We conducted a systematic search of English literature from March 2001 to December 2020 following PRISMA guidelines. Two outcomes were assessed, abduction strength using the Medical Research Council (MRC) scale and range of motion (ROM). Twenty-two studies describing the use of donor nerves met the inclusion criteria for the systematic review. Donor nerves investigated included the radial nerve, intercostal nerves, medial pectoral nerve, ulnar nerve fascicle, median nerve fascicle and the lower subscapular nerve. Fifteen studies that investigated the radial and intercostal nerves met the inclusion criteria for a meta-analysis. We found no statistically significant difference between either of these nerves in the abduction strength according to MRC score (radial nerve 3.66 ± 1.02 vs intercostal nerves 3.48 ± 0.64, p = 0.086). However, the difference in ROM was statistically significant (radial nerve 106.33 ± 39.01 vs. intercostal nerve 80.42 ± 24.9, p < 0.001). Our findings support using a branch of the radial nerve for the triceps muscle as a donor for axillary nerve reconstruction when possible. Intercostal nerves can be used in cases of total brachial plexus injury or involvement of the C7 root or posterior fascicle. Other promising methods need to be studied more thoroughly in order to validate and compare their results with the more commonly used methods.

WS7.4. NMUS of the brachial plexus

The brachial plexus can be involved in a variety of neuromuscular disorders, such as inflammatory and hereditary demyelinating neuropathies, neurofibromatosis, traumatic injuries, neoplasms, nerve sheath tumors. Traditionally, the evaluation of brachial plexus involvement has relied on combination of clinical features, electrodiagnostic testing and MRI imaging. Nerve imaging is an important and powerful add-on strategy, that can help to localize site of lesion and uncover nature and extend of nerve involvement. The apparent lack of clear association between nerve morphology and function further supports complementary role of imaging modalities in routine diagnostic work-up of peripheral nerve disorders. Although MRI has dedicated sequences that allow refined tissue discrimination, lack of objective cut-off values hamper it’s used in the routine clinical setting. Nerve ultrasound is an emerging practical bedside alternative to MRI, which the advantage of flexible field of view, superior image resolution for superficial structures, broad availability and relatively low cost. This neuromuscular ultrasound workshop will focus on main anatomical targets for sonographic evaluation of brachial plexus, including important landmarks and notes for discrimination. The workshop will also address standardized assessment and reference values for abnormality, including sonographic examples of neuromuscular disorders.

Clinical and neurophysiological findings in patients with hereditary neuropathy with liability to pressure palsy and chromosome 17p11.2 deletion

IntroductionHereditary neuropathy with liability to pressure palsy (HNPP) is an autosomal dominant disorder, typically presenting with recurrent episodes of mononeuropathy in nerves susceptible to compression, with similar neurophysiological characteristics. However, other clinical and neurophysiological presentations have been reported. MethodsWe retrospectively analysed the clinical and neurophysiological characteristics of 20 patients with genetically confirmed HNPP. Sixteen patients were studied in our department between 1996 and 2016. ResultsIn addition to the typical characteristics of HNPP, we found atypical forms including recurrent positional sensory symptoms in 3 patients, chronic sensorimotor polyneuropathy in one, and non-progressive mononeuropathy in one. Onset was early in 2 patients: one at the age of 7 years, with common peroneal nerve injury, and another at birth, with brachial plexus involvement. By frequency, the main pathological findings in the nerve conduction study were: decreased sensory nerve conduction velocity in the sural (84%) and the median and superficial peroneal nerves (94%); decreased motor nerve conduction velocity in the ulnar nerve through the elbow (97%), and increased motor distal latency of the median and deep peroneal nerves (74%). ConclusionOur results confirm the clinical variability of HNPP, with the most frequent nerve conduction study findings being the generalised decrease in sensory nerve conduction velocity, in addition to motor involvement, mainly in locations susceptible to nerve compression. The nerve conduction study can detect typical, atypical, and asymptomatic cases of HNPP.

Epidemiology of Brachial Plexus Injury in North Indian Tertiary Care Hospital: A Retrospective Study

Introduction: Epidemiological studies on Brachial Plexus Injuries (BPI) are in limited numbers. Such epidemiological factors can be different in different countries. Aim: To determine the epidemiological factors on brachial plexus injuries in North Indian tertiary care hospital. Materials and Methods: A retrospective observational study was conducted in which all patients of brachial plexus injury who underwent surgery for same in Department of Plastic Surgery of a tertiary care hospital in Lucknow, Uttar Pradesh, India from January 2017 to December 2019 were included. Those who were managed conservatively were excluded from study. Their demographic and epidemiological factors like type of injury, limb involvement, nature of trauma were evaluated. Data was tabulated and results were expressed in terms of numbers and percentages. Results: There were total 221 patients,out of which 147 patients had pan brachial plexus involvement and 74 patients suffered from partial involvement of brachial plexus roots. Majority of the patients had their right upper limb involved (n=139). Motor cycle accidents (n=155) were the primary cause followed by four wheeler accident (n=25) and fall from height (n=18). Conclusion: Brachial plexus injury is a challenge for surgeons. Road Traffic Accidents are the dominant cause of these injuries and among them motorcycle accidents remained the major cause.

Scapulothoracic Dissociation: a Systematic Review, Current Concepts, and Meta-analysis of Case Reports

Scapulothoracic dissociation is a rare entity which is frequently associated with arterial and brachial plexus injuries. It is frequently missed especially in the scenario of polytrauma. To examine the incidence, mode and mechanism of injury, associated injuries, diagnosis, treatment protocol, and existing current concepts in the literature. Ovid MEDLINE from January 1980 to August 2019. Published case reports/case series/observational studies. Patient characteristics were summarized descriptively. Appropriate statistical tests were applied. 54.3% of the patients between the age group of 20 and 40 with a male to female ratio of 6.2. In 51.9% of the cases, motorcycle accident was the mode of injury. 68.7% of the cases were associated with vascular injuries either at the level of subclavian or axillary. Brachial plexus involvement was seen in 86.1% of the cases. Isolated fracture of the clavicle was found in 53.9% of the cases. In 13.6% of the patients, scapulothoracic dissociation was associated with polytrauma. Zelle type 4 injuries were the commonest (51.9%). One-fourth of the patients were managed conservatively. Primary amputation was done in 15% of the cases. Mortality rate was about 10%. About 46% of the patients landed up in flail limb or amputation. The most significant predictors of the functional outcome were vascular injury, brachial plexus injury, and classification type. Polytrauma was the most significant predictor of mortality. The results from this systematic review have revealed the most common age group involved, mode of injury, and prognostic indicators and helped in the formulation of treatment protocol in the management of this rare but devastating injury which can be easily missed especially in the polytrauma scenarios.

Long-term neuromusculoskeletal side effects and quality of life in nasopharyngeal cancer patients receiving radiochemotherapy.

In this study, we aimed to evaluate the neuromusculoskeletal late side effects and their impact on the quality of life of patients with nasopharyngeal carcinoma treated with radiochemotherapy. Twenty-seven patients were included. The mean follow-up was 61months (range, 18-111months). The median external radiotherapy dose applied to the nasopharynx and primary tumor was 70Gy (range, 61-73Gy). The mean dose received by the temporomandibular joint in the dose-volume histograms of these patients was 60.7Gy. The maximal doses of the muscles responsible for cervical motion in different ranges were greater than 60Gy, and the mean doses were greater than 40Gy in the muscle groups, except for the extensor muscles. Two patients had brachial plexus involvement, while 89% of the patients had restriction in flexion and extension movements. Of the patients, 52% had trismus. There was a significant correlation between extension restriction and general heath score and the physical subscale of the quality-of-life questionnaire (p = 0.01). There was also a correlation between trismus and pain killer usage (p = 0.004). This is the first study to analyze long-term muscle and nerve toxicity and their correlation between doses in nasopharyngeal cancer patients following radiochemotherapy. Despite the advances in radiotherapy techniques, it is necessary to pay attention to the doses of the nerves and muscles for late effects.

Magnetic resonance imaging of traumatic brachial plexus injuries

Purpose: The aim of this study is to evaluate role of MRI in diagnosing brachial plexus injuries, to evaluate site of injury and to differentiate pre and post ganglionic injury in all age group patients who have history of trauma.Patients and methods: This study include 22 patients (18 male and 4 female) with history of trauma due to fall from height, road traffic accident, impact of heavy objects on shoulder or sports injuries who underwent Magnetic Resonance Imaging of the brachial plexus.Results: In our study, 22 patients with history of trauma and suspicious involvement of brachial plexus were subjected to MRI of the affected side of brachial plexus after initial clinical examination. Out of 22 patients, 59.09 % was postganglionic neuropraxic injury and 40.91 % was preganglionic and root avulsion. The most common component involved in brachial plexus injuries was roots in 68.18% (15 patients) of cases followed by trunks in 63.63% (14 patients) of cases. The most common nerve root segment involved was C6 and C7 in 73.33% (11 patients) of cases followed by C5 in 40.00% (6 patients) of cases. The most common level involved in pseudo meningocele formation was C6-C7 in 88.88% (8 patients) of cases. Multiple segment of root and trunk injury is more common than single segment.Conclusion: Because of exquisite soft tissue contrast resolution, non-invasive nature and multiplanar capabilities of MR imaging make it especially valuable for the detection and assessment of brachial plexus injuries.

AN EXTINCT CURE FOR AN ANCIENT DISEASE: RECOGNIZING PLOMBAGE

SESSION TITLE: Monday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Despite advances in the treatment of pulmonary tuberculosis (TB) in the last century tuberculosis remains one of the top ten causes of death worldwide [1]. Antibiotic therapy has supplanted surgical treatment and it is unusual to recognize patients with previous surgical treatments. We review the case of a patient with a history of TB who presented with a lung mass. Our goal is to reinforce awareness of an outdated TB treatment and to emphasize the importance of thorough history-taking in reaching the correct diagnosis. CASE PRESENTATION: A 71-year-old lady was referred to our service for evaluation of a left upper lobe mass. She reported no respiratory symptoms, but confirmed an abnormal sensation and a stabbing pain from her fingers radiating up her arm and across her chest. Given her suspicious arm pain a shoulder and spine x-ray were ordered which showed a large calcified mass in the left lung apex and volume loss in the left lung. She revealed that she grew up in an orphanage in Columbia . When specifically questioned, she recalls being diagnosed with TB and treated with surgery as a teenager in 1961 eight years before immigrating to the United States. Physical exam was significant for a left posterior thoracotomy scar and equal bronchovesicular breath sounds. All other components of the physical exam were within normal limits. A subsequent CT scan showed a non-enhancing 12 cm heavily ossified septated left upper thorax mass possibly arising from an upper left ribs. The mass contains chondroid matrix and peripherally high-density septations throughout with a low-density center. Brachial plexus involvement cannot be excluded. The mass was consistent with plombage treatment for TB and biopsy was not recommended. DISCUSSION: During the 1930s-1950s the standard of care for TB involved surgical collapse of the lung; a treatment called, “plombage”. A shift toward antibiotic treatment was made with the development of streptomycin in 1946, which was found to have curative effects [2]. Inert plombage materials included mineral oil, air, paraffin wax, and polymethyl-methacrylate (Lucite) balls [3]. Upon insertion into the chest cavity, the affected lobe would collapse, decreasing ventilation to the region and starving the aerobic bacteria of oxygen. As antibiotics to TB were developed plombage treatment fell out of favor in most parts of the world. Late complications of plombage can include hemorrhage, infection, chest wall deformities, fistulization to bronchi, great vessels in the thoracic cavity, and esophagus or brachial plexopathy. CONCLUSIONS: Obtaining the patient’s complete history particularly of tuberculosis treated in her native country in 1961 became central to the diagnosis of retained calcified Plombage material.It is important for physicians to move beyond the most likely diagnosis and rely on thorough history-taking skills to arrive at the correct diagnosis. Reference #1: 1. Mathers et al (2009). “Global and Regional Causes of Death” British Medical Journal Reference #2: 2. D'Arcy Hart P (August 1999). "A change in scientific approach: from alternation to randomised allocation in clinical trials in the 1940s". British Medical Journal. Reference #3: 3. Historical TB treatment – Plombage; QJM: An International Journal of Medicine, 2017 DISCLOSURES: No relevant relationships by Kristin Fless, source=Web Response no disclosure on file for Nirav Mistry; No relevant relationships by Mihir Odak, source=Web Response No relevant relationships by Vagram Ovnanian, source=Web Response No relevant relationships by Killol Patel, source=Web Response No relevant relationships by Fariborz Rezai, source=Web Response No relevant relationships by Paul Yodice, source=Web Response

Hallazgos clínico-neurofisiológicos en neuropatías hereditarias sensibles a la presión con deleción del cromosoma 17p11.2

IntroductionHereditary neuropathy with liability to pressure palsy (HNPP) is an autosomal dominant disorder, typically presenting with recurrent episodes of mononeuropathy in nerves susceptible to compression, with similar neurophysiological characteristics. However, other clinical and neurophysiological presentations have been reported. MethodsWe retrospectively analysed the clinical and neurophysiological characteristics of 20 patients with genetically confirmed HNPP. Sixteen patients were studied in our department between 1996 and 2016. ResultsIn addition to the typical characteristics of HNPP, we found atypical forms including recurrent positional sensory symptoms in 3 patients, chronic sensorimotor polyneuropathy in one, and non-progressive mononeuropathy in one. Onset was early in 2 patients: one at the age of 7 years, with common peroneal nerve injury, and another at birth, with brachial plexus involvement. By frequency, the main pathological findings in the nerve conduction study were: decreased sensory nerve conduction velocity in the sural (84%) and the median and superficial peroneal nerves (94%); decreased motor nerve conduction velocity in the ulnar nerve through the elbow (97%), and increased motor distal latency of the median and deep peroneal nerves (74%). ConclusionOur results confirm the clinical variability of HNPP, with the most frequent nerve conduction study findings being the generalised decrease in sensory nerve conduction velocity, in addition to motor involvement, mainly in locations susceptible to nerve compression. The nerve conduction study can detect typical, atypical, and asymptomatic cases of HNPP.

Ultrasound-guided subomohyoid suprascapular nerve block and phrenic nerve involvement: a cadaveric dye study

Backgrounds and objectivesThe anterior approach to the subomohyoid suprascapular (SOS) nerve is a new, technically easy and reliable regional anesthesia technique for postoperative shoulder analgesia. However, due to its proximity,...

A case of neuralgic amyotrophy presented Vernet syndrome and suprascapular nerve palsy

AbstractA 54 year‐old‐man had pain and stiffness at the left hind neck. One month later, dysphagia, hoarseness, atrophy, and weakness of left shoulder muscles appeared. Neurological and neurophysiological examination revealed left IX, X, XI cranial (Vernet syndrome) and ipsilateral suprascapular nerves were disabled. Major causes of Vernet syndrome, jugular foramen lesions, were not identified by comprehensive imaging studies. VZV and other infectious diseases were excluded by serological tests. Immunotherapy alleviated the large part of his symptoms including supra/infraspinatus muscle strength. Although brachial plexus involvement was minimal, this case was consistent with neuralgic amyotrophy. We would suggest examining the ipsilateral limb and girdle muscles of a patient in Vernet syndrome with the unknown cause.

Pancoast tumour: current therapeutic options.

Pancoast's syndrome is caused by malignant neoplasm of superior sulcus of the lung which produces destructive lesions of thoracic inlet and comes along with the involvement of brachial plexus and stellate ganglion. Computed tomography (CT) or magnetic resonance imaging (MRI) scans can detect early lesions otherwise missed by routine radiographs and can also define the local extent or metastatic progression of the disease. Protocols involving combinations of irradiation, chemotherapy, and surgery are currently being under investigation to determine the best management. This work reviewed the current diagnostic and therapeutic approaches to Pancoast's tumors. Patients with lung superior sulcus carcinoma should be considered for surgery only after an appropriate diagnostic assessment. The perfect candidate for surgery should have a confined to the chest disease with T3N0M0 staging. Inoperable patient with severe pain after irradiation therapy may benefit from palliative surgical resection. Medical therapy plays only a secondary role in lung cancers, patients with disseminated lung cancer might require palliative treatment and medical management of paraneoplastic syndrome symptoms. Following surgery, radiation and chemotherapy may improve local and systemic control by addressing individual adverse findings. The cooperation of surgeons, clinicians and radiologists represents the gold standard today and a multidisciplinary approach is essential to achieve the best outcome possible. Further studies are advisable in order to define the best surgical approach and the real advantage of mini-invasive surgery by comparison with open surgery.