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Search Results for : Brachial Plexus Neuritis
Merck Online Lab
Diagnosis Therapy Rehabilitation Imaging Clinical Laboratory
Nerve injury by needle nerve perforation in regional anaesthesia: does size matter?
Author(s): Steinfeldt, T; Nimphius, W; Werner, T; Vassiliou, T; Kill, C; Karakas, E; Wulf, H; Graf, J
Journal: Br J Anaesth 2010 Feb 26; Vol. 104, Issue 2; Page(s) 245-53
[Medline ID - 20551032]

BACKGROUND: In regional anaesthesia, there is a risk of direct nerve injury. The purpose of this study was to determine whether the diameter of the applied needle is associated with the magnitude of nerve injury after needle nerve perforation. METHODS: In five anaesthetized pigs, the brachial plexus were exposed bilaterally. Up to eight nerves underwent needle nerve perforation using a 24 G pencil-point cannula (small diameter) or a 19 G pencil-point needle (large diameter). After 48 h, the nerves were resected during anaesthesia. The specimens were processed for visual examination and the detection of inflammatory cells, myelin damage and intraneural haematoma. The grade of nerve injury was scored ranging from 0 (no injury) to 4 (severe injury). RESULTS: Forty-eight nerves were examined. The applied injury score was significantly lower in the small-diameter group [median (inter-quartile range) 2.0 (2.0-2.0)] compared with the large-diameter group [3.5 (3.0-4.0) P < 0.01]. Myelin damage and intraneural haematoma occurred predominantly in the large-diameter group. Signs of post-traumatic regional inflammation were comparable among both groups. CONCLUSIONS: The severity of nerve injury after needle nerve perforation was related to the diameter of the applied cannula. However, no such difference exists for regional inflammation. Functional consequences of these findings need to be determined. Currently, small-diameter cannulae may be advisable for peripheral nerve blocks to minimize the risk of nerve injury in the case of nerve perforation.

Phenotypic spectrum of hereditary neuralgic amyotrophy caused by the SEPT9 R88W mutation.
Author(s): Ueda, M; Kawamura, N; Tateishi, T; Sakae, N; Motomura, K; Ohyagi, Y; Kira, JI
Journal: J Neurol Neurosurg Psychiatry 2010 Jan 6; Vol. 81, Issue 1; Page(s) 94-6
[Medline ID - 20019224]

BACKGROUND: Hereditary neuralgic amyotrophy (HNA), also known as hereditary brachial plexus neuropathy, has phenotypic and genetic heterogeneity. Mutations in the septin 9 (SEPT9) gene were recently identified in some HNA patients. The phenotypic spectrum of HNA caused by SEPT9 mutations is not well known. OBJECTIVE: To characterise the phenotype of a large family of HNA patients with the SEPT9 R88W mutation. METHODS: We report clinical, electrophysiological, neuroimaging and genetic findings of six HNA patients from a Japanese family. RESULTS: All 17 neuropathic episodes identified were selectively and asymmetrically distributed in the upper-limb nerves. Severe pain was an initial symptom in 16 episodes (94%). Motor weakness occurred in 15 (88%) and sensory signs in 10 (59%). A minor dysmorphism, hypotelorism, was seen in all. Nerve conduction studies revealed focal demyelination as well as prominent axonal degeneration changes. Needle electromyography revealed chronic neurogenic patterns only in the upper limbs. An MRI study showed a gadolinium-enhanced brachial plexus. The missense mutation c.262C > T; p.R88W was found in exon 2 of SEPT9 in all patients. CONCLUSIONS: The SEPT9 R88W mutation in this family causes selective involvement of the brachial plexus and upper-limb nerves. Wider and more universal recognition of clinical hallmarks and genetic counselling are of diagnostic importance for HNA caused by the SEPT9 mutation.

Bilateral phrenic nerve paralysis manifested by orthopnea for 6 months in a patient with neuralgic amyotrophy.
Author(s): Ikegami, G; Abe, T; Akasaka, K; Kouyama, A; Souma, R; Matsuo, T; Kouyama, K; Fujiwara, H; Ichiwata, T; Nagao, K
Journal: Intern Med 2010 Apr 13; Vol. 48, Issue 24; Page(s) 2123-7
[Medline ID - 20009405]

Bilateral phrenic nerve paralysis (BPP) is a relatively rare disease manifested by slight dyspnea at rest and on exertion in the sitting and standing positions and by dyspnea in the supine position. A 67-year-old man, who was a painter, presented with severe pain in both shoulder regions that had evolved into orthopnea and forced him to sleep in a sitting position at night. Dyspnea and paradoxical respiratory movement in the supine position raised suspicions of BPP. The most striking feature in this case was that the rapid onset of pain in both shoulder regions was followed by BPP. The BPP was considered to be secondary to neuralgic amyotrophy (NA).

Idiopathic brachial neuritis.
Author(s): Sumner, AJ
Journal: Neurosurgery 2010 Mar 17; Vol. 65, Issue 4 Suppl; Page(s) A150-2
[Medline ID - 19927060]

Parsonage-Turner syndrome (PTS) is a rare syndrome of unknown cause, affecting mainly the lower motor neurons of the brachial plexus. The brachial plexus is a group of nerves that conduct signals from the spine to the shoulder, arm, and hand. PTS is usually characterized by the sudden onset of severe 1-sided shoulder pain, followed by paralysis of the shoulder and lack of muscle control in the arm, wrist, or hand several days later. PTS can vary greatly in presentation and nerve involvement. Also known as brachial plexus neuritis or neuralgic amyotrophy, PTS is a common condition characterized by inflammation of a network of nerves that control and supply, or innervate, the muscles of the chest, shoulders, and arms. Individuals with the condition first experience severe pain across the shoulder and upper arm. Within a few hours or days, weakness, wasting (atrophy), and paralysis may affect the muscles of the shoulder. Although individuals with the condition may experience paralysis of the affected areas for months or, in some cases, years, recovery is usually eventually complete.

Things that go bump in the body: musculoskeletal sports medicine magnetic resonance imaging cases: part 2 of 2.
Author(s): Leswick, DA; Davidson, JM; Bock, GW; Major, PA; Maycher, B
Journal: Can Assoc Radiol J 2010 Feb 5; Vol. 60, Issue 5; Page(s) 248-62
[Medline ID - 19931131]

ABSTRACT NOT AVAILABLE

Best of the 2009 annual meeting of the american academy of neurology.
Author(s): Kelly, JJ
Journal: Rev Neurol Dis 2010 Mar 10; Vol. 6, Issue 3; Page(s) E94-6
[Medline ID - 19898274]

ABSTRACT NOT AVAILABLE

Herpes zoster brachial plexopathy with predominant radial nerve palsy.
Author(s): Jeevarethinam, A; Ihuoma, A; Ahmad, N
Journal: Clin Med 2009 Dec 16; Vol. 9, Issue 5; Page(s) 500-1
[Medline ID - 19886118]

Herpes zoster or shingles is the reactivation of dormant varicella zoster virus (VZV) in the dorsal root ganglia. Segmental motor paresis is rare and only few cases of brachial plexitis have been reported in the literature. This case reports herpes zoster resulting in unilateral brachial plexitis with predominant radial nerve palsy. The patient was treated successfully with aciclovir, gabapentin and physiotherapy with good recovery. Radial neuritis secondary to active herpes zoster has been rarely reported in the past.

Neuralgic amyotrophy following botulinum toxin injection.
Author(s): Alcalay, RN; Sim; ões, RM; Feigin, A; Frucht, S
Journal: Parkinsonism Relat Disord 2010 Jul 14; Vol. 16, Issue 4; Page(s) 301-2
[Medline ID - 19815448]

ABSTRACT NOT AVAILABLE

Differential diagnosis of shoulder pain followed by progressive weakness: a case report.
Author(s): Rosenthal, MD
Journal: J Spec Oper Med 2010 Sep 8; Vol. 9, Issue 1; Page(s) 16-9
[Medline ID - 19813344]

Upper extremity weakness can be the result of a myriad of conditions ranging from contractile tissue injury, joint injury, or injury to central or peripheral nervous system components. Accurate diagnosis is important in establishing an optimal treatment regimen and sound prognosis. This report provides an overview of the diagnosis and treatment of Parsonage-Turner Syndrome, a relatively rare cause of upper extremity weakness and dysfunction.

[An unusual cause of acute dyspnoea: neuralgic amyotrophy]
Author(s): van de Ven, AC; van Alfen, N; Heijdra, YF
Journal: Ned Tijdschr Geneeskd 2009 Dec 16; Vol. 153; Page(s) A181
[Medline ID - 19785818]

A 40-year-old man presented at the neurology outpatient clinic with sudden severe pain in both shoulders, followed by paresis of the muscles in this region. These complaints, in combination with acute dyspnoea when lying flat, and paradoxal movements of the abdomen during respiration, led to the diagnosis of neuralgic amyotrophy with phrenic nerve involvement. A 43-year-old man was seen on the pulmonary unit with severe pain in the shoulder area, followed by acute severe dyspnoea, worsening when he lay flat. Lung function analysis showed severe restriction and decreased maximal inspiratory mouth pressure. Taking into account the pain in the shoulder in combination with decreased inspiratory mouth pressure suggestive of diaphragmatic paresis, isolated neuralgic amyotrophy with phrenic nerve involvement was diagnosed. As these cases demonst rate, the diagnosis 'neuralgic amyotrophy with phrenic nerve involvement' often can be determined by history taking and physical examination. Unfamiliarity with this condition may lead to severe delay in the diagnostic process and to unnecessary investigations, especially when no accompanying paresis of the shoulder girdle and arm musculature is present.
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