Course of Rehabilitation Treatment of Neuralgic Amyotrophy Presenting with Collet-Sicard Syndrome / The Japanese Journal of Rehabilitation Medicine

Typical cases of neuralgic amyotrophy present with sudden onset of excruciating pain in the shoulders and upper extremities, followed by marked muscle weakness and atrophy over a period of hours to days. Neuralgic amyotrophy is not confined to the brachial plexus, and difficulties in its diagnosis may delay the start of rehabilitation therapy. Here, we report a case of rehabilitation of a patient with neuralgic amyotrophy presenting with Collet-Sicard syndrome (9th, 10th, 11th, and 12th cranial nerve disorder)．A 44-year-old man developed severe pain from the left posterior neck to the occipital region, followed by sporadic onset of dysarthria, dysphagia, and difficulty in raising the left upper limb over several weeks. Nerve conduction studies showed marked bilateral differences in the amplitude of the compound muscle action potential recorded from the trapezius during accessory nerve stimulation. Needle electromyography showed abnormal resting potentials in the left trapezius and left side of the tongue and a decrease in the interference pattern during voluntary contraction. Based on the clinical course, neurological and laboratory findings, a diagnosis of neuralgic amyotrophy was made. Speech language hearing therapy was performed for dysarthria and dysphagia, and physical therapy was performed for difficulty in raising the left upper limb due to accessory nerve palsy. Rehabilitation along with recovery from inflammation-induced neuropathy allowed the patient to become independent in activities of daily living.

Course of Rehabilitation Treatment of Neuralgic Amyotrophy Presenting with Collet-Sicard Syndrome / The Japanese Journal of Rehabilitation Medicine

Typical cases of neuralgic amyotrophy present with sudden onset of excruciating pain in the shoulders and upper extremities, followed by marked muscle weakness and atrophy over a period of hours to days. Neuralgic amyotrophy is not confined to the brachial plexus, and difficulties in its diagnosis may delay the start of rehabilitation therapy. Here, we report a case of rehabilitation of a patient with neuralgic amyotrophy presenting with Collet-Sicard syndrome (9th, 10th, 11th, and 12th cranial nerve disorder)．A 44-year-old man developed severe pain from the left posterior neck to the occipital region, followed by sporadic onset of dysarthria, dysphagia, and difficulty in raising the left upper limb over several weeks. Nerve conduction studies showed marked bilateral differences in the amplitude of the compound muscle action potential recorded from the trapezius during accessory nerve stimulation. Needle electromyography showed abnormal resting potentials in the left trapezius and left side of the tongue and a decrease in the interference pattern during voluntary contraction. Based on the clinical course, neurological and laboratory findings, a diagnosis of neuralgic amyotrophy was made. Speech language hearing therapy was performed for dysarthria and dysphagia, and physical therapy was performed for difficulty in raising the left upper limb due to accessory nerve palsy. Rehabilitation along with recovery from inflammation-induced neuropathy allowed the patient to become independent in activities of daily living.

The clinical manifestations and outcomes of neuralgic amyotrophy

Background & Objective: Although the clinical manifestations and outcomes of neuralgic amyotrophy have been previously described, some controversies remain. Thus, we evaluated clinical manifestations and outcomes of patients with neuralgic amyotrophy. Methods: We evaluated the clinical and electrodiagnostic data, and the outcomes, of 32 patients with neuralgic amyotrophy.Of the 32 patients, 26 were followed-up for one year after onset of the disease.Results:The initial symptoms were pain (50.0%), pain with weakness (21.9%), other sensory symptoms without weakness (6.3%), and painless weakness or atrophy (21.9%). The commonly involved nerves were the median (75.0%), radial (68.8%), suprascapular (50.0%), ulnar (50.0%), axillary (46.9%), and musculocutaneous (40.6%) nerves. The initial symptoms were not associated with nerve involvement. Of all patients, 59% recovered fully, 16% had residual mild weakness without functional disability, and 6% experienced persistent severe weakness and were unable to return to work. Some patients were not evaluated because they were lost to follow-up. Conclusions: Painless weakness as an initial symptom of neuralgic amyotrophy may be more common than previously noted. Of all patients, 75% enjoyed favorable outcomes by one year after disease onset. These results will be useful when planning treatment strategies and will deepen our understanding of prognosis of neuralgic amyotrophy.

Neuralgic Amyotrophy Manifesting as Mimicking Posterior Interosseous Nerve Palsy

The upper trunk of the brachial plexus is the most common area affected by neuralgic amyotrophy (NA), and paresis of the shoulder girdle muscle is the most prevalent manifestation. Posterior interosseous nerve palsy is a rare presentation in patients with NA. It results in dropped finger on the affected side and may be misdiagnosed as entrapment syndrome or compressive neuropathy. We report an unusual case of NA manifested as PIN palsy and suggest that knowledge of clinical NA phenotypes is crucial for early diagnosis of peripheral nerve palsies.

Magnetic Resonance Neurography Findings in Idiopathic Neuralgic Amyotrophy / 계명의대학술지

Idiopathic neuralgic amyotrophy (INA) is known as Parsonage-Turner syndrome or idiopathic brachial plexitis and is characterized by sudden onset of severe limb pain, followed by weakness and atrophy of limb. There is no specific tests for the diagnosis of INA. The diagnosis of INA is mainly dependent on the clinical history and electrodiagnostic study. It is often confused with more common disorders such as acute cervical radiculopathy, rotator cuff tear, or acute calcific tendinitis. A few recent reports have revealed that magnetic resonance image (MRI) of brachial plexus and shoulder can be helpful in the diagnosis of INA. We report two cases of classic INA in which MRI enhanced specificity and confidence in the diagnosis. MRI of the brachial plexus and corresponding limb as well as cervical spine should be included in patients clinically suspected of INA.

Spinal Cord Stimulation for Refractory Neuropathic Pain of Neuralgic Amyotrophy / 대한신경손상학회지

The aim of this paper was to report the effect of temporary and chronic spinal cord stimulation for refractory neuropathic pain in neuralgic amyotrophy (NA). A 35-year-old female presented with two-months history of a severe, relentless neuropathic pain of the left shoulder, forearm, palm, and fingers. The neuropathic pain was refractory to various medical treatments, including nonsteroidal anti-inflammatory drugs, opiates, epidural and stellate ganglion blocks, and typically unrelenting. The diagnosis of NA was made with the characteristic clinical history and magnetic resonance imaging. The patient underwent a temporary spinal cord stimulation to achieve an adequate pain relief because her pain was notoriously difficult to control and lasted longer than the average duration (about 4 weeks on average) of a painful phase of NA. Permanent stimulation was given with paddle lead. The neuropathic pain in her NA persisted and she continued using the spinal cord stimulation with 12 months after development of NA. The temporary spinal cord stimulation was effective in a patient with an extraordinary prolonged, acute painful phase of NA attack, and the subsequent chronic stimulation was also useful in achieving an adequate analgesia during the chronic phase of NA.

Magnetic Resonance Neurographic Findings in Classic Idiopathic Neuralgic Amyotrophy in Subacute Stage: A Report of Four Cases

Neuralgic amyotrophy (NA) is characterized by acute onset of severe pain, followed by muscular weakness and wasting of the shoulder girdle. While the diagnosis of NA mainly relies on the clinical history and examination, some investigations including electrophysiologic study and radiologic study may help to confirm the diagnosis. Magnetic resonance neurography (MRN), a new technique for the evaluation of peripheral nerve disorders, can be helpful in the diagnosis of NA. MRN presents additional benefits in comparison to conventional magnetic resonance imaging in the diagnosis of idiopathic NA (INA). In this report, we present the first four cases of classic INA diagnosed with MRN in subacute stage. MRN imaging modality should be considered in patients clinically suspected of INA.

Brachial Plexopathies.

Lesions of the brachial plexus are most commonly caused by traumatic injuries. Other causes include infiltration by tumors, intrinsic or extrinsic compressions, damage from radiation therapy, or neuralgic amyotrophy (Parsonage-Turner syndrome). Less frequent causes of brachial plexus lesions include metabolic disease (e.g. diabetes), viral infections, immunological reactions to vaccination or infections, drugs, malignancies, paraneoplastic conditions, or hereditary disease (SEPT9 mutations, HNPP). The diagnosis of brachial plexus lesion is based upon history, clinical examination, and instrumental investigations, particularly, nerve conduction studies, electromyography, evoked potentials, magnetic stimulation, and the MRI. Treatment depends on the cause of the plexus lesion and includes prophylactic measures, physiotherapy, drugs, or surgery. Rarely applied measures include therapeutic magnetic stimulation or pulsed radiofrequency treatment. Outcome of plexus lesions depends on the underlying cause and the effectiveness of the treatment and ranges from favorable to deleterious. The outcome can be improved if diagnosis is made early and treatment is immediately applied after diagnosis.

Neuralgia amiotrófica posterior a la vacunación contra la leptospirosis humana / Neuralgic amyotrophy following vaccination against human leptospirosis

Introducción: la neuralgia amiotrófica o síndrome de Parsonage-Turner se asocia a vacunaciones en 15 por ciento de los casos. No existen reportes que vinculen esta condición con la vacuna contra la leptospirosis humana. Objetivo: describir las características clínicas de un paciente que presentó una plexopatía braquial aguda posterior a la inmunización contra la leptospirosis humana. Presentación del caso: un varón de 31 años de edad, obrero agrícola en 2008 recibió una dosis de la vacuna cubana contra la leptospirosis humana (vax-Spiral); 3 semanas después presentó dolor intenso localizado en ambos hombros, a la semana siguiente aparece debilidad muscular y posteriormente atrofia del músculo deltoides derecho. La evaluación neurológica era compatible con afección aguda asimétrica de la porción superior del plexo braquial, con mayor intensidad en el lado derecho, en el cual también estaba involucrado el diafragma. Se comprobó el compromiso de la porción superior del plexo braquial con estudios de neuroconducción y electromiografía. El paciente es tratado con analgésicos y fisioterapia, evolucionando de modo favorable. Conclusiones: el evento ocurrido en este caso sugiere que la vacuna cubana contra leptospirosis humana pudiera producir inmunorreactividad cruzada contra antígenos del sistema nervioso periférico

Introduction: neuralgic amyotrophy or Parsonage-Turner syndrome is associated with vaccination in 15 percent of cases. There are no reports linking this condition to the vaccine against human leptospirosis. Objective: describe the clinical characteristics of a patient who developed acute brachial plexopathy after vaccination against human leptospirosis. Case presentation: a male 31 year-old agricultural worker received a dose of the Cuban vaccine against human leptospirosis (vax-SPIRAL) in 2008. Three weeks later he presented intense pain in both shoulders. The following week he had muscular weakness, and then atrophy of the right deltoid muscle. Neurological evaluation showed acute asymmetric damage to the upper brachial plexus, with greater intensity on the right side, and involvement of the diaphragm. Nerve conduction examination and electromyography revealed involvement of the upper brachial plexus. The patient was treated with analgesics and physical therapy, and was found to evolve favorably. Conclusions: the events described suggest that the Cuban vaccine against human leptospirosis might produce immunological cross-reactivity against antigens of the peripheral nervous system

Neuroradiologic and Neurophysiologic Findings of Neuralgic Amyotrophy

OBJECTIVE: Neuralgic amyotrophy (NA) is a distinct clinical syndrome that is characterized by the acute onset of shoulder and arm pain, weakness, and sensory loss. The purpose of this study was to assess the clinical characteristics of NA and to determine appropriate diagnostic modalities. METHODS: We reviewed the medical and radiologic records of 10 patients diagnosed with NA retrospectively. Neurophysiologic studies were performed in all patients and magnetic resonance neurography was performed in the last three patients. RESULTS: A total of 10 patients were enrolled in our study. All patients had clinical findings compatible with NA. The most common clinical presentation was severe shoulder pain and weakness in seven patients (70%). Neurophysiologic study results were abnormal in all patients. Brachial plexus magnetic resonance neurography showed that the affected brachial plexus showed a thickened and hyper-intense trunk. All patients were managed conservatively with analgesics and physical therapy. The pain and paralysis of all patients improved clinically within 6 months of the initiation of treatment. CONCLUSION: NA is a rare disease but the symptoms of NA can mimic those of other diseases. Neurophysiologic studies and magnetic resonance neurography are extremely useful tools for the diagnosis of NA.

Neuralgic Amyotrophy Considered as Cervical Radiculopathy: A case report

Neuralgic amyotrophy is a syndrome with a broad range of clinical manifestations. It is characterized by acute, severe pain in the shoulder or arm lasting several days or weeks, followed by muscle weakness and atrophy as the pain diminishes. The diagnosis is based on typical clinical features, electromyography (EMG) and a nerve conduction study. The early and correct diagnosis is important to preclude unnecessary testing or surgical procedures. A 59-year-old female patient presented with pain and weakness involving her right palm and 1-3rd fingers. Three weeks before presentation, she noted the sudden onset of severe right shoulder and forearm pain. After the pain was reduced, she noted persistent right palm and 1-3rd finger pain and weakness. On cervical MRI, there was a mild central disc protrusion at C4-5 and C5-6. Electrodiagnostic testing was performed and she was diagnosed with neuralgic amyotrophy. One week after hospital treatment, her pain was relieved from VAS 10 to 3 and she was discharged with mild weakness of the thumb and index finger during pinch grips.

Neuralgic Amyotrophy:8 Cases Report and Relevant Literatures Review / 中国康复理论与实践

@# Objective To investigate the clinical features and characteristic of auxiliary examination of neuralgic amyotrophy(NA).Methods8 patients with idiopathic neuralgic amyotrophy were analyzed retrospectively with literature review.Results and ConclusionAntecedent events were found before attack in 5 patients.Serious pain,which was followed by paresis and atrophy,as initial symptom,was found in 7 patients.Damage in the upper and middle trunk distribution occurred most frequently.Elevated liver enzymes were found during the early phase of their attacks in 2 patients.CSF analysis was performed in 5 patients,and mildly elevated protein was found in two.5 patients had been misdiagnosed as cervical spondylosis.After medical and/or physical therapy(6 patients with corticosteroid and physical therapy,2 only with physical therapy),all the patients had been followed up for 2～13 months.Muscle power was recovered in 67% of all the patients,partially recovered in 33%.

Clinical Investigation and Nursing Care of Neuralgic Amyotrophy / 中国康复理论与实践

@#ObjectiveTo investigate the clinical features and nursing care of neuralgic amyotrophy.MethodsThe course of the treatment and nursing in a group of patients with idiopathic neuralgic amyotrophy was analyzed retrospectively.ResultsMyoatrophy was found in all patients, while 42% of patients were involved in both sides. Serious pain, as initial symptom, was found in 92% of patients. After medical and physical treatment, as well as holistic nursing care, the pain disappeared in 1～2 weeks in all patients but one. All patients had been followed up for 2～13 months, muscle power was recovered in 67% of all patients, partially recovered in 33% of patients.ConclusionThe careful nursing and observation is very helpful for recover of neuralgic amyotrophy and can decrease complications.

Neuralgic Amyotrophy: A case report / 대한마취과학회지

Neuralgic amyotrophy is an uncommon disorder characterized by acute onset of severe shoulder and upper arm pain followed by marked upper arm weakness. It is easily confused with other neck and upper extremity abnormalities, such as cervical spondylosis and cervical radiculopathy. The diagnosis is based on histroy, clinical findings, electromyography and excluding other disease. Early diagnosis and adequate treatment is important to avoid unnecessary tests and surgery, and prevent complications, especially adhesive capsulitis of the shoulder. 20-year old female patient presented with a history of severe pain involing left shoulder and upper extremity. 1 month after onset of pain suddenly, she noted weakness of left shouler muscles, especially abduction and flexion. At first visit in our clinic, she felt persistant pain for 4 months in the left shoulder, upper extremity and mild pain in the left lower extremity. She diagnosed with neuralgic amyotrophy with complex regional pain syndrome. Her pain managed with epidural block, sympathetic ganglion block, brachial plexus block, stellate ganglion block, intravenous regional block, intravenous local anesthetic infusion, oral analgesics, and exercise therapy. 5 months after the onset of pain, weakness of her shoulder muscles were fully recovered and 9 weaks after caring in our clinic, she had tolerable pain in her extremities and discharged.