ABSTRACT
We report a 59-year-old male who, three weeks after a coronary revascularization surgery, reported a sudden intense burning pain in his left upper limb. Two weeks later, he reports a paresis with difficulty to extend his left wrist and fingers. The electromyography showed a severe axonal damage of the radial nerve with distal denervation signs. This clinical picture probably corresponds to a neuralgic amyotrophy, an inflammatory disorder of the brachial plexus known by a number of terms, including Parsonage-Turner syndrome.
Subject(s)
Humans , Male , Middle Aged , Brachial Plexus Neuritis/etiology , Percutaneous Coronary Intervention/adverse effects , Brachial Plexus Neuritis/physiopathology , Brachial Plexus Neuropathies/etiology , Brachial Plexus Neuropathies/physiopathology , ElectromyographyABSTRACT
BACKGROUND: Prevalence of subclinical involvement of motor pathways in clinically diagnosed Brachial Monomelic Amyotrophy (BMMA) is unknown. AIMS: To determine the prevalence of subclinical involvement of central motor pathways in BMMA using transcranial magnetic stimulation. SETTING AND DESIGN: Prospective case-control study. MATERIALS AND METHODS: Central motor conduction time (CMCT) was determined by 'F' wave method using figure-of-eight coil attached to Magstim 200 stimulator, in 17 patients with BMMA. Motor evoked potentials were recorded from first dorsal interosseous of the affected (AFF) and unaffected upper limbs (UNAFF) at rest and during partial contraction. Comparison was made with data from 10 healthy controls (CTRL). STATISTICAL ANALYSIS: Descriptive analysis and Analysis of Variance (ANOVA). RESULTS: Compared to controls, the mean CMCT of AFF was significantly prolonged, both at rest and contraction: (a) Rest: AFF-6.68+/-1.78 ms, UNAFF-6.36+/-1.16 ms, CTRL-5.71+/-1.02 ms; Fisher's PLSD for AFF vs. CTRL: P =0.037, (b) Contraction: AFF-5.78+/-1.62 ms, UAFF - 4.86+/-1.38 ms, CTRL-4.06+/-0.80 ms; Fisher's PLSD for AFF vs. CTRL; P =0.0002, AFF vs. UNAFF- P =0.044). Prolonged CMCT (>mean+2SD of controls) was observed in 29.4% of AFF and 6.25% of UNAFF at rest, and in 47.1% and 23.5% respectively during contraction. CONCLUSIONS: Dysfunction of central motor pathways was observed in both affected and unaffected upper limbs of some patients with BMMA of upper limbs. The dysfunction was more pronounced during voluntary contraction. A larger study is needed to validate the significance of these findings.
Subject(s)
Adolescent , Adult , Brachial Plexus Neuritis/physiopathology , Efferent Pathways/physiopathology , Electromyography , Female , Humans , Magnetic Resonance Imaging , Male , Neural Conduction/physiology , Transcranial Magnetic Stimulation , Upper Extremity/innervation , Young AdultABSTRACT
Se presentan dos casos clínicos de neuritis braquial (síndrome de Parsonage-Turner). Se discuten los aspectos clínicos y los hallazgos en resonancia magnética destacando el valor de ésta en su diagnóstico.
Subject(s)
Humans , Male , Adult , Middle Aged , Brachial Plexus Neuritis/diagnosis , Diagnosis, Differential , Shoulder Pain/etiology , Magnetic Resonance Imaging , Brachial Plexus Neuritis/physiopathology , Paresis/etiologyABSTRACT
Se enfatiza la imperativa necesidad de contar un diagnóstico exacto para aplicar la terapéutica adecuada al amanejo de los dolores cervicales irradiados a las extremidades superiores en la actualidad, teniendo presente la importancia de la clínica así como del diagnóstico clínico y evitar así que el diagnóstico complementario imagenológico moderno acelere prematuramente el tratamiento final hasta no haber valorado, exhaustivamente y con conocimiento de causa, los beneficios y las complicaciones a derivarse del manejo tanto médico como quirúrgico de estas patologías. Con ese objetivo, este trabajo expone los criterios derivados de la experiencia neuroquirúrgica del autor desde 1960 a la fecha