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Pacing Clin Electrophysiol ; 45(4): 574-577, 2022 04.
Article in English | MEDLINE | ID: covidwho-1794593


A middle-aged woman presented with symptomatic complete heart block and underwent an uneventful dual chamber pacemaker implantation. Three weeks post procedure, she developed left arm pain and weakness, with neurological localization to the lower trunk of left brachial plexus. Possibilities of traumatic compression by the device/leads or postoperative idiopathic brachial plexopathy were considered. After ruling out traumatic causes, she was started on oral steroids, to which she responded remarkably. This case highlights the importance of recognizing this rare cause of brachial plexopathy following pacemaker implantation, because not only does an expedited diagnosis and medical treatment lead to prompt recovery with minimal neurological deficits, but it also circumvents an unnecessary surgical re-exploration.

Brachial Plexus Neuropathies , Brachial Plexus , Pacemaker, Artificial , Brachial Plexus Neuropathies/diagnosis , Brachial Plexus Neuropathies/etiology , Female , Humans , Middle Aged , Pacemaker, Artificial/adverse effects
BMJ Case Rep ; 14(3)2021 Mar 25.
Article in English | MEDLINE | ID: covidwho-1153656


COVID-19 affects a wide spectrum of organ systems. We report a 52-year-old man with hypertension and newly diagnosed diabetes mellitus who presented with hypoxic respiratory failure due to COVID-19 and developed severe brachial plexopathy. He was not treated with prone positioning respiratory therapy. Associated with the flaccid, painfully numb left upper extremity was a livedoid, purpuric rash on his left hand and forearm consistent with COVID-19-induced microangiopathy. Neuroimaging and electrophysiological data were consistent with near diffuse left brachial plexitis with selective sparing of axillary, suprascapular and pectoral fascicles. Given his microangiopathic rash, elevated D-dimers and paucifascicular plexopathy, we postulate a patchy microvascular thrombotic plexopathy. Providers should be aware of this significant and potentially under-recognised neurologic complication of COVID-19.

Brachial Plexus Neuropathies/etiology , COVID-19/complications , Arm/pathology , Brachial Plexus Neuropathies/diagnosis , COVID-19/diagnosis , Diabetes Mellitus , Exanthema/complications , Fibrin Fibrinogen Degradation Products/analysis , Humans , Hypertension/complications , Magnetic Resonance Imaging , Male , Middle Aged , Neuralgia/complications , Patient Positioning/adverse effects , Respiratory Insufficiency/etiology , SARS-CoV-2/isolation & purification