RESUMO
The lesion of the accessory spinal nerve is often of iatrogenic origin. We report the case of an injury after a right jugulocarotid lymph node biopsy. A 30-year-old patient was referred for the treatment of right cervical lymphadenopathy suspected of tuberculosis. After the intervention and confirmation of tuberculosis diagnosis, the patient presented a functional impotence of the right shoulder and swarming of the right hand. The clinical examination found an active limitation of the shoulder, and a wasting of the upper bundle of the right trapezius muscle and the sternocleidomastoid. The EMG showed axonotmesis of the accessory spinal nerve and the MRI an amyotrophy of the trapezius with denervation edema. A simple rehabilitation has been scheduled. Damage of the accessory spinal nerve most often occurs after local surgery. EMG is essential for diagnosis. Rehabilitation is the first therapeutic option. Surgery can be considered if it fails. The surgeons must consider the protection of the accessory spinal nerve in case of cervical lymph node surgery.
Assuntos
Traumatismos do Nervo Acessório/etiologia , Linfonodos/patologia , Nervo Acessório/patologia , Doenças do Nervo Acessório/diagnóstico , Doenças do Nervo Acessório/etiologia , Traumatismos do Nervo Acessório/diagnóstico , Adulto , Biópsia/efeitos adversos , Humanos , Doença Iatrogênica , Masculino , Atrofia Muscular Espinal/diagnóstico , Atrofia Muscular Espinal/etiologia , Pescoço , Tuberculose dos Linfonodos/diagnóstico , Tuberculose dos Linfonodos/patologiaRESUMO
Tuberculosis is a major global public health problem. Osteoarticular tuberculosis is very rare. In half of the cases it affects the vertebrae. Symptoms are insidious over a prolonged period and isolation of the pathogen is difficult, mostly leading to difficult and delayed diagnosis. We here report a new case of tuberculous arthritis of the knee in a teenager in whom the mean time between symtom onset and definitive diagnosis based on the detection of Mycobacterium tuberculosis genome by Xpert MTB/RIF test was eight months. This study emphasizes the importance of bacteriological sampling and diagnostic methods by molecular assay in early and definitive diagnosis of tuberculous arthritis.
