1/50. Neuralgic amyotrophy with phrenic nerve involvement.phrenic nerve involvement is a rare feature in patients with neuralgic amyotrophy (Parsonage-turner syndrome). We report four patients who initially presented with severe dyspnea in the absence of lung disease. All patients had a history of infectious disease or surgery and of pain of sudden onset in the shoulder region. Weakness of the proximal arm was observed in only one. Radiographic and pulmonary function studies, phrenic nerve conduction studies, and needle electromyogram (EMG) of the diaphragm documented diaphragmatic paralysis which was unilateral in one patient, bilateral in two patients, and recurrent on alternating sides in another one. follow-up studies remained abnormal for up to 4 years. Neuralgic amyotrophy with phrenic nerve involvement should be considered in patients presenting with severe, unexplained dyspnea of sudden onset.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
2/50. Distal neuralgic amyotrophy.Neuralgic amyotrophy consists of severe pain around the shoulder and arm followed by weakness in one or several muscles of the same area. We describe four patients with distal neuralgic amyotrophy in whom acute, severe, and transient pain around the shoulder or arm was followed by weakness of the forearm and hand muscles only. Minor sensory symptoms were present in only one patient. The presence of structural lesions causing the extent of the forearm and hand motor deficit was excluded by ancillary examinations. Electrophysiological studies showed a motor axonopathy and minimal sensory axonopathy. A follow-up of 2 years or longer showed either spontaneous improvement or residual motor deficit. Unfamiliarity with a clinically distal localization of neuralgic amyotrophy may result in misdiagnosis of lower cervical (poly)radiculopathy in view of the distal localization of the motor deficit and the high prevalence of coincidental abnormalities of the lower cervical spine on plain radiography, computed tomography, or magnetic resonance imaging.- - - - - - - - - - ranking = 2.008180391723keywords = pain, area (Clic here for more details about this article) |
3/50. Congenital dilation of the cervical epidural venous plexus: neuroradiology and endovenous management.We report a case of a 15-year-old girl suffering from cervicobrachialgia who was admitted to our service due to an enlarged neural foramen suspicious for a neurinoma. The cervical phlebography, however, revealed a space-occupying dilated epidural vein with increased blood supply from the suboccipital venous plexus. Lesions like this are absolutely rare, presumably of congenital origin and have not been described before. The lesion was treated by feeder occlusion applying platinum coils and enbucrilate via the internal jugular vein.- - - - - - - - - - ranking = 2778.9379244917keywords = plexus (Clic here for more details about this article) |
4/50. Clinical observations on 278 cases of cervical spondylopathy treated with electroacupuncture and massotherapy.From Dec. 1990 to Dec. 1993, 278 cases of cervical spondylopathy were treated with electroacupuncture and massotherapy. The cure rate was 82.7%; but in the control group, it was only 61%, indicating that electroacupuncture may enhance the cure rate (P < 0.05). Of the 278 cases treated by three to five sessions, the pain and numbness disappeared in about 96% of the patients.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
5/50. Adhesive capsulitis of the glenohumeral joint with an unusual neuropathic presentation: a case report.A 37-yr-old woman presented with a 7-mo history of unilateral shoulder girdle stiffness, pain, and weakness and had already been diagnosed with frozen shoulder. physical examination revealed scapular winging and suspicious focal paralysis of shoulder girdle muscles. Subsequently, electrodiagnostic studies reported denervation of deltoid, infraspinatus, serratus anterior, and lower cervical paraspinal muscles, in addition to a prolonged long thoracic nerve latency. The history, physical examination, and cervical magnetic resonance imaging scan seemed most consistent with neuralgic amyotrophy, although the electrodiagnostic examination could be interpreted as cervical radiculopathy. Some of the difficulties in identifying neuralgic amyotrophy and distinguishing it from cervical radiculopathy are discussed herein. Historically, frozen shoulder has seemed to develop as a complication of the neuropathic process. Both neuralgic amyotrophy and frozen shoulder have a poorly understood pathogenesis, and their combined presence is presumed to be rare. Because of difficulties inherent in the physical examination of frozen shoulder, a coexistent neuropathic process may go undetected.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
6/50. Hypertrophic inflammatory neuropathy involving bilateral brachial plexus.BACKGROUND: The present case is an example of hypertrophic inflammatory neuropathy (HIN). This entity is a rare tumor-like, chronic inflammatory, focal or multifocal, mainly demyelinating neuropathy of unknown origin, most frequently involving the brachial plexus. CASE DESCRIPTION: The authors describe a 67-year-old man presenting with a nodular mass in his right supraclavicular fossa. A nodular mass grossly resembling a schwannoma originating from a single nerve fascicle was surgically removed from the right C6 spinal nerve. Histologically, endoneurial edema, fibrosis, focal chronic inflammation, and extensive "onion bulb" formation were seen. Electron microscopy studies and immunohistochemistry proved that the onion bulb-forming cells were schwannian in nature and that the whorls of onion bulbs surrounded a generally demyelinated axon. Three months following surgery the patient developed acute painless paralysis of his right biceps brachii muscle that rapidly reversed; after that he remained neurologically asymptomatic. MRI revealed multiple fusiform mass lesions involving the brachial plexus bilaterally. Electrophysiologic studies demonstrated a bilateral, asymmetrical, mainly demyelinating neuropathy involving the brachial plexus; they failed to reveal any abnormality suggestive of generalized neuropathy. CONCLUSION: HIN is different from other focal tumor-like neuropathies and in particular from localized hypertrophic neuropathy (LHN).- - - - - - - - - - ranking = 3891.5130942883keywords = plexus, pain (Clic here for more details about this article) |
7/50. Viral brachial neuritis in emergency medicine.brachial plexus neuritis is a rare neurologic disease that may be overlooked in emergency medicine because other conditions are much more common. We report a case of brachial plexus neuropathy due to cytomegalovirus infection. The diagnosis was based on history, clinical findings, laboratory tests, and electromyography. early diagnosis and adequate treatment is important to avoid unnecessary investigation, prevent complications (especially adhesive capsulitis of the shoulder), and reassure the patient.- - - - - - - - - - ranking = 1111.5751697967keywords = plexus (Clic here for more details about this article) |
8/50. magnetic resonance imaging features of subacute idiopathic brachial neuritis.A 60-year-old man presented with sudden onset of left shoulder pain followed 2 weeks later by the development of left shoulder girdle weakness. A clinical and electrophysiological diagnosis of subacute idiopathic brachial neuritis was made. The MRI features of subacute muscular denervation in this patient are discussed and the relevant literature reviewed.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
9/50. Neuralgic amyotrophy as a presenting feature of infective endocarditis.A 35 year old man presented to his general practitioner with severe right shoulder pain and subsequent weakness and wasting of the muscles in the affected shoulder girdle three weeks after a dental filling. His symptoms persisted despite standard treatment. He developed malaise, night sweats, weight loss, a petechial rash and a microcytic anaemia. On admission to hospital three months after the start of his symptoms he had also developed splenomegaly and the murmur of aortic regurgitation. Investigations confirmed the diagnoses of infective endocarditis and neuralgic amyotrophy. In this case neuralgic amyotrophy appears to have been the presenting feature of infective endocarditis. This association has not previously been described.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
10/50. Respiratory weakness in neuralgic amyotrophy: report of two cases with phrenic nerve involvement.An isolated affection of the phrenic nerve is a rare feature in patients with neuralgic amyotrophy. We report 1 case each of bilateral and unilateral phrenic neuropathy. The first patient presented a sudden onset of severe respiratory failure without pain. The second patient developed intense pain in the neck and in the right shoulder followed by dyspnea on mild effort and orthopnea. Chest x-rays showed elevation of the diaphragm. Needle electromyography revealed denervation restricted to the diaphragm. The phrenic nerve conduction was within the normal range. The diagnosis of neuralgic amyotrophy may be particularly difficult when the palsy of the phrenic nerve appears without brachial plexus involvement or the typical shoulder pain of acute onset. In our patients, electrophysiological evaluation combined with radiographic studies, ventilatory parameters and biochemical analyses were helpful in establishing the diagnosis.- - - - - - - - - - ranking = 558.78758489833keywords = plexus, pain (Clic here for more details about this article) |
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