|
1
|
Ambati VS, Madugala N, Anderson N, Poncelet AN, Bedell BR, Kolala RP, Mummaneni PV, Shah VN. Postprocedural Brachial Neuritis: Clinical, Electrodiagnostic, and Neuroimaging Features. AJNR Am J Neuroradiol 2025; 46:1050-1055. [PMID: 39500524 DOI: 10.3174/ajnr.a8561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Accepted: 11/01/2024] [Indexed: 05/03/2025]
Abstract
BACKGROUND AND PURPOSE Brachial neuritis is a monophasic condition affecting the brachial plexus and its branches, manifesting as acute shoulder and upper arm pain, followed by weakness and paresthesias. It can be triggered by antecedent events, including procedures such as surgery. Misdiagnosis and delay in diagnosis are common. Imaging is important to confirm the diagnosis of postprocedural brachial neuritis and exclude other etiologies. MATERIALS AND METHODS Clinical, electrodiagnostic, and neuroimaging features of patients with postprocedural brachial neuritis from a single quaternary care institution were identified and analyzed. RESULTS Six patients (2 women) were identified with a median age of 62 (range 49-70) years. Antecedent procedures included 4 cervical spine surgeries, 1 rotator cuff repair, and 1 central venous catheter placement. Time to symptom onset ranged from 1 day to 2 weeks. The initial symptom for 5 of the 6 patients was severe upper extremity pain followed by weakness. All patients had electrodiagnostic tests and MR neurography consistent with brachial neuritis. MR neurogram showed plexus and/or terminal branch abnormalities with associated muscular denervation edema. The C5 or C6 root and/or upper trunk were always involved. The most common branches affected were the suprascapular, long thoracic, and axillary nerves. Hourglass constrictions (HGCs) of these nerves were seen in 3 of 6 patients. The average time to diagnosis was 3.4 (range 1.5-5) months. CONCLUSIONS Postprocedural brachial neuritis is an under-recognized cause of acute upper extremity pain and weakness. MR neurography can exclude iatrogenic causes and document the presence of HGCs in affected nerves. Diagnostic neuroradiologists should be aware of this clinical entity and associated neuroimaging findings.
Collapse
Affiliation(s)
- Vardhaan S Ambati
- From the School of Medicine (V.S.A.), University of California San Francisco, San Francisco, California
- Department of Neurological Surgery (V.S.A., P.V.M.), University of California San Francisco, San Francisco, California
| | - Neha Madugala
- Department of Neurology (N.M., N.A., A.N.P., B.R.B., R.P.K.), University of California San Francisco, San Francisco, California
| | - Noriko Anderson
- Department of Neurology (N.M., N.A., A.N.P., B.R.B., R.P.K.), University of California San Francisco, San Francisco, California
| | - Ann N Poncelet
- Department of Neurology (N.M., N.A., A.N.P., B.R.B., R.P.K.), University of California San Francisco, San Francisco, California
| | - Bradley R Bedell
- Department of Neurology (N.M., N.A., A.N.P., B.R.B., R.P.K.), University of California San Francisco, San Francisco, California
| | - Reshma P Kolala
- Department of Neurology (N.M., N.A., A.N.P., B.R.B., R.P.K.), University of California San Francisco, San Francisco, California
| | - Praveen V Mummaneni
- Department of Neurological Surgery (V.S.A., P.V.M.), University of California San Francisco, San Francisco, California
| | - Vinil N Shah
- Department of Radiology and Biomedical Imaging (V.N.S.), University of California San Francisco, San Francisco, California
| |
Collapse
|
|
2
|
Gabet JM, Anderson N, Groothuis JT, Zeldin ER, Norbury JW, Jack AS, Jacques L, Sneag DB, Poncelet A. Neuralgic amyotrophy: An update in evaluation, diagnosis, and treatment approaches. Muscle Nerve 2025; 71:846-856. [PMID: 39402917 DOI: 10.1002/mus.28274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 09/21/2024] [Accepted: 09/23/2024] [Indexed: 04/16/2025]
Abstract
Neuralgic amyotrophy (NA) is an underrecognized peripheral nerve disorder distinguished by severe pain followed by weakness in the distribution of one or more nerves, most commonly in the upper extremity. While classically felt to carry a favorable prognosis, updates in research have demonstrated that patients frequently endure delay in diagnosis and continue to experience long term pain, paresis, and fatigue even years after the diagnosis is made. A transition in therapeutic approach is recommended and described by this review, which emphasizes the necessity to target compensatory abnormal motor control and fatigue by focusing on motor coordination, energy conservation strategies, and behavioral change, rather than strength training which may worsen the symptoms. The development of structural hourglass-like constrictions (HGCs) on imaging can help confirm the suspected clinical diagnosis, and in association with persistent weakness and limited recovery on electrodiagnostic testing may be considered for surgical consultation. Given the complex nature of management, a multidisciplinary approach is described, which can provide an optimal level of care and support for patients with persistent symptoms from NA and allow more unified guidance of rehabilitation and surgical referrals.
Collapse
Affiliation(s)
- Joelle M Gabet
- Department of Physical Medicine and Rehabilitation, MetroHealth Rehabilitation Institute, The MetroHealth System and Case Western Reserve University, Cleveland, Ohio, USA
| | - Noriko Anderson
- Department of Neurology, University of California San Francisco Medical Center and Weill Institute for Neurosciences, San Francisco, California, USA
| | - Jan T Groothuis
- Department of Rehabilitation, Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Evan R Zeldin
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - John W Norbury
- Department of Neurology, Division of Physical Medicine and Rehabilitation, Texas Tech Health Sciences Center, Lubbock, Texas, USA
| | - Andrew S Jack
- Division of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada
| | - Line Jacques
- Department of Neurological Surgery, University of California San Francisco Medical Center and Weill Institute for Neurosciences, San Francisco, California, USA
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
| | - Ann Poncelet
- Department of Neurology, University of California San Francisco Medical Center and Weill Institute for Neurosciences, San Francisco, California, USA
| |
Collapse
|
|
3
|
Nwawka OK, Adriaensen M, Andreisek G, Drakonaki EE, Lee KS, Lutz AM, Martinoli C, Nacey N, Symanski JS. Imaging of Peripheral Nerves: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2025; 224:e2431064. [PMID: 38775432 DOI: 10.2214/ajr.24.31064] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2025]
Abstract
Peripheral nerve imaging provides information that can be critical to the diagnosis, staging, and management of peripheral neuropathies. MRI and ultrasound are the imaging modalities of choice for clinical evaluation of the peripheral nerves given their high soft-tissue contrast and high resolution, respectively. This AJR Expert Panel Narrative Review describes MRI- and ultrasound-based techniques for peripheral nerve imaging; highlights considerations for imaging in the settings of trauma, entrapment syndromes, diffuse inflammatory neuropathies, and tumor; and discusses image-guided nerve interventions, focusing on nerve blocks and ablation.
Collapse
Affiliation(s)
- O Kenechi Nwawka
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
| | - Miraude Adriaensen
- Department of Medical Imaging, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Gustav Andreisek
- Institute of Radiology, Cantonal Hospital Munsterlingen, Munsterlingen, Switzerland
- Institute of Diagnostic and Interventional Radiology, University of Zurich, Zurich, Switzerland
| | - Elena E Drakonaki
- Department of Anatomy, University of Crete School of Medicine, Heraklion, Greece
- Department of MSK Imaging, Diagnostic and Interventional Ultrasound Practice, Heraklion, Greece
| | - Kenneth S Lee
- Department of Radiology, University of Wisconsin, Madison, WI
| | - Amelie M Lutz
- Institute of Radiology, Cantonal Hospital Munsterlingen, Munsterlingen, Switzerland
- Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | - Carlo Martinoli
- Department of Health Sciences, University of Genoa, Genova, Italy
| | - Nicholas Nacey
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA
| | - John S Symanski
- Department of Radiology, University of Wisconsin, Madison, WI
| |
Collapse
|
|
4
|
Pitman J, Fayad LM, Ahlawat S. A neuromuscular clinician's guide to magnetic resonance neurography. Muscle Nerve 2025; 71:293-308. [PMID: 39479875 DOI: 10.1002/mus.28283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 10/04/2024] [Accepted: 10/13/2024] [Indexed: 02/07/2025]
Abstract
Magnetic resonance neurography (MRN) is increasingly used in clinical practice for the evaluation of patients with a wide spectrum of peripheral nerve disorders. This review article discusses the technical aspects of MRN highlighting the core sequences performed for clinical care. A robust, high-resolution, heavily T2-weighted fluid-sensitive sequence performed on a 3.0 Tesla magnet system remains the main workhorse MRN sequence. In specific clinical scenarios, adjunct techniques such as diffusion-weighted imaging can be added to a protocol for disease characterization. In addition, gadolinium-based contrast material can also be administered for the purposes of image optimization (suppress adjacent vascular signal) and disease characterization. Technical modifications to field of view and planes of imaging can be made based on the clinical question and discussion with the radiologist(s). On fluid-sensitive MRN sequences, a normal peripheral nerve exhibits iso- to minimally hyperintense signal relative to skeletal muscle with a predictable trajectory, preserved "fascicular" architecture, and tapered caliber from proximal to distal. Peripheral nerve abnormalities on MRN include alterations in signal, caliber, architecture, diffusion characteristics as well as enhancement and provide information regarding the underlying etiology. Although some MRN findings including nerve hyperintensity and long-segmental enlargement are nonspecific, there are certain diagnoses that can be made with high certainty based on imaging including benign peripheral nerve tumors, high-grade peripheral nerve injury, and intraneural ganglia. The purpose of this article is to familiarize a neuromuscular clinician with fundamentals of MRN acquisition and interpretation to facilitate communication with the neuromuscular radiologist and optimize patient care.
Collapse
Affiliation(s)
- Jenifer Pitman
- Musculoskeletal Imaging Division, The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Laura M Fayad
- Musculoskeletal Imaging Division, The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Shivani Ahlawat
- Musculoskeletal Imaging Division, The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
|
5
|
Colucci PG, Gao MA, Tan ET, Queler S, Belanger M, Tsai J, Carrino JA, Sneag DB. Development of an interactive ultra-high resolution magnetic resonance neurography atlas of the brachial plexus and upper extremity peripheral nerves. Clin Imaging 2025; 119:110400. [PMID: 39765207 DOI: 10.1016/j.clinimag.2024.110400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2024] [Revised: 12/16/2024] [Accepted: 12/29/2024] [Indexed: 02/12/2025]
Abstract
PURPOSE To develop an educational, interactive, ultra-high resolution, in vivo magnetic resonance (MR) neurography atlas for direct visualization of the brachial plexus and upper extremity. METHODS A total of 16 adult volunteers without known peripheral neuropathy underwent magnetic resonance (MR) neurography of the brachial plexus and upper extremity. To improve vascular suppression, subjects received an intravenous infusion of ferumoxytol. To improve image quality, MR neurography datasets were reconstructed using a deep learning algorithm. The atlas was then developed using a web-based user-interface software, which allowed for labeling of peripheral nerves and muscles, and mapping of muscles to their respective innervation. The user interface was optimized to maximize interactivity and user-friendliness. RESULTS Fifteen subjects completed at least one scan with no reported adverse reactions from the ferumoxytol infusions. Adequate vascular suppression was observed in all MR neurography datasets. The images of the brachial plexus and upper extremity included in this atlas allowed for identification and labeling of 177 unique anatomical structures from the neck to the wrist. The atlas was made freely accessible on the internet. CONCLUSION A detailed and interactive MR neurography atlas of the brachial plexus and upper extremity was successfully developed to depict small nerves and fascicular detail with unprecedented spatial and contrast resolution. This freely available online resource (https://www.hss.edu/MRNatlas) can be used as an educational tool and clinical reference. The techniques utilized in this project serve as a framework for continued work in expanding the atlas to cover other peripheral nerve territories.
Collapse
Affiliation(s)
- Philip G Colucci
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, United States of America.
| | - Madeleine A Gao
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, United States of America
| | - Ek Tsoon Tan
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, United States of America.
| | - Sophie Queler
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, United States of America.
| | - Marianne Belanger
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, United States of America.
| | - Joyce Tsai
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, United States of America.
| | - John A Carrino
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, United States of America.
| | - Darryl B Sneag
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, United States of America.
| |
Collapse
|
|
6
|
Daniels SP, Hacquebord JH, Azad A, Adler RS. Peripheral Nerve Injuries: Preoperative Evaluation and Postoperative Imaging. Semin Musculoskelet Radiol 2025; 29:76-84. [PMID: 39933542 DOI: 10.1055/s-0044-1791756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2025]
Abstract
Imaging plays an important role in evaluating peripheral nerves. In the preoperative setting, imaging helps overcome pitfalls of electrodiagnostic testing and provides key anatomical information to guide surgical management. In the postoperative setting, imaging also offers key information for treating physicians, although it comes with several challenges due to postsurgical changes and alteration of normal anatomy. This article reviews our approach to peripheral nerve imaging, including how we use imaging in the pre- and postoperative setting for several common indications.
Collapse
Affiliation(s)
- Steven P Daniels
- Department of Radiology, New York University Grossman School of Medicine, New York University, New York, New York
| | - Jacques H Hacquebord
- Department of Orthopedic Surgery, New York University Grossman School of Medicine, New York University, New York, New York
- Hansjörg Wyss Department of Plastic Surgery, New York University Grossman School of Medicine, New York University, New York, New York
| | - Ali Azad
- Department of Orthopedic Surgery, New York University Grossman School of Medicine, New York University, New York, New York
| | - Ronald S Adler
- Department of Radiology, New York University Grossman School of Medicine, New York University, New York, New York
| |
Collapse
|
|
7
|
Miller NJ, Meiling JB, Cartwright MS, Walker FO. The Role of Neuromuscular Ultrasound in the Diagnosis of Peripheral Neuropathy. Semin Neurol 2025; 45:34-48. [PMID: 39433283 DOI: 10.1055/s-0044-1791577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2024]
Abstract
The classification of peripheral neuropathies has traditionally been based on etiology, electrodiagnostic findings, or histopathologic features. With the advent of modern imaging, they now can also be characterized based on their varied distribution of imaging findings. We describe the major morphologic patterns of these changes, which include homogeneous enlargement; homogeneous thinning; focal, multifocal, and segmental enlargement; and focal thinning and beading (multifocal thinning). Representative disorders in each of these categories are discussed, along with examples of the more complex imaging manifestations of neuralgic amyotrophy, nerve transection, and hereditary amyloidosis. An appreciation of the diverse morphologic manifestations of neuropathy can help neuromuscular clinicians conduct appropriate imaging studies with ultrasound and, when needed, order suitable investigations with magnetic resonance neurography.
Collapse
Affiliation(s)
- Nicholas J Miller
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, 800 Sherbrook Street, Winnipeg, Manitoba, Canada
| | - James B Meiling
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, 200 First Street Southwest, Rochester, Minnesota
| | - Michael S Cartwright
- Department of Neurology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina
| | - Francis O Walker
- Department of Neurology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina
| |
Collapse
|
|
8
|
Fortuna A, Sorarù G. Cervical lower motor neuron syndromes: A diagnostic challenge. J Neurol Sci 2025; 468:123357. [PMID: 39740575 DOI: 10.1016/j.jns.2024.123357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2024] [Revised: 12/10/2024] [Accepted: 12/13/2024] [Indexed: 01/02/2025]
Abstract
Cervical lower motor neuron (LMN) syndromes, also known as brachial paresis, are characterized by muscle atrophy, weakness, and decreased reflexes in the upper limbs, devoid of sensory symptoms. These syndromes can stem from various factors, including degenerative conditions, immune-mediated diseases, infections, toxic exposures, metabolic disorders, and vascular anomalies.1 Clinical presentations vary, with motor neuron involvement potentially limited to the cervical area or extending to other regions, affecting prognosis. Misdiagnosis is a significant issue, particularly in lower motor neuron presentations, with an error rate nearing 20 %.2 This review proposes a classification system based on magnetic resonance imaging (MRI) findings, the onset timing of symptoms (acute, subacute, or chronic), the symmetry and distribution of atrophy, and the etiology (sporadic or hereditary). Acute conditions may include spinal ischemia,3 whereas subacute or chronic forms can manifest as symmetric (e.g., cervical spondylogenic myelopathy)4 or asymmetric (e.g., Hirayama disease)5 presentations. Neurophysiological assessments and cervical MRI are crucial for accurate diagnosis, as they reveal patterns that provide lesion localization and additional clues to the underlying cause. A systematic diagnostic approach is essential for navigating the complexities of these syndromes.
Collapse
Affiliation(s)
- Andrea Fortuna
- Veneto Regional Center Motor Neuron Diseases, Department of Neurosciences, University Hospital of Padova, Italy.
| | - Gianni Sorarù
- Veneto Regional Center Motor Neuron Diseases, Department of Neurosciences, University Hospital of Padova, Italy
| |
Collapse
|
|
9
|
Hazewinkel MH, Lin Y, Li TY, Cisse B, Tan ET, Sneag DB, Gfrerer L. Use of Magnetic Resonance Neurography for Sensory Nerve Injuries of the Head and Neck. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2025; 13:e6475. [PMID: 39872082 PMCID: PMC11771605 DOI: 10.1097/gox.0000000000006475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Accepted: 11/25/2024] [Indexed: 01/29/2025]
Abstract
Background Identification of peripheral nerve injuries of the head and neck can be challenging due to a broad spectrum of symptoms from neuropathic pain to headaches and migraine. This article aimed to present the clinical features and diagnostic workup of patients with acute and chronic peripheral nerve injuries of the head and neck using magnetic resonance neurography (MRN), to demonstrate potential advantages compared with conventional magnetic resonance imaging (MRI). Methods Patients who presented with suspected peripheral nerve injury were either referred for a conventional MRI or MRN. Patients who underwent nerve exploration for suspected nerve transection and/or neuroma formation on imaging were included in this study. Imaging findings were correlated with intraoperative observations. Results Four patients (3 women, 1 man, age range: 34-70 years) were included. Three subjects had a history of head and neck surgery and 1 experienced direct trauma to the medial eyebrow. Clinical symptoms included numbness, allodynia, positive Tinel sign, and pain relief following nerve blocks. Two patients underwent conventional MRI and 2 underwent MRN. MRI provided a vague indication of potential neuromas and failed to accurately depict their locations. MRN offered a comprehensive visualization of the entire nerve path, identifying nerve transection and neuromas, as well as precise location, dimensions, and relation to adjacent bones and muscles. Conclusions High-resolution 3-dimensional MRN provides clear visualization of acute and chronic peripheral nerve injuries of the head and neck region, facilitating early diagnosis of nerve injuries in this region and improving diagnostic accuracy, as well as surgical planning and execution.
Collapse
Affiliation(s)
- Merel H.J. Hazewinkel
- From the Department of Plastic and Reconstructive Surgery, Weill Cornell Medicine, New York, NY
| | - Yenpo Lin
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tim Y. Li
- From the Department of Plastic and Reconstructive Surgery, Weill Cornell Medicine, New York, NY
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY
| | - Babacar Cisse
- Department of Neurological Surgery, Weill Cornell Medicine, New York, NY
| | - Ek T. Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY
| | - Darryl B. Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY
| | - Lisa Gfrerer
- From the Department of Plastic and Reconstructive Surgery, Weill Cornell Medicine, New York, NY
| |
Collapse
|
|
10
|
Druzhinina ES, Druzhinin DS, Tikhonova OA, Zavadenko NN. [Therapeutic options in patients with neuralgic amyotrophy]. Zh Nevrol Psikhiatr Im S S Korsakova 2025; 125:39-45. [PMID: 40195099 DOI: 10.17116/jnevro202512503139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2025]
Abstract
OBJECTIVE To evaluate the outcomes of patients with neuralgic amyotrophy (NA) depending on the type of treatment received - surgical or glucocorticosteroid administration. MATERIAL AND METHODS The outcome of 101 patients with verified NA was analyzed. The mean age of NA patients was 38.21±16.09 years (8 to 76 years), of which 69.3% were males (n=70) and 30.7% were females (n=31). The diagnosis was confirmed by electromyography, cervical spine MRI, and clinical data evaluation: pain according to VAS, duration of pain, timing of diagnosis from the disease onset, and severity of muscle weakness using the MRC scale. Most patients had a classic form (50.5%, n=51), followed by a distal form (39.6%, n=40), and nerve damage above the elbow joint or cranial nerves (9.9%, n=10). Most patients were examined during the phase of pain and muscle weakness (59.4%, n=60) and in the recovery phase (40.6%, n=41). 48.5% (n=49) of patients received steroids. Surgical treatment was performed in 15.8% of cases (n=16). The median follow-up of all patients was 12 months (Q1-Q3 6.00-20.00). RESULTS Patients who received GCS recovered better - 67.7% had a complete recovery compared to patients who did not receive pathogenetic therapy. Regardless of the GCS use, the outcome also depended on the NA form and the initial severity of muscle weakness (p<0.001 and p=0.001, respectively). Comparing the outcomes in the groups with and without surgery showed no statistically significant differences. However, in the non-surgery group, a higher percentage of non-recovery was found (71.4%) compared to the group receiving surgical treatment (28.6%). In 97.4% (n=38) of cases of distal NA, ultrasound revealed focal changes in the nerves, which initially indicated a poor prognosis for recovery. CONCLUSION Steroid therapy affects muscle strength recovery in patients with NA. The NA form and the initial severity of motor deficit also affect the outcome. Surgical treatment is indicated for patients with distal NA.
Collapse
Affiliation(s)
- E S Druzhinina
- Pirogov Russian National Research Medical University (Pirogov University), Moscow, Russia
| | - D S Druzhinin
- Yaroslavl State Medical University, Yaroslavl, Russia
| | - O A Tikhonova
- Immanuel Kant Baltic Federal University, Kaliningrad, Russia
| | - N N Zavadenko
- Pirogov Russian National Research Medical University (Pirogov University), Moscow, Russia
| |
Collapse
|
|
11
|
Gerber F, Zenkhri S, Farron A, Traverso A. Peripheral neuropathy following monkeypox infection: an unexpected diagnosis of Parsonage-Turner syndrome. BMJ Case Rep 2024; 17:e258334. [PMID: 39419600 PMCID: PMC11487814 DOI: 10.1136/bcr-2023-258334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 09/20/2024] [Indexed: 10/19/2024] Open
Abstract
Parsonage-Turner syndrome following monkeypox infection is a rare form of peripheral neuropathy seen in orthopaedic practice and described only once in the literature. We present the case of a man in his 30s with severe shoulder pain and subsequent amyotrophy 2 weeks after monkeypox infection. Our report encompasses the initial findings, radiographic examinations and follow-up over a 6-month period. To confirm the diagnosis, MRI and electrostimulation conduction studies were conducted, highlighting their importance as valuable diagnostic tools in conjunction with a thorough physical examination. Supportive treatment, including physical therapy and pain management, forms the cornerstone of management, while surgical intervention is reserved for refractory cases or when mechanical complications arise. Prognosis varies among individuals. This case report expands the understanding of neurological complications of monkeypox infection. Clinicians should include Parsonage-Turner syndrome in their differential diagnosis for patients presenting with symptoms of peripheral brachial plexus neuropathy following viral infections, including monkeypox.
Collapse
Affiliation(s)
- Filippo Gerber
- Department of Orthopaedics and Traumatology CHUV, Lausanne University Hospital, Lausanne, Switzerland
- University of Lausanne, Lausanne, Switzerland
| | - Salim Zenkhri
- University of Lausanne, Lausanne, Switzerland
- Department of Radiology and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Alain Farron
- Department of Orthopaedics and Traumatology CHUV, Lausanne University Hospital, Lausanne, Switzerland
- University of Lausanne, Lausanne, Switzerland
| | - Aurélien Traverso
- Department of Orthopaedics and Traumatology CHUV, Lausanne University Hospital, Lausanne, Switzerland
- University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
|
12
|
Holle JF, Limmroth V, Windisch W, Zimmerman M. Neuralgic Amyotrophy. DEUTSCHES ARZTEBLATT INTERNATIONAL 2024; 121:483-489. [PMID: 38835178 PMCID: PMC11526358 DOI: 10.3238/arztebl.m2024.0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 04/16/2024] [Accepted: 04/16/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Neuralgic amyotrophy (NA) is a multifactorial, monophasic neuritis that mainly affects the nerves of the shoulder girdle. It is characterized by very severe pain and by weakness that arises some time after the pain. Its reported incidence is high (100 cases per 100 000 persons per year), but our data suggest that many or most cases are diagnosed late or not at all. METHODS This review of the epidemiology, pathophysiology, diagnosis, and treatment of NA is based on pertinent publications retrieved by a selective literature search, and on data provided by the scientific institute of AOK, a German statutory health-insurance carrier. RESULTS It is currently thought that the combination of a genetic predisposition, an immunological trigger factor, and mechanical stress on the affected nerve segment(s) is pathophysiologically determinative. The prognosis of untreated NA is poor, with 25% of patients remaining unable to work at three years. The main form of treatment is with corticosteroids that are administered as early as possible. If there is evidence of nerve constriction or torsion, surgery may also help. There have only been six controlled cohort studies on the treatment of NA, and no randomized trials. It is not uncommon for the acute phase to develop into a chronic pain syndrome requiring multidimensional treatment. CONCLUSION Particularly in view of the high incidence and improved therapeutic options, NA should be included in the differential diagnosis of all patients with suggestive symptoms.
Collapse
Affiliation(s)
- Johannes Fabian Holle
- Department of Neurology, Cologne-Merheim, Hospitals of the City of Cologne, Cologne
- Health Faculty/Department for Human Medicine, University of Witten/Herdecke
| | - Volker Limmroth
- Department of Neurology, Cologne-Merheim, Hospitals of the City of Cologne, Cologne
| | - Wolfram Windisch
- Cologne-Merheim Lung Clinic, Hospitals of the City of Cologne, Cologne
- Health Faculty/Department for Human Medicine, University of Witten/Herdecke
| | - Maximilian Zimmerman
- Cologne-Merheim Lung Clinic, Hospitals of the City of Cologne, Cologne
- Health Faculty/Department for Human Medicine, University of Witten/Herdecke
| |
Collapse
|
|
13
|
Sneag DB, Urban C, Li TY, Colucci PG, Pedrick EG, Nimura CA, Feinberg JH, Milani CJ, Tan ET. Hourglass-like constrictions on MRI are common in electromyography-confirmed cases of neuralgic amyotrophy (Parsonage-Turner syndrome): A tertiary referral center experience. Muscle Nerve 2024; 70:42-51. [PMID: 37610034 PMCID: PMC10884353 DOI: 10.1002/mus.27961] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 08/24/2023]
Abstract
INTRODUCTION/AIMS Hourglass-like constrictions (HGCs) of involved nerves in neuralgic amyotrophy (NA) (Parsonage-Turner syndrome) have been increasingly recognized with magnetic resonance neurography (MRN). This study sought to determine the sensitivity of HGCs, detected by MRN, among electromyography (EMG)-confirmed NA cases. METHODS This study retrospectively reviewed records of patients with the clinical diagnosis of NA, and with EMG confirmation, who underwent 3-Tesla MRN within 90 days of EMG at a single tertiary referral center between 2011 and 2021. "Severe NA" positive cases were defined by a clinical diagnosis and specific EMG criteria: fibrillation potentials or positive sharp waves, along with motor unit recruitment (MUR) grades of "discrete" or "none." On MRN, one or more HGCs, defined as focally decreased nerve caliber or diffusely beaded appearance, was considered "imaging-positive." Post hoc inter-rater reliability for HGCs was measured by comparing the original MRN report against subsequent blinded interpretation by a second radiologist. RESULTS A total of 123 NA patients with 3-Tesla MRN performed within 90 days of EMG were identified. HGCs were observed in 90.2% of all NA patients. In "severe NA" cases, based on the above EMG criteria, HGC detection resulted in a sensitivity of 91.9%. Nerve-by-nerve analysis (183 nerve-muscle pairs, nerves assessed by MRN, muscles assessed by EMG) showed a sensitivity of 91.0%. The second radiologist largely agreed with the original HGC evaluation, (94.3% by subjects, 91.8% by nerves), with no significant difference between evaluations (subjects: χ2 = 2.27, P = .132, nerves: χ2 = 0.98, P = .323). DISCUSSION MRN detection of HGCs is common in NA.
Collapse
Affiliation(s)
- Darryl B. Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA 10021
| | - Casey Urban
- Hand and Upper Extremity Service, Hospital for Special Surgery, New York, NY, USA 10021
| | - Tim Y. Li
- Weill Cornell Medical College, New York, NY, USA 10021
| | - Philip G. Colucci
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA 10021
| | - Emily G. Pedrick
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA 10021
| | - Clare A. Nimura
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA 10021
| | - Joseph H. Feinberg
- Department of Physiatry, Hospital for Special Surgery, New York, NY, USA 10021
| | - Carlo J. Milani
- Department of Physiatry, Hospital for Special Surgery, New York, NY, USA 10021
| | - Ek T. Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA 10021
| |
Collapse
|
|
14
|
Morena J, Tan ET, Campbell G, Bhatti P, Li Q, Geannette CS, Lin Y, Milani CJ, Sneag DB. MR Neurography and Quantitative Muscle MRI of Parsonage Turner Syndrome Involving the Long Thoracic Nerve. J Magn Reson Imaging 2024; 59:2180-2189. [PMID: 37702553 PMCID: PMC10932860 DOI: 10.1002/jmri.29007] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/27/2023] [Accepted: 08/28/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Parsonage-Turner syndrome (PTS) is characterized by severe, acute upper extremity pain and subsequent paresis and most commonly involves the long thoracic nerve (LTN). While MR neurography (MRN) can detect LTN hourglass-like constrictions (HGCs), quantitative muscle MRI (qMRI) can quantify serratus anterior muscle (SAM) neurogenic changes. PURPOSE/HYPOTHESIS 1) To characterize qMRI findings in LTN-involved PTS. 2) To investigate associations between qMRI and clinical assessments of HGCs/electromyography (EMG). STUDY TYPE Prospective. POPULATION 30 PTS subjects (25 M/5 F, mean/range age = 39/15-67 years) with LTN involvement who underwent bilateral chest wall qMRI and unilateral brachial plexus MRN. FIELD STRENGTH/SEQUENCES 3.0 Tesla/multiecho spin-echo T2-mapping, diffusion-weighted echo-planar-imaging, multiecho gradient echo. ASSESSMENT qMRI was performed to obtain T2, muscle diameter fat fraction (FF), and cross-sectional area of the SAM. Clinical reports of MRN and EMG were obtained; from MRN, the number of HGCs; from EMG, SAM measurements of motor unit recruitment levels, fibrillations, and positive sharp waves. qMRI/MRN were performed within 90 days of EMG. EMG was performed on average 185 days from symptom onset (all ≥2 weeks from symptom onset) and 5 days preceding MRI. STATISTICAL TESTS Paired t-tests were used to compare qMRI measures in the affected SAM versus the contralateral, unaffected side (P < 0.05 deemed statistically significant). Kendall's tau was used to determine associations between qMRI against HGCs and EMG. RESULTS Relative to the unaffected SAM, the affected SAM had increased T2 (50.42 ± 6.62 vs. 39.09 ± 4.23 msec) and FF (8.45 ± 9.69 vs. 4.03% ± 1.97%), and decreased muscle diameter (74.26 ± 21.54 vs. 88.73 ± 17.61 μm) and cross-sectional area (9.21 ± 3.75 vs. 16.77 ± 6.40 mm2). There were weak to negligible associations (tau = -0.229 to <0.001, P = 0.054-1.00) between individual qMRI biomarkers and clinical assessments of HGCs and EMG. DATA CONCLUSION qMRI changes in the SAM were observed in subjects with PTS involving the LTN. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 1.
Collapse
Affiliation(s)
- Jonathan Morena
- Department of Neurology, Hospital for Special Surgery, New York, NY
| | - Ek T Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY
| | - Gracyn Campbell
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY
| | - Pravjit Bhatti
- Georgetown University School of Medicine, Washington, DC
| | - Qian Li
- Department of Biostatistics, Hospital for Special Surgery, New York, NY
| | | | - Yenpo Lin
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Carlo J Milani
- Department of Physiatry, Hospital for Special Surgery, New York, NY
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY
| |
Collapse
|
|
15
|
Hannaford A, Paling E, Silsby M, Vincenten S, van Alfen N, Simon NG. Electrodiagnostic studies and new diagnostic modalities for evaluation of peripheral nerve disorders. Muscle Nerve 2024; 69:653-669. [PMID: 38433118 DOI: 10.1002/mus.28068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 03/05/2024]
Abstract
Electrodiagnostic studies (EDx) are frequently performed in the diagnostic evaluation of peripheral nerve disorders. There is increasing interest in the use of newer, alternative diagnostic modalities, in particular imaging, either to complement or replace established EDx protocols. However, the evidence to support this approach has not been expansively reviewed. In this paper, diagnostic performance data from studies of EDx and other diagnostic modalities in common peripheral nerve disorders have been analyzed and described, with a focus on radiculopathy, plexopathy, compressive neuropathies, and the important neuropathy subtypes of Guillain-Barré syndrome, chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), vasculitic neuropathy and diabetic neuropathy. Overall EDx retains its place as a primary diagnostic modality in the evaluated peripheral nerve disorders. Magnetic resonance imaging and ultrasound have developed important complementary diagnostic roles in compressive and traumatic neuropathies and atypical CIDP, but their value is more limited in other neuropathy subtypes. Identification of hourglass constriction in nerves of patients with neuralgic amyotrophy may have therapeutic implications. Investigation of radiculopathy is confounded by poor correlation between clinical features and imaging findings and the lack of a diagnostic gold standard. There is a need to enhance the literature on the utility of these newer diagnostic modalities.
Collapse
Affiliation(s)
- Andrew Hannaford
- Department of Neurology, Concord Hospital, Sydney, New South Wales, Australia
- Brain and Nerve Research Centre, University of Sydney, Sydney, New South Wales, Australia
- Department of Neurology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Elijah Paling
- School of Medicine, University of Notre Dame, Sydney, New South Wales, Australia
| | - Matthew Silsby
- Department of Neurology, Concord Hospital, Sydney, New South Wales, Australia
- Brain and Nerve Research Centre, University of Sydney, Sydney, New South Wales, Australia
- Department of Neurology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Sanne Vincenten
- Department of Neurology and Clinical Neurophysiology, Radboud University Medical Center, Donders Center for Neuroscience, Nijmegen, the Netherlands
| | - Nens van Alfen
- Department of Neurology and Clinical Neurophysiology, Radboud University Medical Center, Donders Center for Neuroscience, Nijmegen, the Netherlands
| | - Neil G Simon
- Northern Beaches Clinical School, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| |
Collapse
|
|
16
|
Park JE, Sneag DB, Choi YS, Oh SH, Choi S. Fascicular Involvement of the Median Nerve Trunk in the Upper Arm: Manifestation as Anterior Interosseous Nerve Syndrome With Unique Imaging Features. Korean J Radiol 2024; 25:449-458. [PMID: 38685735 PMCID: PMC11058432 DOI: 10.3348/kjr.2023.1218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/26/2024] [Accepted: 02/10/2024] [Indexed: 05/02/2024] Open
Abstract
Selective fascicular involvement of the median nerve trunk above the elbow leading to anterior interosseous nerve (AIN) syndrome is a rare form of peripheral neuropathy. This condition has recently garnered increased attention within the medical community owing to advancements in imaging techniques and a growing number of reported cases. In this article, we explore the topographical anatomy of the median nerve trunk and the clinical features associated with AIN palsy. Our focus extends to unique manifestations captured through MRI and ultrasonography (US) studies, highlighting noteworthy findings, such as nerve fascicle swelling, incomplete constrictions, hourglass-like constrictions, and torsions, particularly in the posterior/posteromedial region of the median nerve. Surgical observations have further enhanced the understanding of this complex neuropathic condition. High-resolution MRI not only reveals denervation changes in the AIN and median nerve territories but also illuminates these alterations without the presence of compressing structures. The pivotal roles of high-resolution MRI and US in diagnosing this condition and guiding the formulation of an optimal treatment strategy are emphasized.
Collapse
Affiliation(s)
- Jae Eun Park
- Department of Radiology, Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, USA
| | - Yun Sun Choi
- Department of Radiology, Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea.
| | - Sung Hoon Oh
- Department of Radiology, Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea
| | - SeongJu Choi
- Department of Orthopedic Surgery, Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea
| |
Collapse
|
|
17
|
Pöschl P, Pham M, Pedro MT, Antoniadis G. [Neuralgic amyotrophy: an inflammatory neuropathy and its surgical treatment]. HANDCHIR MIKROCHIR P 2024; 56:40-48. [PMID: 38272037 DOI: 10.1055/a-2226-4260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Neuralgic amyotrophy (NA) is a monofocal or oligofocal inflammatory neuropathy whose incidence has been significantly underestimated. A connection between constrictions and torsions of peripheral nerves with this disease has been increasingly established in recent years. Modern imaging techniques such as high-resolution nerve ultrasound and MR neurography have contributed to a better understanding of the pathophysiology and a better assessment of the prognosis of the disease. This has led to the concept of treating patients with such focal changes surgically in order to improve the prognosis. This review presents current ideas on the pathophysiology, clinical presentation, diagnosis and treatment of the disease. PATIENTS AND METHODS In a retrospective study, pre-, intra- and postoperative findings of 22 patients with 23 constrictions/torsions of peripheral nerves of the upper extremity were analysed. The patients underwent surgery at a nerve surgery centre over a period of 3.5 years (Dec. 2019-May 2023). The median nerve was most frequently affected (N=9), followed by the suprascapular nerve (N=6) and radial nerve (N=4). The axillary nerve (N=3) and the accessory nerve (N=1) were also involved. Surgical exploration revealed nerve torsions (N=9), nerve constrictions (N=5), fascicular torsions (N=12) and fascicular constrictions (N=9). Depending on the intraoperative findings, epineuriotomies (N=1), epi- and perineuriotomies (N=33), end-to-end sutures (N=2), and one epi- and one perineural suture were performed. RESULTS After an average follow-up of 10 months (3-28 months), 17 patients were re-examined. All of them reported a clear subjective improvement in motor deficits. Clinically and electromyographically, a reinnervation and significant increase in strength from a pre-existing strength grade of M0 to at least M3 in the vast majority of affected muscles was demonstrated in these patients. SUMMARY The incidence of NA continues to be underestimated and, in a significant proportion of patients, leads to permanent motor deficits, most likely due to constrictions and torsions of affected nerves. Surgical treatment is recommended as early as possible. Very good results can usually be achieved with epi- and perineuriotomy. In rare cases, end-to-end neurorrhaphy or nerve grafting is required.
Collapse
Affiliation(s)
- Peter Pöschl
- Neurologie, Neurologische Praxis Sinzing, Sinzing, Germany
| | - Mirko Pham
- Institut für Neuroradiologie, Universität Würzburg, Wurzburg, Germany
| | | | | |
Collapse
|
|
18
|
Kawazoe T, Morishima R, Nakata Y, Sugaya K, Shimizu T, Takahashi K. [MR neurography reveals fascicular constriction of the median nerve in a patient with neuralgic amyotrophy]. Rinsho Shinkeigaku 2024; 64:39-44. [PMID: 38072441 DOI: 10.5692/clinicalneurol.cn-001926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Diagnosing neuralgic amyotrophy can be challenging in clinical practice. Here, we report the case of a 37-years old Japanese woman who suddenly developed neuropathic pain in the right upper limb after influenza vaccination. The pain, especially at night, was severe and unrelenting, which disturbed her sleep. However, X-ray and MRI did not reveal any fractures or muscle injuries, and brain MRI did not reveal any abnormalities. During neurological consultation, she was in a posture of flexion at the elbow and adduction at the shoulder. Manual muscle testing suggested weakness of the flexor pollicis longus, pronator quadratus, flexor carpi radialis (FCR), and pronator teres (PT), while the flexor digitorum profundus was intact. Medical history and neurological examination suggested neuralgic amyotrophy, particularly anterior interosseous nerve syndrome (AINS) with PT/FCR involvement. Innervation patterns on muscle MRI were compatible with the clinical findings. Conservative treatment with pain medication and oral corticosteroids relieved the pain to minimum discomfort, whereas weakness remained for approximately 3 months. For surgical exploration, lesions above the elbow and fascicles of the median nerve before branching to the PT/FCR were indicated on neurological examinations; thus, we performed high-resolution imaging to detect possible pathognomonic fascicular constrictions. While fascicular constrictions were not evident on ultrasonography, MR neurography indicated fascicular constriction proximal to the elbow joint line, of which the medial topographical regions of the median nerve were abnormally enlarged and showed marked hyperintensity on short-tau inversion recovery. In patients with AINS, when spontaneous regeneration cannot be expected, timely surgical exploration should be considered for a good outcome. In our case, MR neurography was a useful modality for assessing fascicular constrictions when the imaging protocols were appropriately optimized based on clinical assessment.
Collapse
Affiliation(s)
- Tomoya Kawazoe
- Department of Neurology, Tokyo Metropolitan Neurological Hospital (TMNH)
| | - Ryo Morishima
- Department of Neurology, Tokyo Metropolitan Neurological Hospital (TMNH)
| | - Yasuhiro Nakata
- Department of Neuroradiology, Tokyo Metropolitan Neurological Hospital (TMNH)
| | - Keizo Sugaya
- Department of Neurology, Tokyo Metropolitan Neurological Hospital (TMNH)
| | - Toshio Shimizu
- Department of Neurology, Tokyo Metropolitan Neurological Hospital (TMNH)
| | - Kazushi Takahashi
- Department of Neurology, Tokyo Metropolitan Neurological Hospital (TMNH)
| |
Collapse
|
|
19
|
Granata G, Tomasello F, Sciarrone MA, Stifano V, Lauretti L, Luigetti M. Neuralgic Amyotrophy and Hourglass Nerve Constriction/Nerve Torsion: Two Sides of the Same Coin? A Clinical Review. Brain Sci 2024; 14:67. [PMID: 38248282 PMCID: PMC10813384 DOI: 10.3390/brainsci14010067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/29/2023] [Accepted: 01/09/2024] [Indexed: 01/23/2024] Open
Abstract
Neuralgic amyotrophy, also called Parsonage-Turner syndrome, in its classic presentation is a brachial plexopathy or a multifocal neuropathy, involving mainly motor nerves of the upper limb with a monophasic course. Recently, a new radiological entity was described, the hourglass constriction, which is characterized by a very focal constriction of a nerve, or part of it, usually associated with nerve thickening proximally and distally to the constriction. Another condition, which is similar from a radiological point of view to hourglass constriction, is nerve torsion. The pathophysiology of neuralgic amyotrophy, hourglass constriction and nerve torsion is still poorly understood, and a generic role of inflammation is proposed for all these conditions. It is now widely accepted that nerve imaging is necessary in identifying hourglass constrictions/nerve torsion pre-surgically in patients with an acute mononeuropathy/plexopathy. Ultrasound and MRI are useful tools for diagnosis, and they are consistent with intraoperative findings. The prognosis is generally favorable after surgery, with a high rate of good motor recovery.
Collapse
Affiliation(s)
- Giuseppe Granata
- Dipartimento di Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (G.G.); (V.S.); (L.L.)
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.T.); (M.A.S.)
| | - Fabiola Tomasello
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.T.); (M.A.S.)
| | - Maria Ausilia Sciarrone
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.T.); (M.A.S.)
| | - Vito Stifano
- Dipartimento di Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (G.G.); (V.S.); (L.L.)
| | - Liverana Lauretti
- Dipartimento di Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (G.G.); (V.S.); (L.L.)
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.T.); (M.A.S.)
| | - Marco Luigetti
- Dipartimento di Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (G.G.); (V.S.); (L.L.)
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.T.); (M.A.S.)
| |
Collapse
|
|
20
|
Telleman JA, Sneag DB, Visser LH. The role of imaging in focal neuropathies. HANDBOOK OF CLINICAL NEUROLOGY 2024; 201:19-42. [PMID: 38697740 DOI: 10.1016/b978-0-323-90108-6.00001-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Electrodiagnostic testing (EDX) has been the diagnostic tool of choice in peripheral nerve disease for many years, but in recent years, peripheral nerve imaging has been used ever more frequently in daily clinical practice. Nerve ultrasound and magnetic resonance (MR) neurography are able to visualize nerve structures reliably. These techniques can aid in localizing nerve pathology and can reveal significant anatomical abnormalities underlying nerve pathology that may have been otherwise undetected by EDX. As such, nerve ultrasound and MR neurography can significantly improve diagnostic accuracy and can have a significant effect on treatment strategy. In this chapter, the basic principles and recent developments of these techniques will be discussed, as well as their potential application in several types of peripheral nerve disease, such as carpal tunnel syndrome (CTS), ulnar neuropathy at the elbow (UNE), radial neuropathy, brachial and lumbosacral plexopathy, neuralgic amyotrophy (NA), fibular, tibial, sciatic, femoral neuropathy, meralgia paresthetica, peripheral nerve trauma, tumors, and inflammatory neuropathies.
Collapse
Affiliation(s)
- Johan A Telleman
- Department of Neurology and Clinical Neurophysiology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, United States
| | - Leo H Visser
- Department of Neurology and Clinical Neurophysiology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.
| |
Collapse
|
|
21
|
Vazquez Do Campo R, Dyck PJB. Focal inflammatory neuropathies. HANDBOOK OF CLINICAL NEUROLOGY 2024; 201:273-290. [PMID: 38697745 DOI: 10.1016/b978-0-323-90108-6.00009-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
This chapter focuses on neuropathies that present with focal involvement of nerve roots, plexus, and/or peripheral nerves associated with autoimmune and inflammatory mechanisms that present with focal involvement of nerve roots, plexus and/or peripheral nerves. The clinical presentation, diagnosis, and treatment of focal autoimmune demyelinating neuropathies, focal nonsystemic vasculitic disorders (diabetic and nondiabetic radiculoplexus neuropathies, postsurgical inflammatory neuropathy, and neuralgic amyotrophy), and focal neuropathies associated with sarcoidosis and bacterial and viral infections are reviewed.
Collapse
Affiliation(s)
- Rocio Vazquez Do Campo
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - P James B Dyck
- Division of Neuromuscular Medicine, Department of Neurology, Mayo Clinic, Rochester, MN, United States; Peripheral Neuropathy Research Laboratory, Mayo Clinic, Rochester, MN, United States.
| |
Collapse
|
|
22
|
Hagemann C, Antoniadis G, Pham M, Bischoff C, Ghosh T, Grieser T, Naumann M, Holzapfel K. [Diagnostics and treatment of hourglass-like nerve constrictions and torsions in neuralgic amyotrophy]. DER NERVENARZT 2023; 94:1157-1165. [PMID: 37943327 DOI: 10.1007/s00115-023-01562-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 11/10/2023]
Abstract
Neuralgic amyotrophy is a disease of the peripheral nervous system characterized by severe neuropathic pain followed by peripheral paralysis. A distinction is made between a hereditary and an idiopathic form, which is assumed to have an autoimmunological origin. Conservative medicinal treatment mainly consists of nonsteroidal anti-inflammatory drugs (NSAID), opioids and glucocorticoids; however, despite treatment, symptoms in the form of pain or paralysis persist in over 50% of cases. Inflammation can lead to strictures and torsions of peripheral nerves, which can be visualized by imaging using nerve sonography or magnetic resonance (MR) neurography and confirmed intraoperatively during surgical exploration. Based on the currently available data, patients with strictures and torsions of peripheral nerves can benefit from neurosurgical treatment.
Collapse
Affiliation(s)
- Christian Hagemann
- Klinik für Neurologie und klinische Neurophysiologie, Universitätsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland.
| | - Gregor Antoniadis
- Sektion "Periphere Nervenchirurgie", Neurochirurgische Klinik der Universität Ulm am Bezirkskrankenhaus Günzburg, Günzburg, Deutschland
| | - Mirko Pham
- Diagnostische und interventionelle Neuroradiologie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Christian Bischoff
- Neurologische Gemeinschaftspraxis am Marienplatz, Burgstraße 7, 80331, München, Deutschland
| | - Tanupriya Ghosh
- Klinik für Neurologie und klinische Neurophysiologie, Universitätsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland
| | - Thomas Grieser
- Diagnostische und interventionelle Radiologie, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - Markus Naumann
- Klinik für Neurologie und klinische Neurophysiologie, Universitätsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland
| | - Korbinian Holzapfel
- Klinik für Neurologie und klinische Neurophysiologie, Universitätsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland
| |
Collapse
|
|
23
|
Jung JY, Lin Y, Carrino JA. An Updated Review of Magnetic Resonance Neurography for Plexus Imaging. Korean J Radiol 2023; 24:1114-1130. [PMID: 37899521 PMCID: PMC10613850 DOI: 10.3348/kjr.2023.0150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 08/02/2023] [Accepted: 08/06/2023] [Indexed: 10/31/2023] Open
Abstract
Magnetic resonance neurography (MRN) is increasingly used to visualize peripheral nerves in vivo. However, the implementation and interpretation of MRN in the brachial and lumbosacral plexi are challenging because of the anatomical complexity and technical limitations. The purpose of this article was to review the clinical context of MRN, describe advanced magnetic resonance (MR) techniques for plexus imaging, and list the general categories of utility of MRN with pertinent imaging examples. The selection and optimization of MR sequences are centered on the homogeneous suppression of fat and blood vessels while enhancing the visibility of the plexus and its branches. Standard 2D fast spin-echo sequences are essential to assess morphology and signal intensity of nerves. Moreover, nerve-selective 3D isotropic images allow improved visualization of nerves and multiplanar reconstruction along their course. Diffusion-weighted and diffusion-tensor images offer microscopic and functional insights into peripheral nerves. The interpretation of MRN in the brachial and lumbosacral plexi should be based on a thorough understanding of their anatomy and pathophysiology. Anatomical landmarks assist in identifying brachial and lumbosacral plexus components of interest. Thus, understanding the varying patterns of nerve abnormalities facilitates the interpretation of aberrant findings.
Collapse
Affiliation(s)
- Joon-Yong Jung
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yenpo Lin
- Department of Radiology and Imaging, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, USA
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - John A Carrino
- Department of Radiology and Imaging, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, USA.
| |
Collapse
|
|
24
|
Zimmermann M, Wollsching-Strobel M, Majorski DS, Kroppen D, Schwarz SB, Berger M, Windisch W, Holle JF. [Neuralgic amyotrophy: a common cause of unilateral and bilateral diaphragmatic pareses]. Pneumologie 2023; 77:814-824. [PMID: 37647918 DOI: 10.1055/a-2113-0385] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
There are several causes for unilateral or bilateral diaphragmatic paresis. The most common cause is an (intraoperative) injury to the phrenic nerve.However, in up to 20% of cases, no explanation can be found despite extensive workup. Neuralgic amyotrophy (NA, also known as Parsonage-Turner syndrome) is a common underdiagnosed multifocal autoimmune-inflammatory disease that predominantly affects proximal nerve segments of the upper extremities. Classic symptoms include acute onset of severe pain in the shoulder girdle with delayed onset of paresis of the shoulder and arm muscles. In at least 7% of cases, the phrenic nerve is also affected. Based on the annual incidence of NA of 1:1000, the entity as a cause of diaphragmatic dysfunction is probably not as uncommon as previously thought. However, clinical experience shows that this diagnosis is often not considered, and diaphragmatic paresis gets wrongly classified as idiopathic.This is particularly disastrous because in the early stage of NA, medical therapy with corticosteroids is mostly not considered and the possibility that surgical repair of the diaphragm may be performed prematurely, given that the condition may resolve spontaneously many months after symptom onset.The aim of the present article is to raise awareness of the entity of NA as a cause of diaphragmatic paresis and to establish a standardized approach to diagnosis and treatment.
Collapse
Affiliation(s)
- Maximilian Zimmermann
- Pneumologie, Kliniken der Stadt Köln gGmbH, Köln, Deutschland
- Lehrstuhl für Pneumologie, Universität Witten/Herdecke Fakultät für Gesundheit, Köln, Deutschland
| | - Maximilian Wollsching-Strobel
- Pneumologie, Kliniken der Stadt Köln gGmbH, Köln, Deutschland
- Humanmedizin, Universität Witten/Herdecke Fakultät für Gesundheit, Witten, Deutschland
| | | | - Doreen Kroppen
- Pneumologie, Kliniken der Stadt Köln gGmbH, Universität Witten/Herdecke, Köln, Deutschland
| | - Sarah Bettina Schwarz
- Pneumologie, Kliniken der Stadt Köln gGmbH, Universität Witten/Herdecke, Köln, Deutschland
| | - Melanie Berger
- Pneumologie, Kliniken der Stadt Köln gGmbH, Universität Witten/Herdecke, Köln, Deutschland
| | - Wolfram Windisch
- Pneumologie, Kliniken der Stadt Köln gGmbH, Universität Witten/Herdecke, Köln, Deutschland
| | - Johannes Fabian Holle
- Neurologie, Kliniken der Stadt Köln gGmbH, Köln, Deutschland
- Lehrstuhl für Pneumologie, Universität Witten/Herdecke Fakultät für Gesundheit, Köln, Deutschland
| |
Collapse
|
|
25
|
Yu M, Ding W, Shao G, Li M, Zhou X, Liu L, Li X. Application of a nerve stereoscopic reconstruction technique based on ultrasonic images in the diagnosis of neuralgic amyotrophy. Front Physiol 2023; 14:1201275. [PMID: 37791346 PMCID: PMC10543234 DOI: 10.3389/fphys.2023.1201275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/30/2023] [Indexed: 10/05/2023] Open
Abstract
Objective: To propose a nerve stereoscopic reconstruction technique based on ultrasound imaging for site diagnosis, intuitive reflection of disease severity, and classification of neuralgic amyotrophy (NA). Methods: We enrolled 44 patients with NA who underwent high-frequency ultrasonography examination. Multiple sites on the normal side and the affected side were scanned to calculate the ratio of the cross-section area (CSA) of the affected side to the normal side at each location measured, i.e., the cross-section area swelling ratio (CSASR). The CSASR of 44 patients and 30 normal controls was analyzed to determine their threshold value for the diagnosis of NA. Then, ultrasound images of the cross-section were used to reconstruct the stereoscopic model of the nerve on the affected side and the normal side. Using the CSASR values in each measurement location, a CSASR stereoscopic model was developed. Results: The threshold value of CSASR for ultrasound diagnosis of NA was 1.55. The average diseased segments per patient was 2.49 ± 1.97, with an average overall length of 10.03 ± 7.95 cm. Nerve stereoscopic reconstruction could be conducted for swelling, torsion, incomplete constriction, and complete constriction. Conclusion: The ultrasound image reconstruction method proposed in this study can accurately determine the site, range, and type of neuropathies in patients with NA, and simultaneously provide complete and accurate data information and intuitive morphological information.
Collapse
Affiliation(s)
- Miao Yu
- Department of Hand Surgery, Ningbo No. 6 Hospital, Ningbo, China
- Department of Plastic Reconstructive Surgery, Ningbo No. 6 Hospital, Ningbo, China
| | - Wenquan Ding
- Department of Hand Surgery, Ningbo No. 6 Hospital, Ningbo, China
- Department of Plastic Reconstructive Surgery, Ningbo No. 6 Hospital, Ningbo, China
| | - Guoqing Shao
- Department of Ultrasonic Medicine, Ningbo No. 6 Hospital, Ningbo, China
| | - Miaozhong Li
- Department of Hand Surgery, Ningbo No. 6 Hospital, Ningbo, China
- Department of Plastic Reconstructive Surgery, Ningbo No. 6 Hospital, Ningbo, China
| | - Xiaoling Zhou
- Department of Hand Surgery, Ningbo No. 6 Hospital, Ningbo, China
- Department of Plastic Reconstructive Surgery, Ningbo No. 6 Hospital, Ningbo, China
| | - Linhai Liu
- Department of Hand Surgery, Ningbo No. 6 Hospital, Ningbo, China
- Department of Plastic Reconstructive Surgery, Ningbo No. 6 Hospital, Ningbo, China
| | - Xueyuan Li
- Department of Hand Surgery, Ningbo No. 6 Hospital, Ningbo, China
- Department of Plastic Reconstructive Surgery, Ningbo No. 6 Hospital, Ningbo, China
| |
Collapse
|
|
26
|
Nimura CA, Milani C, Tan ET, Sneag DB. Parsonage-Turner syndrome following monkeypox infection and vaccination. Skeletal Radiol 2023; 52:1781-1784. [PMID: 36752829 PMCID: PMC9907186 DOI: 10.1007/s00256-023-04298-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/23/2022] [Accepted: 01/31/2023] [Indexed: 02/09/2023]
Abstract
Beginning in May 2022, monkeypox infection and vaccination rates dramatically increased due to a worldwide outbreak. This case highlights magnetic resonance (MR) neurography findings in an individual who developed Parsonage-Turner syndrome (PTS) 5 days after monkeypox symptom onset and 12 days after receiving the JYNNEOS vaccination. MR neurography of the patient's left suprascapular nerve demonstrated intrinsic hourglass-like constrictions, a characteristic finding of peripheral nerves involved in PTS. Other viral infections and vaccinations are well-documented triggers of PTS, an underrecognized peripheral neuropathy that is thought to be immune-mediated and results in severe upper extremity pain and weakness. The close temporal relationship between monkeypox infection and vaccination, and PTS onset, in this case, suggests a causal relationship and marks the first known report of peripheral neuropathy associated with monkeypox.
Collapse
Affiliation(s)
- Clare A Nimura
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA.
| | - Carlo Milani
- Department of Spine and Sports Medicine, Hospital for Special Surgery, New York, NY, USA
| | - Ek Tsoon Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| |
Collapse
|
|
27
|
Burch SJ, Shepard E, Lipira AB. An unusual case of lower trunk brachial plexus zoster reactivation. Case Reports Plast Surg Hand Surg 2023; 10:2242497. [PMID: 37547269 PMCID: PMC10399487 DOI: 10.1080/23320885.2023.2242497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/25/2023] [Indexed: 08/08/2023]
Abstract
We discuss the case of a 42-year-old woman who presented with severe left cubital tunnel neuropathic pain and subsequently developed a vesicular rash spanning the C8-T1 dermatomal distribution. These symptoms resolved after initiation of acyclovir, highlighting VZV brachial plexopathy as a potentially treatable etiology of acute onset severe neuropathic pain.
Collapse
Affiliation(s)
- Samantha J. Burch
- Division of Plastic and Reconstructive Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Elizabeth Shepard
- Division of Plastic and Reconstructive Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Angelo B. Lipira
- Division of Plastic and Reconstructive Surgery, Oregon Health and Science University, Portland, OR, USA
| |
Collapse
|
|
28
|
Glorioso D, Palestini R, Cuccagna C, Lauretti L, Padua L. Nerve Torsion as a Pattern of Parsonage-Turner Syndrome: Literature Review and Two Representative Cases. J Clin Med 2023; 12:4542. [PMID: 37445577 DOI: 10.3390/jcm12134542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/07/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023] Open
Abstract
(1) Background: Parsonage-Turner Syndrome (PTS) is a rare peripheral nerve disease characterized by different degrees of nerve impairment. The recent development of nerve ultrasound has enabled the use of new data in the diagnosis of the disease. The aim of this study is to conduct a literature review about the ultrasound evaluation of PTS and present two clinical cases that are characteristic of the disease. (2) Methods: A review of the literature from the last 10 years on the topic containing data regarding nerve ultrasound was performed. In addition, two cases of patients on whom nerve ultrasound was performed at the first evaluation and at follow-up after the indicated treatment were described. (3) Results: The results of our review show that although it is defined as plexopathy, PTS is most often a form of multifocal neuropathy. We also report the most frequently used ultrasound classification and possible prognostic correlations and report our experience with the description of two paradigmatic clinical cases. (4) Conclusions: Further studies are needed to understand the true prognostic power of each degree of nerve impairment and the possible implications in clinical practice regarding treatment indications.
Collapse
Affiliation(s)
- Davide Glorioso
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Rita Palestini
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli, 00168 Rome, Italy
| | - Cristina Cuccagna
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli, 00168 Rome, Italy
| | - Liverana Lauretti
- Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Department of Neurosurgery, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Rome, Italy
| | - Luca Padua
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli, 00168 Rome, Italy
| |
Collapse
|
|
29
|
He R, Yu JL, Jin HL, Ng L, Wang JC, Li X, Gai TT, Zhou Y, Li DP. Hourglass-like constriction of the anterior interosseous nerve in the left forearm: A case report. World J Clin Cases 2023; 11:4194-4201. [PMID: 37388800 PMCID: PMC10303608 DOI: 10.12998/wjcc.v11.i17.4194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/01/2023] [Accepted: 05/19/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Hourglass-like constriction neuropathy is a rare neurological disorder. The main clinical manifestation is peripheral nerve injury with no apparent cause, and the pathomorphological change is an unexplained narrowing of the diseased nerve. The diagnosis and treatment of the disease are challenging and there is no accepted diagnostic or therapeutic approach.
CASE SUMMARY This report describes a rare hourglass constriction of the anterior interosseous nerve in the left forearm in a 47-year-old healthy male who was treated surgically and gradually recovered function over a 6-mo follow-up period.
CONCLUSION Hourglass-like constriction neuropathy is a rare disorder. With the development of medical technology, more examinations are now available for diagnosis. This case aims to highlight the rare manifestations of Hourglass-like constriction neuropathy and provides a reference for enriching the clinical diagnosis and treatment experience.
Collapse
Affiliation(s)
- Rong He
- Bone and Hand Microsurgery, Yantai Hospital of Shandong Wendeng Osteopathic & Traumatology, Yantai 264009, Shandong Province, China
| | - Jian-Long Yu
- Bone and Hand Microsurgery, Yantai Hospital of Shandong Wendeng Osteopathic & Traumatology, Yantai 264009, Shandong Province, China
| | - Hai-Long Jin
- Bone and Hand Microsurgery, Shandong Wendeng Osteopathic Hospital, Weihai 264400, Shandong Province, China
| | - Liqi Ng
- Institute of Orthopaedic and Musculoskeletal Science, University College London, London HA7 4LP, United Kingdom
| | - Jin-Chao Wang
- Bone and Hand Microsurgery, Yantai Hospital of Shandong Wendeng Osteopathic & Traumatology, Yantai 264009, Shandong Province, China
| | - Xin Li
- Foot and Ankle Surgery, Chongqing Orthopedic Hospital of Traditional Chinese Medicine, Chongqing 400012, China
| | - Ting-Ting Gai
- Bone and Hand Microsurgery, Yantai Hospital of Shandong Wendeng Osteopathic & Traumatology, Yantai 264009, Shandong Province, China
| | - Yu Zhou
- Foot and Ankle Surgery, Chongqing Orthopedic Hospital of Traditional Chinese Medicine, Chongqing 400012, China
| | - Da-Peng Li
- Bone and Hand Microsurgery, Yantai Hospital of Shandong Wendeng Osteopathic & Traumatology, Yantai 264009, Shandong Province, China
| |
Collapse
|
|
30
|
Parsonage-Turner Syndrome Following SARS-CoV-2 Infection: A Systematic Review. Biomedicines 2023; 11:biomedicines11030837. [PMID: 36979815 PMCID: PMC10045449 DOI: 10.3390/biomedicines11030837] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 03/12/2023] Open
Abstract
Parsonage-Turner syndrome (PTS) is an inflammatory disorder of the brachial plexus. Hypothesized underlying causes focus on immune-mediated processes, as more than half of patients present some antecedent event or possible predisposing condition, such as infection, vaccination, exercise, or surgery. Recently, PTS was reported following the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We aimed to investigate data on PTS triggered by SARS-CoV-2 infection to provide an extensive perspective on this pathology and to reveal what other, more specific, research questions can be further addressed. In addition, we aimed to highlight research gaps requiring further attention. We systematically reviewed two databases (LitCOVID and the World Health Organization database on COVID-19) to January 2023. We found 26 cases of PTS in patients with previous SARS-CoV-2 infection. The clinical and paraclinical spectrum was heterogeneous, ranging from classical PTS to pure sensory neuropathy, extended neuropathy, spinal accessory nerve involvement, and diaphragmatic palsy. Also, two familial cases were reported. Among them, 93.8% of patients had severe pain, 80.8% were reported to present a motor deficit, and 53.8% of patients presented muscle wasting. Paresthesia was noted in 46.2% of PTS individuals and a sensory loss was reported in 34.6% of patients. The present systematic review highlights the necessity of having a high index of suspicion of PTS in patients with previous SARS-CoV-2 infection, as the clinical manifestations can be variable. Also, there is a need for a standardized approach to investigation and reporting on PTS. Future studies should aim for a comprehensive assessment of patients. Factors including the baseline characteristics of the patients, evolution, and treatments should be consistently assessed across studies. In addition, a thorough differential diagnosis should be employed.
Collapse
|
|
31
|
Cejas C, Pastor Rueda JM, Hernández Pinzón J, Stefanoff N, Barroso F. Neuralgic amyotrophy detected by magnetic resonance neurography: subclinical, bilateral, and multifocal brachial plexus involvement. Neurol Res 2023; 45:283-289. [PMID: 36281961 DOI: 10.1080/01616412.2022.2138038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
INTRODUCTION Neuralgic amyotrophy (NA) is a painful non-traumatic peripheral nervous system condition affecting the brachial plexus. Signal abnormalities in nerves and muscles have been detected in these patients using magnetic resonance neurography (MRN). METHODS Electronic medical records and MRN images obtained in a 3 T scanner, in 14 adult patients diagnosed with NA at our Neurological institution (Neuromuscular Disorders Section), between December 2015 and December 2019 were retrospectively reviewed. The study was first approved by our Institutional Ethics Committee. RESULTS Subclinical, multifocal, and bilateral nerve signal anomalies were recorded in the brachial plexus of these patients. We identified four different types of nerve constriction without entrapment, which we categorized as follows: incomplete focal (type I), complete focal or hourglass (type II), multifocal or string of pearls (type III) and segmental (type IV). CONCLUSIONS Given that MRN is an accurate diagnostic tool to detect nerve damage, we believe abnormal findings could improve early detection of NA patients.
Collapse
Affiliation(s)
- Claudia Cejas
- Radiology Department, Fleni, Buenos Aires, Argentina
| | - José M Pastor Rueda
- Neuromuscular Disorders Section, Neurology Department, Fleni, Buenos Aires, Argentina
| | | | | | - Fabio Barroso
- Neuromuscular Disorders Section, Neurology Department, Fleni, Buenos Aires, Argentina
| |
Collapse
|
|
32
|
Restoring the function in neuralgic shoulder amyotrophy by modified Somsak nerve transfer. INTERDISCIPLINARY NEUROSURGERY 2023. [DOI: 10.1016/j.inat.2023.101745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
|
|
33
|
Hayden ME, Kim J, Arányi Z, Wolfe SW. Outcome of Tendon Transfer for Monomelic Amyotrophy (Hirayama Disease). J Hand Surg Am 2023; 48:90.e1-90.e5. [PMID: 35078694 DOI: 10.1016/j.jhsa.2021.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/15/2021] [Accepted: 11/24/2021] [Indexed: 02/02/2023]
Abstract
Hirayama disease is a motor neuron disease predominantly affecting adolescent males. The identifying feature of Hirayama disease is unilateral forearm and intrinsic muscle weakness that spares the brachioradialis, termed "oblique atrophy." Hirayama disease progresses slowly over several years, followed by an abrupt arrest. The pathognomonic finding is the anterior displacement of the cervical spinal cord with the detachment of the posterior dura. Systematic clinical evaluation and appropriate diagnostic studies are crucial to rule out a variety of compressive, immune-mediated, and genetic disorders. We present a patient with Hirayama disease whose hand function was improved dramatically by a tendon transfer after nearly 3 years without a definitive diagnosis and call attention to the hand surgeon's role in identifying this rare disease to enable timely functional restoration.
Collapse
Affiliation(s)
- Mallory E Hayden
- Department of Orthopedic Surgery, Hand and Upper Extremity, Hospital for Special Surgery, New York, NY
| | - Jinseong Kim
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Zsuzsanna Arányi
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Scott W Wolfe
- Department of Orthopedic Surgery, Hand and Upper Extremity, Hospital for Special Surgery, New York, NY.
| |
Collapse
|
|
34
|
Abstract
ABSTRACT Magnetic resonance neurography of the brachial plexus (BP) is challenging owing to its complex anatomy and technical obstacles around this anatomic region. Magnetic resonance techniques to improve image quality center around increasing nerve-to-background contrast ratio and mitigating imaging artifacts. General considerations include unilateral imaging of the BP at 3.0 T, appropriate selection and placement of surface coils, and optimization of pulse sequences. Technical considerations to improve nerve conspicuity include fat, vascular, and respiratory artifact suppression techniques; metal artifact reduction techniques; and 3-dimensional sequences. Specific optimization of these techniques for BP magnetic resonance neurography greatly improves image quality and diagnostic confidence to help guide nonoperative and operative management.
Collapse
|
|
35
|
Abstract
The autoimmune peripheral neuropathies with prominent motor manifestations are a diverse collection of unusual peripheral neuropathies that are appreciated in vast clinical settings. This chapter highlights the most common immune-mediated, motor predominant neuropathies excluding acute, and chronic inflammatory demyelinating polyradiculoneuropathy (AIDP and CIDP, respectively). Other acquired demyelinating neuropathies such as distal CIDP and multifocal motor neuropathy will be covered. Additionally, the radiculoplexus neuropathies, resulting from microvasculitis-induced injury to nerve roots, plexuses, and nerves, including diabetic and nondiabetic lumbosacral radiculoplexus neuropathy and neuralgic amyotrophy (i.e., Parsonage-Turner syndrome), will be included. Finally, the motor predominant peripheral neuropathies encountered in association with rheumatological disease, particularly Sjögren's syndrome and rheumatoid arthritis, are covered. Early recognition of these distinct motor predominant autoimmune neuropathies and initiation of immunomodulatory and immunosuppressant treatment likely result in improved outcomes.
Collapse
Affiliation(s)
- Ryan Naum
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, United States
| | - Kelly Graham Gwathmey
- Neuromuscular Division, Department of Neurology, Virginia Commonwealth University, Richmond, VA, United States.
| |
Collapse
|
|
36
|
Ripellino P, Arányi Z, van Alfen N, Ventura E, Peyer AK, Cianfoni A, Gobbi C, Pedrick E, Sneag DB. Imaging of neuralgic amyotrophy in the acute phase. Muscle Nerve 2022; 66:709-714. [PMID: 36214185 DOI: 10.1002/mus.27732] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 09/23/2022] [Accepted: 10/04/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION/AIMS Hourglass-like constrictions (HGCs) occur in neuralgic amyotrophy (NA), but the earliest time at which they can be recognized by imaging is poorly understood. We aimed to determine the prevalence of abnormal imaging findings in the acute phase of NA. METHODS Magnetic resonance neurography (MRN) and high-resolution ultrasound (US) examinations were performed at five sites. The investigation included 39 patients with acute NA who underwent imaging within 31 days of symptom onset. Correlation between imaging and electromyography (EMG) findings was measured. RESULTS US was performed in 29 patients and MRN in 23; 16 patients underwent US only, 10 MRN only, and 13 had both. US and MRN showed nerve abnormalities within 1 mo from NA onset in 90% of patients. HGCs were found in 74% (29/39) of the patients: 4 within 1 wk, 8 within 2 wk, 5 within 3 wk, and 12 within 4 wk. The earliest HGC on US was found within 12 h, and on MRN within 3 days from symptom onset. MRN demonstrated a denervation edema pattern of affected muscles in 91% of the patients. The shortest time to observe an edema pattern on MRN was 8 days. EMG was performed in 30 patients and revealed fibrillation potentials in affected muscles in 22 (73%). A denervation edema pattern on MRN was significantly associated with the presence of HGCs both on MRN and US, and with fibrillation potentials on EMG. DISCUSSION In the early phase of NA, US and MRN are useful diagnostic techniques for demonstrating nerve abnormalities.
Collapse
Affiliation(s)
- Paolo Ripellino
- Department of Neurology, Neurocenter of Southern Switzerland EOC, Lugano, Switzerland
| | - Zsuzsanna Arányi
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Nens van Alfen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Elisa Ventura
- Department of Neuroradiology, Neurocenter of Southern Switzerland EOC, Lugano, Switzerland
| | | | - Alessandro Cianfoni
- Department of Neuroradiology, Neurocenter of Southern Switzerland EOC, Lugano, Switzerland
- Department of Neuroradiology, Inselspital, Bern, Switzerland
| | - Claudio Gobbi
- Department of Neurology, Neurocenter of Southern Switzerland EOC, Lugano, Switzerland
| | - Emily Pedrick
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
| | - Darryl Brett Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
| |
Collapse
|
|
37
|
Tan ET, Serrano KC, Bhatti P, Pishgar F, Vanderbeek AM, Milani CJ, Sneag DB. Quantitative MRI Differentiates Electromyography Severity Grades of Denervated Muscle in Neuropathy of the Brachial Plexus. J Magn Reson Imaging 2022; 56:1104-1115. [PMID: 35195321 PMCID: PMC9395546 DOI: 10.1002/jmri.28125] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Quantitative MRI (qMRI) metrics reflect microstructural skeletal muscle changes secondary to denervation and may correspond to conventional electromyography (EMG) assessments of motor unit recruitment (MUR) and denervation. HYPOTHESIS Differences in quantitative T2 , diffusion-based apparent fiber diameter (AFD), and fat fraction (FF) exist between EMG grades, in patients with clinically suspected neuropathy of the brachial plexus. STUDY TYPE Prospective. POPULATION A total of 30 subjects (age = 37.5 ± 17.5, 21M/9F) with suspected brachial plexopathy. FIELD STRENGTH/SEQUENCE 3-Tesla; qMRI using fast spin echo (T2 -mapping), multi-b-valued diffusion-weighted echo planar imaging (for AFD), and dual-echo Dixon gradient echo (FF-mapping) sequences. ASSESSMENT qMRI values were compared against EMG grades (MUR and denervation). qMRI values (T2 , AFD, and FF) were obtained for five regional shoulder muscles. A 4-point scale was used for MUR/denervation severity. STATISTICAL TESTS Linear mixed models and least-squares pairwise comparisons were used to evaluate qMRI differences between EMG grades. Predictive accuracy of EMG grades from qMRI was quantified by 10-fold cross-validated logistic models. A P value < 0.05 was considered statistically significant. RESULTS Mean (95% confidence interval) qMRI for "full" MUR were T2 = 39.40 msec (35.72-43.08 msec), AFD = 78.35 μm (72.52-84.19 μm), and FF = 4.54% (2.11-6.97%). Significant T2 increases (+8.36 to +14.67 msec) and significant AFD decreases (-11.04 to -21.58 μm) were observed with all abnormal MUR grades as compared to "full" MUR. Significant changes in both T2 and AFD were observed with increased denervation (+9.59 to +15.04 msec, -16.25 to -18.66 μm). There were significant differences in FF between some MUR grades (-1.45 to +2.96%), but no significant changes were observed with denervation (P = 0.089-0.662). qMRI prediction of abnormal MUR or denervation was strong (mean accuracy = 0.841 and 0.810, respectively) but moderate at predicting individual grades (accuracy = 0.492 and 0.508, respectively). DATA CONCLUSION Quantitative T2 and AFD differences were observed between EMG grades in assessing muscle denervation. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 1.
Collapse
Affiliation(s)
- Ek T. Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA 10021
| | - Kenneth C. Serrano
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA 11794
| | - Pravjit Bhatti
- Georgetown University School of Medicine, Washington DC, USA, 20007
| | - Farhad Pishgar
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA, 21205
| | - Alyssa M. Vanderbeek
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA 10021
- Biostatistics Core, Research Administration, Hospital for Special Surgery, New York, NY, USA 10021
| | - Carlo J. Milani
- Department of Physiatry, Hospital for Special Surgery, New York, NY, USA 10021
| | - Darryl B. Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA 10021
| |
Collapse
|
|
38
|
Waheed W, Sneag D. Parsonage-Turner Syndrome: Fascicular Involvement and Focal Constriction. J Clin Neuromuscul Dis 2022; 23:227-228. [PMID: 35608647 DOI: 10.1097/cnd.0000000000000407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Waqar Waheed
- Department of Neurology, University of Vermont, Burlington, VT; and
| | - Darryl Sneag
- Department of Radiology, Hospital for Special Surgery, New York, NY
| |
Collapse
|
|
39
|
Amjad MA, Hamid Z, Patel Y, Husain M, Saddique A, Liaqat A, Ochieng P. COVID-19 Vaccine-Induced Parsonage-Turner Syndrome: A Case Report and Literature Review. Cureus 2022; 14:e25493. [PMID: 35783889 PMCID: PMC9242527 DOI: 10.7759/cureus.25493] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2022] [Indexed: 11/05/2022] Open
|
|
40
|
Chua MMJ, Hayes MT, Cosgrove R. Parsonage-Turner syndrome following COVID-19 vaccination and review of the literature. Surg Neurol Int 2022; 13:152. [PMID: 35509574 PMCID: PMC9062946 DOI: 10.25259/sni_4_2022] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 04/01/2022] [Indexed: 12/22/2022] Open
Abstract
Background Parsonage-Turner syndrome (PTS) is a rare brachial plexopathy characterized by self-limiting shoulder girdle and upper arm pain followed by the upper extremity weakness and sensory changes. While the etiology is not well-understood, the most common cause of PTS is thought to be postviral. There are at least nine reports, to the best of our knowledge, of PTS associated with COVID-19 infection and nine reports associated with COVID-19 vaccination. Case Description Here, we present a case of PTS after COVID-19 vaccination in a 64-year-old male and a review of the current literature. Conclusion PTS can occur post-COVID-19 vaccination and should be on the differential diagnosis when patient continues to experience shoulder pain and develops weakness or sensory changes in the extremity.
Collapse
Affiliation(s)
- Melissa Ming Jie Chua
- Departments of Neurosurgery, Brigham and Women’s Hospital, Boston, Massachusetts, United States
| | - Michael T. Hayes
- Neurology, Brigham and Women’s Hospital, Boston, Massachusetts, United States
| | - Rees Cosgrove
- Departments of Neurosurgery, Brigham and Women’s Hospital, Boston, Massachusetts, United States
| |
Collapse
|
|
41
|
Neurosurgical Mimics. Neurol Clin 2022; 40:455-469. [DOI: 10.1016/j.ncl.2021.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
|
42
|
Campbell WW, Landau M. Treatment and Management of Segmental Neuromuscular Disorders. Neuromuscul Disord 2022. [DOI: 10.1016/b978-0-323-71317-7.00017-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
|
43
|
Daniels SP, Ross AB, Sneag DB, Gardon SN, Li G, Hanna A, Tuite MJ. Intravenous contrast does not improve detection of nerve lesions or active muscle denervation changes in MR neurography of the common peroneal nerve. Skeletal Radiol 2021; 50:2483-2494. [PMID: 34021773 DOI: 10.1007/s00256-021-03812-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the effect of intravenous (IV) contrast on sensitivity, specificity, and accuracy of magnetic resonance (MR) neurography of the knee with attention to the common peroneal nerve (CPN) in identifying nerve lesions and active muscle denervation changes. MATERIALS AND METHODS A retrospective search for contrast-enhanced MR neurography cases evaluating the CPN at the knee was performed. Patients with electrodiagnostic testing (EDX) within 3 months of imaging were included and those with relevant prior surgery were excluded. Two radiologists independently reviewed non-contrast sequences and then 4 weeks later evaluated non-contrast and contrast sequences. McNemar's tests were performed to detect a difference between non-contrast only and combined non-contrast and contrast sequences in identifying nerve lesions and active muscle denervation changes using EDX as the reference standard. RESULTS Forty-four exams in 42 patients (2 bilateral) were included. Twenty-eight cases had common peroneal neuropathy and 29, 21, and 9 cases had active denervation changes in the anterior, lateral, and posterior compartment/proximal muscles respectively on EDX. Sensitivity, specificity, and accuracy of non-contrast versus combined non-contrast and contrast sequences for common peroneal neuropathy were 50.0%, 56.2%, and 52.3% versus 50.0%, 56.2%, and 52.3% for reader 1 and 57.1%, 50.0%, and 54.5% versus 64.3%, 56.2%, and 61.4% for reader 2. Sensitivity, specificity, and accuracy of non-contrast and combined non-contrast and contrast sequences in identifying active denervation changes for anterior, lateral, and posterior compartment muscles were not significantly different. McNemar's tests were all negative. CONCLUSION IV contrast does not improve the ability of MR neurography to detect CPN lesions or active muscle denervation changes.
Collapse
Affiliation(s)
- Steven P Daniels
- Department of Radiology, NYU Langone Health, 660 First Avenue, New York, NY, 10016, USA.
| | - Andrew B Ross
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 E. Highland Avenue, Madison, WI, 53792, USA
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70th St., New York, NY, 10021, USA
| | - Stephanie N Gardon
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, 600 E. Highland Avenue, Madison, WI, 53792, USA
| | - Geng Li
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, 600 E. Highland Avenue, Madison, WI, 53792, USA
| | - Amgad Hanna
- Department of Neurosurgery, University of Wisconsin School of Medicine and Public Health, 600 E. Highland Avenue, Madison, WI, 53792, USA
| | - Michael J Tuite
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 E. Highland Avenue, Madison, WI, 53792, USA
| |
Collapse
|
|
44
|
Mooshage C, Bendszus M, Jende JME, Kurz FT. MR-Neurografie bei neuralgischer Schulteramyotrophie. KLIN NEUROPHYSIOL 2021. [DOI: 10.1055/a-1626-6024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
HintergrundDas Parsonage-Turner-Syndrom (PTS) bzw. die neuralgische Schulteramyotrophie ist eine Erkrankung des peripheren Nervensystems, die typischerweise den Plexus brachialis sowie dessen Äste betrifft 1. Das Krankheitsbild scheint dabei häufiger zu sein als früher angenommen bei einer Prävalenz von bis zu ca. 1 Fall pro 100 000 pro Jahr 1. Die Pathophysiologie des PTS ist bisher unvollständig verstanden, jedoch wird angenommen, dass eine immun-vermittelte Genese ursächlich ist 2. Mögliche Trigger-Faktoren können u. a. virale Infekte, Impfungen, Traumata oder Operationen sein 3. Am häufigsten sind die Nn. thoracicus longus, suprascapularis und interosseus anterior betroffen 1. Charakterisiert ist das PTS durch akute, nachts eintretende Schmerzen im Schultergürtel, welche von Paresen und entsprechenden Atrophien gefolgt werden.
Collapse
Affiliation(s)
- Christoph Mooshage
- Abteilung für Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg
| | - Martin Bendszus
- Abteilung für Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg
| | - Johann ME Jende
- Abteilung für Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg
| | - Felix T Kurz
- Abteilung für Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg
| |
Collapse
|
|
45
|
Boulter DJ, Job J, Shah LM, Wessell DE, Lenchik L, Parsons MS, Agarwal V, Appel M, Burns J, Hutchins TA, Kendi AT, Khan MA, Liebeskind DS, Moritani T, Ortiz AO, Shah VN, Singh S, Than KD, Timpone VM, Beaman FD, Corey AS. ACR Appropriateness Criteria® Plexopathy: 2021 Update. J Am Coll Radiol 2021; 18:S423-S441. [PMID: 34794598 DOI: 10.1016/j.jacr.2021.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 08/28/2021] [Indexed: 10/19/2022]
Abstract
Plexopathy may be caused by diverse pathologies, including trauma, nerve entrapment, neoplasm, inflammation, infection, autoimmune disease, hereditary disease, and idiopathic etiologies. For patients presenting with brachial or lumbosacral plexopathy, dedicated plexus MRI is the most appropriate initial imaging modality for all clinical scenarios and can identify processes both intrinsic and extrinsic to the nerves. Other imaging tests may be appropriate for initial imaging depending on the clinical scenario. This document addresses initial imaging strategies for brachial and lumbosacral plexopathy in the following clinical situations: nontraumatic plexopathy with no known malignancy, traumatic plexopathy (not perinatal), and plexopathy occurring in the context of a known malignancy or posttreatment syndrome. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Collapse
Affiliation(s)
- Daniel J Boulter
- Clinical Director of MRI, The Ohio State University Wexner Medical Center, Columbus, Ohio.
| | - Joici Job
- Research Author, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Lubdha M Shah
- Panel Chair, University of Utah, Salt Lake City, Utah
| | | | - Leon Lenchik
- Panel Vice-Chair, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Matthew S Parsons
- Panel Vice-Chair, Mallinckrodt Institute of Radiology, Saint Louis, Missouri
| | - Vikas Agarwal
- Vice Chair of Education, Chief, Neuroradiology, and Director, Spine Intervention, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Marc Appel
- James J. Peters VA Medical Center, Bronx, New York; American Academy of Orthopaedic Surgeons
| | - Judah Burns
- Program Director, Diagnostic Radiology Residency Program, Montefiore Medical Center, Bronx, New York
| | - Troy A Hutchins
- Chief Value Officer for Radiology, University of Utah Health, Salt Lake City, Utah
| | | | - Majid A Khan
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - David S Liebeskind
- University of California Los Angeles, Los Angeles, California; President, SVIN; and American Academy of Neurology
| | | | - A Orlando Ortiz
- Chairman, Department of Radiology, Jacobi Medical Center, Bronx, New York
| | - Vinil N Shah
- University of California San Francisco, San Francisco, California; and Executive Committee, American Society of Spine Radiology
| | - Simranjit Singh
- Indiana University School of Medicine, Indianapolis, Indiana; Secretary, SHM, Indiana Chapter; Secretary, SGIM, Midwest Region; and American College of Physicians
| | - Khoi D Than
- Duke University, Durham, North Carolina; Neurosurgery expert
| | - Vincent M Timpone
- Co-Director, Neuroradiology Spine Intervention Service, Department of Radiology, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | | | - Amanda S Corey
- Specialty Chair, Atlanta VA Health Care System and Emory University, Atlanta, Georgia
| |
Collapse
|
|
46
|
Kim W, Kang SH, An JY. Posterior Interosseous Fascicular Constriction Within the Radial Nerve in a Diabetic Patient With Bilateral Neuralgic Amyotrophy: A Case Report. Front Neurol 2021; 12:701571. [PMID: 34566846 PMCID: PMC8457354 DOI: 10.3389/fneur.2021.701571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 08/09/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Neuralgic amyotrophy (NA) is an acute, monophasic, painful inflammatory dysimmune focal, or multifocal mononeuropathy. The lesion in NA is not always restricted to the brachial plexus but also involves individual nerves or branches. The prognosis of NA is less favorable than previously assumed, but the reasons for poor recovery remain unknown. Nerve constriction may be one of the causes of poor prognosis in NA. Case Presentation: Herein, we described a 54-year-old male with a history of type 2 diabetes in whom bilateral neuralgic amyotrophy developed with constriction of the posterior interosseous fascicle within the radial nerve. The patient experienced sudden-onset severe pain in both shoulders followed, 2 days later, by weakness in bilateral shoulders and the left forearm extensors over the subsequent month. The left forearm extensors were more severely affected than both shoulder girdle muscles. He noted a 7-kg weight loss for 1 month before pain onset. After diagnosing diabetic NA based on the clinical symptoms, imaging, and electrophysiological studies, treatment with systemic steroids improved pain and weakness in both shoulder muscles. Weakness in the left forearm extensors persisted after 1 month of steroid treatment. Follow-up ultrasound revealed constriction of the posterior interosseous fascicle within the main trunk of the left radial nerve at the elbow. Surgical exploration at 6 months after onset identified fascicle constriction, for which neurolysis was performed. Weakness in the extensors of the wrist and fingers did not improve during the 16-month follow-up. Conclusion: A single constriction of the fascicle within a peripheral nerve may often be under-recognized if NA presents with variable degrees of weakness in bilateral upper limbs. Furthermore, fascicular constriction without edema of the parent nerve may be easily missed on the initial ultrasound. A lack of early recognition of nerve constriction and delay in surgical intervention can result in unfavorable outcomes. The physician should consider the possibility of the fascicular constriction when evaluating patients suspected of brachial NA with significant weakness in the distal upper limb compared to the proximal weakness or weakness of the distal upper limb that does not improve over time.
Collapse
Affiliation(s)
- Woojun Kim
- Department of Neurology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Soo Hwan Kang
- Department of Orthopedic Surgery, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Jae Young An
- Department of Neurology, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Seoul, South Korea
| |
Collapse
|
|
47
|
Sneag DB, Kiprovski K. MR Neurography of Bilateral Parsonage-Turner Syndrome. Radiology 2021; 300:515. [PMID: 34227884 DOI: 10.1148/radiol.2021204688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Darryl B Sneag
- From the Department of Radiology and Imaging, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 E 70th St, New York, NY 10021 (D.B.S.); and Department of Neurology, New York University Grossman School of Medicine, New York, NY (K.K.)
| | - Kiril Kiprovski
- From the Department of Radiology and Imaging, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 E 70th St, New York, NY 10021 (D.B.S.); and Department of Neurology, New York University Grossman School of Medicine, New York, NY (K.K.)
| |
Collapse
|
|
48
|
Nagao R, Ishikawa T, Mizutani Y, Niimi Y, Shima S, Ito M, Murayama K, Toyama H, Ueda A, Watanabe H. Magnetic Resonance Neurography in a Patient with Distal Neuralgic Amyotrophy. Intern Med 2021; 60:1759-1761. [PMID: 33361681 PMCID: PMC8222128 DOI: 10.2169/internalmedicine.6440-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The pathophysiology of neuralgic amyotrophy (NA) remains to be elucidated. However, high-resolution magnetic resonance imaging and ultrasound sonography have provided new insights into the mechanism underlying the development of NA and its diagnosis. We report a case of idiopathic distal NA with hyperintensity and thickening in the inferior trunk extending to the posterior and medial fasciculus of the left brachial plexus, which was detected by magnetic resonance neurography (MRN) with diffusion-weighted whole-body imaging with background body signal suppression (DWIBS). The abnormal signal intensity diminished after the improvement of symptoms following corticosteroid treatment. MRN with DWI can help diagnose distal NA and evaluate the post-therapeutic response.
Collapse
Affiliation(s)
- Ryunosuke Nagao
- Department of Neurology, Fujita Health University School of Medicine, Japan
| | - Tomomasa Ishikawa
- Department of Neurology, Fujita Health University School of Medicine, Japan
| | - Yasuaki Mizutani
- Department of Neurology, Fujita Health University School of Medicine, Japan
| | - Yoshiki Niimi
- Department of Neurology, Fujita Health University School of Medicine, Japan
| | - Sayuri Shima
- Department of Neurology, Fujita Health University School of Medicine, Japan
| | - Mizuki Ito
- Department of Neurology, Fujita Health University School of Medicine, Japan
| | - Kazuhiro Murayama
- Department of Radiology, Fujita Health University School of Medicine, Japan
| | - Hiroshi Toyama
- Department of Radiology, Fujita Health University School of Medicine, Japan
| | - Akihiro Ueda
- Department of Neurology, Fujita Health University School of Medicine, Japan
| | - Hirohisa Watanabe
- Department of Neurology, Fujita Health University School of Medicine, Japan
| |
Collapse
|
|
49
|
Abstract
PURPOSE OF REVIEW This review focuses on the current insights and developments in neuralgic amyotrophy (NA), an auto-immune multifocal peripheral nervous system disorder that leaves many patients permanently impaired if not recognized and treated properly. RECENT FINDINGS NA is not as rare as previously thought. The phenotype is broad, and recent nerve imaging developments suggest that NA is the most common cause of acute anterior or posterior interosseous nerve palsy. Phrenic nerve involvement occurs in 8% of all NA patients, often with debilitating consequences. Acute phase treatment of NA with steroids or i.v. immunoglobulin may benefit patients. Long-term consequences are the rule, and persisting symptoms are mainly caused by a combination of decreased endurance in the affected nerves and an altered posture and movement pattern, not by the axonal damage itself. Patients benefit from specific rehabilitation treatment. For nerves that do not recover, surgery may be an option. SUMMARY NA is not uncommon, and has a long-term impact on patients' well-being. Early immunomodulating treatment, and identifying phrenic neuropathy or complete nerve paralysis is important for optimal recovery. For persistent symptoms a specific treatment strategy aiming at regaining an energy balance and well-coordinated scapular movement are paramount.
Collapse
|
|
50
|
Abstract
Peripheral nerve imaging is a helpful and sometimes essential adjunct to clinical history, physical examination, and electrodiagnostic studies. Advances in imaging technology have allowed the visualization of nerve structures and their surrounding tissues. The clinical applications of ultrasound and magnetic resonance imaging (MRI) in the evaluation of peripheral nerve disorders are growing exponentially. This article reviews basics of ultrasound and MRI as they relate to nerve imaging, reviews advantages and limitations of each imaging modality, reviews the applications of ultrasound and MRI in disorders of peripheral nerve, and discusses emerging advances in the field.
Collapse
Affiliation(s)
- Natalia L Gonzalez
- Department of Neurology, Neuromuscular Division, Duke University, Duke University Hospital, 3403 DUMC, Duke South Clinic 1L, Durham, NC 27710, USA.
| | - Lisa D Hobson-Webb
- Department of Neurology, Neuromuscular Division, Duke University, Duke University Hospital, 3403 DUMC, Duke South Clinic 1L, Durham, NC 27710, USA
| |
Collapse
|