Articles: brachial-plexus-neuritis-diagnosis.
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J. Neurol. Neurosurg. Psychiatr. · Aug 2020
ReviewNeuralgic amyotrophy: a paradigm shift in diagnosis and treatment.
Neuralgic amyotrophy (NA), also known as Parsonage-Turner syndrome, is characterised by sudden pain attacks, followed by patchy muscle paresis in the upper extremity. Recent reports have shown that incidence is much higher than previously assumed and that the majority of patients never achieve full recovery. Traditionally, the diagnosis was mainly based on clinical observations and treatment options were confined to application of corticosteroids and symptomatic management, without proven positive effects on long-term outcomes. ⋯ Furthermore, surgery has shown to improve clinical outcomes in such cases, indicating the viability of peripheral nerve surgery as a valuable treatment option in NA. In this review, we present an update on the current knowledge on this disease, including pathophysiology and clinical presentation, moving on to diagnostic and treatment paradigms with a focus on recent radiological findings and surgical reports. Finally, we present a surgical treatment algorithm to support clinical decision making, with the aim to encourage translation into day-to-day practice.
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Brachial plexitis is characterized by acute onset pain followed by weakness due to dysfunction of the nerves constituting the brachial plexus. The exact pathophysiology of this condition remains unknown but it is known to follow acute infections, such as a viral illness. ⋯ Brachial plexitis may follow peripheral stem cell transplantation. Awareness of this phenomenon is helpful to clinicians involved in the care of these patients.
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Journal of neurovirology · Feb 2019
Herpes zoster increased risk of neuralgic amyotrophy: a retrospective, population-based matched cohort study.
Although neuralgic amyotrophy (NA) has occasionally been reported to be associated with reactivated herpes zoster, their associated risk remains unknown. The aim of this study was to assess the risk of developing NA following preceding herpes zoster. The authors used the National Health Insurance Research Database of Taiwan to select 41,548 patients with newly diagnosed herpes zoster during the period 2000 to 2010 and randomly extracted 166,192 matched control subjects. ⋯ The patients with herpes zoster had a higher risk of developing NA (adjusted hazard ratio = 1.408, 95% confidence interval = 1.013-2.319, P = 0.030). In the patients with herpes zoster, female sex, age ≥ 65, hepatitis E virus (HEV), and having had a recent infectious event including pneumonia and influenza were risk factors for developing NA (adjusted HR 2.746, 1.998, 2.735, 2.016, and 1.718, respectively, all P < 0.05). Patients with herpes zoster attack have a higher risk of developing NA over a 3-month period after diagnosis, especially those who are female, age ≥ 65, HEV, or have experienced a recent infectious event or pneumonia and influenza.
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Shoulder pain and weakness are common presenting Emergency Department complaints. Patients are often diagnosed with fractures, dislocations, bursitis, and muscle strain. Here we present an unusual cause of shoulder pain in an athletic and otherwise healthy young patient that does not respond to typical treatments for musculoskeletal pain.
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Reg Anesth Pain Med · Sep 2017
Case ReportsNeuralgic Amyotrophy Attributed Incorrectly to Block-Related Injury: Understanding Errors in Clinical Reasoning.
We report a case of misdiagnosed neuralgic amyotrophy (brachial plexus neuritis, Parsonage-Turner syndrome). Our primary objective is to review the scientific basis for errors in clinical reasoning. ⋯ Cognitive bias may lead to errors in clinical reasoning and consequent misdiagnosis. Temporal proximity may falsely implicate regional anesthesia as the causative agent.