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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Metastatic plexopathy is often a disabling accompaniment of advanced systemic cancer and may involve any of the peripheral nerve plexus. Brachial plexopathy most commonly occurs in carcinoma of the breast and lung; lumbosacral plexopathy is most common with colorectal and gynecologic tumors, sarcomas, and lymphomas. Regardless of the location, carcinomatous plexopathy typically is associated with severe unrelenting pain as the cardinal clinical feature. Later, weakness and focal sensory disturbances occur in the distribution of plexuses involvement. Epidural tumor involvement frequently (in more than 50% of patients) coexists with either plexopathy. In previously treated patients, the main differential diagnostic consideration is radiation-induced plexopathy. Treatment of metastatic plexopathy is palliative and includes radiotherapy to the tumor mass and chemotherapy. In selected patients, subtotal surgical resection of the tumor may be warranted. The response to therapy is modest and generally short lived. Efforts should be made to provide adequate pain control, to maximize remaining neurologic function, and to prevent complications of immobility produced by the neuromuscular dysfunction.
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PMID:Nerve plexus metastases. 172 1

Brachial plexus neuropathy is a common syndrome that, although a distinct clinical entity, is often unrecognized. The illness is characterized by the acute onset of shoulder girdle pain without constitutional symptoms. The pain persists for 1 to 2 weeks, then subsides, with the development of weakness and atrophy in the affected muscles. Good recovery usually occurs but may take up to three years. There is no effective treatment. Since this condition may masquerade as bursitis, cervical disc disease, or other conditions commonly seen by general physicians, it is important to recognize this disorder.
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PMID:Brachial plexus neuropathy. 184 87

The purpose of this study was to determine the clinical and electromyographical characteristics of the initial picture, and the subsequent course of the radiation-induced brachial plexopathy. The AA. studied 13 females affected by infiltrating carcinoma of the breast, who underwent a radical mastectomy with removal of the axillary cavity, followed by radiotherapy (total dose was 50 Gy per cycle). The symptom-free interval between the end of radiotherapy and the appearance of symptoms varied considerably (from one month to 15 years). The initial clinical picture presented pain (5 cases), paresthesia (6 cases) and motor deficit (8 cases). EMG examination showed a pluriradicular denervation in 10 cases (with a very frequent damage of the lower roots of the plexus) and a monoradicular denervation in 3 cases. In 6 cases it was possible to carry out a follow-up with repeated tests for 3-17 years after radiotherapy. The role of the EMG in the diagnosis and prognosis of this plexopathy is then discussed.
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PMID:Radiation-induced brachial plexopathy: clinical and electromyographical (EMG) considerations in 13 cases. 222 71

The clinical and neurophysiological characteristics of radiation-induced brachial plexopathy (RBP) were assessed in 79 breast cancer patients without signs of recurrent disease at least 60 months after radiotherapy (RT). Clinically, 35% (95% confidence limits: 25-47%) had RBP. Fifty percent (31-69%) had affection of the entire plexus, 18% (7-36%) of the upper trunk only, and 4% (1-18%) of the lower trunk. In 28% (14-48%), assessment of a definite level was not possible. In most, symptoms began during or immediately after RT, thus being without significant latency. Numbness or paresthesias (71%, 52-86%) and pain (43%, 25-62%) were the most prominent symptoms, while the most prominent objective signs were decreased or absent muscle stretch reflexes (93%, 77-99%) closely followed by sensory loss (82%, 64-93%) and weakness (71%, 52-86%). Neurophysiological investigations were carried out in 46 patients (58%). The most frequent abnormalities in patients with RBP were signs of chronic partial denervation with increased mean duration of individual motor unit potentials, and decreased amplitude of compound muscle and sensory action potentials. Nerve conduction velocities were normal.
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PMID:Clinical and electrodiagnostic findings in breast cancer patients with radiation-induced brachial plexus neuropathy. 232 36

Twelve patients who developed radiation-induced brachial plexopathy (RIBP) after receiving radiation therapy for breast carcinoma (7 patients) or Hodgkin's lymphoma (5 patients) were followed for 12 or more years, with a mean follow-up time of 20 years. Tingling and numbness of the fingers as well as weakness of the hand or arm were the most prominent presenting symptoms of RIBP. Whereas pain in most patients evolved only later in the course, it became a predominant feature in only 2. In 8 of the 12 patients, the plexopathy was surgically treated, either by neurolysis only or by neurolysis plus omental grafting in order to stop progression or paresis and/or pain. In 8 patients, including 6 of the operated group, there was slow and steady progression of RIBP over time, with the final outcome being almost complete paralysis of the arm (2 patients) or severe sensorimotor paresis rendering the hand useless (6 patients). In only 4 patients, including 2 of the non-operated group, was there absence of progression and stabilization of the paresis with only slight functional loss of the affected arm in 3 patients and severe palsy in 1. None of the 12 patients had any clear long-lasting improvement of their sensorimotor impairment. It is concluded from this study that RIBP, irrespective of surgery (neurolysis and/or omentum transplant), left two-thirds of the patients with severe or total paresis of the arm. However, the almost complete relief of severe pain (6 of 8 patients), both immediately and in follow-up patients treated with neurolysis and/or omental transplant, indicates that surgical treatment has a beneficial effect on pain relief.
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PMID:Natural history of radiation-induced brachial plexopathy compared with surgically treated patients. 239 47

Thirty patients with superior sulcus carcinoma were prospectively evaluated over an 18-month period. All patients underwent complete neuroradiological evaluation by computed tomography (CT) and myelography. Prior to operation, brachial plexopathy was noted in 20 patients (67%), and invasion of the spine in eight (27%). Using a team approach, gross total resection of tumor was achieved in 17 of 26 patients (65%) undergoing thoracotomy. There was no operative mortality. The use of a team approach allows extended surgical resection, especially when the spine is involved. In patients presenting with brachial plexopathy or cord compression, de novo surgery before radiation may provide better long-term palliation and pain relief.
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PMID:The combined neurosurgical-thoracic management of superior sulcus tumors. 244 29

The results of clinical, radiologic, and electrophysiologic studies are retrospectively reviewed for 55 patients with neoplastic and 35 patients with radiation-induced brachial plexopathy. The presence or absence of pain as the presenting symptom, temporal profile of the illness, presence of a discrete mass on CT of the plexus, and presence of myokymic discharges on EMG contributed significantly to the prediction of the underlying cause of the brachial plexopathy. The distribution of weakness and the results of nerve conduction studies were of no help in distinguishing neoplastic from radiation-induced brachial plexopathy.
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PMID:Distinction between neoplastic and radiation-induced brachial plexopathy, with emphasis on the role of EMG. 253 77

Brachial plexus neuropathy (BPN) is a clinical entity of unknown cause characterized by the acute or subacute onset of pain and weakness, with occasional atrophy of the arm muscles. Information on the incidence of the disease in a delineated population is lacking, as the data available on BPN have come essentially from case reports or selected series. Using the Mayo Clinic records-linkage system as the source of data, 579 clinical records were reviewed of Rochester, Minnesota, residents in which a diagnosis suggestive of BPN was reported for the period 1970 through 1981. Eleven cases fulfilled all criteria, providing an overall annual incidence rate of 1.64 cases per 100,000 population. An infectious disease and/or tetanus toxoid immunization preceded the onset of BPN in 4 cases. The upper brachial plexus was involved in 6 cases, the lower brachial plexus in 2, and the whole plexus in 3; in 1 case there was bilateral BPN. The neuropathy ran a mild to moderate course in 10 cases, and complete recovery was recorded in 6, with slight residua in the others. The occurrence of antecedent events and the features of the disease are supportive of the concept of an immune-mediated process.
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PMID:Brachial plexus neuropathy in the population of Rochester, Minnesota, 1970-1981. 299 15

The distinction between radiation and tumor brachial plexopathy may be difficult. The electrophysiological recording of myokymic discharges, frequently present in the former but rare in the latter type of plexopathy, can be helpful for the diagnosis. However, the pathophysiology and the site of origin of these discharges remain unclear. We describe a patient presenting with radiation brachial plexopathy, clinical myokymia, cramps and pain. In this patient, the myokymia--due to abundant myokymic discharges--and the cramps, were related to the existence of persistent conduction block of several years duration. Several findings suggest that the myokymic discharges were generated on blocked axons: voluntary activity did not influence their occurrence nor modify their course; the motor unit potentials involved in the discharges were not evoked by stimulation proximal to the site of the conduction block, whereas the stimulation distal to this site could evoke, modify the rhythm, or interrupt the course of the discharges; the latency of these evoked responses indicated that the site of reflection was proximal on the axon, and likely coincided with that of the conduction block. Recent observations (Roth and Magistris, 1987b) indicated that myokymia, produced by numerous single or grouped fasciculations generated on axon terminals, may be related to persistent conduction blocks of various etiologies. The present case demonstrates that myokymia provoked by myokymic discharges may as well be related to persistent conduction block. The reason why these blocks are accompanied by fasciculations in some situations and by myokymic discharges in others remains an unsolved question. The cramps observed in this patient were also of interest as they occurred in the muscle territory of blocked axons and were provoked by passive muscle shortening. Their origin, distal to the conduction block, is unknown. Finally, a neurolysis did not prevent the progressive transformation of conduction block into axonotmesis.
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PMID:[Post-radiation brachial plexopathy. Persistent conduction block. Myokymic discharges and cramps]. 336 92

Twenty-three patients with the clinical or pathologic diagnosis of carcinomatous brachial plexopathy received external irradiation. Significant pain relief was achieved in 77.2% (17/22) of the patients for a median duration of 3 months. The observed objective response rate was 46.1%. The total administered dose (range, 1000 rad/5 fractions-5800 rad/31 fractions) as well as the treatment field width size (range, 5-24 cm) varied. Analysis of these two technical radiotherapy factors indicated that the total amount of delivered dose rather than the therapy-port-width size was the more important factor in the achievement of optimal symptomatic palliation. A literature review summarizes results of external irradiation for this painful disease syndrome, including superior sulcus Pancoast tumor.
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PMID:Radiotherapy for carcinomatous brachial plexopathy. A clinical study of 23 cases. 405 65


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