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

Brachial plexus neuropathy is a disorder which usually occurs sporadically, and is characterized by pain and varying degrees of weakness in one or both upper limbs. Some patients experience recurrent episodes. The hereditary form is usually associated with dysmorphic features. We describe a mother and son with recurrent episodes. Despite very slight dysmorphic features, we believe this is a case of the inherited form.
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PMID:Recurrent brachial plexus neuropathy in a family with subtle dysmorphic features -- a case of hereditary neuralgic amyotrophy. 923 8

A retrospective review over 6 yr of patients presenting to the hand clinic was performed to identify cases of postoperative brachial plexopathy (PBP) and to assess both prognosis and early indices of prognosis. Over this period (1989-1995), 22 patients were referred by the hospital's surgical departments to the hand clinic because of PBP. Eight cases followed open heart surgery (OHS) and 14 followed non-cardiac surgery (NCS). Median full recovery took 10 (range 4-16) weeks and 20 (8-50) weeks, respectively. Long-term follow-up revealed one OHS patient with residual tingling and three NCS patients with residual weakness. Brachial plexopathy after median sternotomy was characterized by a predominance of sensory complaint in the lower roots of the plexus. Injury after non-cardiac surgery was reflected by a predominance of motor deficit in the upper and middle roots. Brachial plexus injury after cardiac surgery carries an excellent prognosis for full functional recovery. Although the limited number of cases precludes statistical substantiation, the data suggest that the prognosis of PBP after non-cardiac surgery may be worse in males, diabetics, those with injury to all roots of the plexus and, when in addition to the motor deficit there is sensory loss and pain or dysaesthesia. At a 1 week "prognostic milestone", 79% of NCS patients with significant symptomatology enjoyed complete recovery although this took as long as 5 months to 1 yr in 50% of patients. At a 6-8 week "prognostic milestone", 50% of those who had not yet had improvement in the motor deficit suffered residual neurological deficit. All patients recovered to a significant extent even when recovery was not complete and none suffered from late deterioration or chronic pain.
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PMID:Prognosis of intraoperative brachial plexus injury: a review of 22 cases. 938 59

A 24-year-old woman with previously known pseudotumor cerebri syndrome (PTCS) presented with severe pain in the neck and shoulders followed by the classical symptoms and signs of bilateral brachial neuritis. At the same time, there was a recurrence of the PTCS which had been in remission for more than one-and-a-half years. Despite treatment with high doses of methylprednisolone, intravenous immunoglobulins and repeated cerebrospinal fluid drainage, both brachial plexopathy and the PTCS continued to worsen. Both lumbosacral plexuses became involved and the visual acuity deteriorated to a level such that a lumboperitoneal shunt had to be inserted. The neurological condition started to improve progressively after 8 weeks. This case is, to our knowledge, the first where brachial plexopathy has been described in association with a PTCS. Although the pathogenesis of this association is not clear, there are enough data to suggest the existence of a continuum between extended brachial plexopathy and Guillain Barre syndrome, with which PTCS has been associated in some instances.
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PMID:Atypical brachial plexopathy with pseudotumor cerebri. 1020 59

Although cancer is a frequent condition, neoplastic involvement of the peripheral nervous system is rare. The mechanisms are heterogeneous and include lesions within the cerebrospinal fluid (CSF) space, local invasion (e.g. brachial plexus), compression, rarely direct infiltration, perineurial spread and even rarer intranerval metastasis. A 47-year-old woman had been treated for a carcinoid 10 years earlier and had received axillar irradiation. At presentation she suffered from weakness of the biceps brachii and was experiencing pain radiating from the axilla into the forearm and thumb. MR scans of the brachial plexus were negative and her symptoms were primarily considered to stem from a postradiation brachial plexopathy, Because of increasing pain, the brachial plexus was explored and a metastasis in the left musculocutaneous nerve was resected. Several months later, numbness and pain appeared in the ulnar nerve and another intrafascicular metastasis in the ulnar nerve was discovered. Resection with preservation of remaining fascicles was performed. This rare case report demonstrates that multiple mononeuropathies, resembling multiplex neuropathy, may be caused by intranerval metastasis.
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PMID:Intraneural nerve metastasis with multiple mononeuropathies. 1144 73

Radiation-induced arteritis of large vessels and brachial plexus neuropathy are uncommon delayed complications of local radiation therapy. We describe a 66-year-old woman with right arm discomfort, weakness, and acrocyanosis that developed 21 years after local radiation for breast adenocarcinoma. Arteriography revealed arteritis, with ulcerated plaque formation at the subclavian-axillary artery junction, consistent with radiation-induced disease, and diffuse irregularity of the axillary artery. Electromyography showed a chronic brachial plexopathy. The patient's acrocyanosis, thought to be due to digital embolization from her vascular disease, improved with antiplatelet therapy. The concurrent combination of radiation-induced arteritis and brachial plexopathy is uncommon but should be considered in patients presenting with upper extremity pain or weakness after radiation therapy.
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PMID:Arteritis and brachial plexus neuropathy as delayed complications of radiation therapy. 1149 27

Traumatic brain injury (TBI) is often accompanied by additional trauma that can be obscured by cognitive dysfunction or multiple injuries in the same region of the body. This report describes the case of an unhelmeted motorcycle rider who collided with a telephone pole. He sustained a diffuse subarachnoid hemorrhage, bilateral subdural hematomas (right frontal and left temporal), diffuse axonal injury in the subcortical and periventricular white matter, and a left tibial fracture. After medical and surgical stabilization, he was transferred to a subacute rehabilitation facility and then to a rehabilitation center. He was evaluated for pain and limited range of motion in his right shoulder, where both a rotator cuff tear and a brachial plexopathy were diagnosed. This report discusses concomitant injuries that occur with TBI, and the management of rotator cuff tears and brachial plexopathy.
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PMID:Delayed diagnosis of concomitant rotator cuff tear and brachial plexopathy in a patient with traumatic brain injury: a case report. 1173 90

Metastatic involvement of brachial plexopathy is a rare condition that is often associated with advanced systemic breast cancer and the role of surgeon appears to be restricted because radio-chemotherapy is better recommended in this setting. We report a case of a 64-year-old woman that presented a very delayed breast cancer metastatic lower trunks lesions without associated radiation injury, treated by surgery. MRI of plexus and CT of chest and axilla are methods of choice in preoperative radiological evaluation. Neurosurgeon effort is restricted to provide pathologic diagnosis (confirm of metastasis), adequate pain control and improvement of neurological function. So that surgical exploration and neurolysis should be performed as soon as possible after appearance of neurological deficits before denervation signs occurs. General surgeon presence should be warranted for more radical removal of remain lymph nodes and metastatic nodal infiltration of adjacent anatomical structures (vessels and so on) when detected by preoperative radiological work-up.
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PMID:Metastatic breast cancer delayed brachial plexopathy. A brief case report. 1269 Mar 40

Infraclavicular brachial plexopathy is a potential complication of axillary regional block. We retrospectively reviewed 13 such injuries and found the median nerve most often affected, followed by combined median and ulnar neuropathies, and then by various combinations involving the median, ulnar, radial, and musculocutaneous nerves. All were axon-loss in type and most were severe in degree electrophysiologically. The clinical and electrodiagnostic features of these injuries are strikingly similar to those sustained after axillary arteriography, which has been associated with the medial brachial fascial compartment (MBFC) syndrome. This syndrome is characterized by the evolution of neurologic deficits and pain following hematoma formation within a compartment of the upper arm. Thus, we believe that this mechanism underlies most nerve injuries that result from axillary angiography or axillary regional block. This has important treatment implications, as timely surgical intervention may lead to improved outcome.
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PMID:Infraclavicular brachial plexus injury following axillary regional block. 1522 77

Metastatic plexopathy is often a disabling accompaniment of advanced systemic cancer and may involve any of the peripheral nerve plexuses. 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, neoplastic plexopathy is often characterized by severe, unrelenting pain. Later, weakness and focal sensory disturbances occur in the distribution of plexus involvement. 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, chemotherapy, and symptomatic treatment. In selected cases, 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, maximize remaining neurological function, and prevent complications of immobility produced by the neuromuscular dysfunction.
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PMID:Neurological manifestations of neoplastic and radiation-induced plexopathies. 1563 50

We determined the incidence, distribution, and resolution of neurologic sequelae and the association with anesthetic, surgical, and patient factors after single-injection interscalene block (ISB) using levobupivacaine 0.625% with epinephrine 1:200,000 in subjects undergoing shoulder or upper arm surgery, or both, in 693 consecutive adult patients. After a standardized ISB, assessments were made at 24 and 48 h and at 2 and 4 wk for anesthesia, hypesthesia, paresthesias, pain/dysesthesias, and motor weakness. Symptomatic patients were monitored until resolution. Subjects reporting pain or discomfort >3 of 10 and those with motor or extending sensory symptoms received diagnostic assessment. Six-hundred-sixty subjects completed 4 wk of follow-up. Fifty-eight neurologic sequelae were reported by 56 subjects. Symptoms were sensory except for two cases of motor weakness (lesions identified distant from the ISB site). Thirty-one sequelae with likely ISB association were reported by 29 subjects, including 14 at the ISB site, 9 at the distal phalanx of thumb/index finger, 7 involving the posterior auricular nerve, and 1 clinical brachial plexopathy. Sequelae not likely associated with the ISB were reported by 27 subjects with symptoms reported in the median (n = 9) and ulnar (n = 4) nerves, surgical neuropraxias (n = 12), and motor weakness (n = 2). Symptoms resolved spontaneously (median 4 wk; range, 2-16 wk) except in the two patients with motor weaknesses and the patient with clinical brachial plexopathy, who received therapeutic interventions. Variables identified as independent predictors of neurologic sequelae likely related to ISB were paresthesia at needle insertion and ISB site pain or bruising at 24 h. In contrast, surgery preformed in the sitting position, as well as ISB site bruising, was identified as a predictor of neurologic sequelae not likely related to ISB. In conclusion, neurologic sequelae after single-injection ISB using epinephrine mainly involve transient minor sensory symptoms.
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PMID:Neurologic sequelae after interscalene brachial plexus block for shoulder/upper arm surgery: the association of patient, anesthetic, and surgical factors to the incidence and clinical course. 1584 12


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