Naime Evrim Karadağ SAYGI, Canan ŞANAL TOPRAK, Koza ÇUBUKÇU, Osman Hakan GÜNDÜZ

Idiopathic Brachial Neuritis Mimics Cervical Radiculopathy: A Case Report

Idiopathic brachial neuritis (IBN) is an uncommon clinical disorder with an onset of acute, aching shoulder pain, followed by progressive muscle weakness and atrophy of the shoulder girdle and upper extremity. A 47-year-old male patient presented with an onset of acute left shoulder pain, which has lasted for two months. On physical examination, he also demonstrated a severe upper extremity weakness. Imaging tests showed a compression at C6 level on the left foraminal canal. According to these findings, the primary diagnosis was cervical radiculopathy, which may have required surgical intervention. However, the detailed history of pain, physical examination findings and electroneuromyography (ENMG) results were consistent with IBN that has a slow but progressive recovery with conservative treatment. Although a detailed history and physical examination are key points in the diagnosis of IBN, ENMG is the most helpful method for early and correct diagnosis that helps avoid unnecessary interventions.

İdiyopatik Brakiyal Nörit Servikal Radikülopatiyi Taklit Eder: Olgu Sunumu

İdiyopatik brakiyal nörit (İBN) akut başlangıçlı omuz ağrısını, omuz kuşağı ve üst ekstremitede gelişen progresif kas güçsüzlüğü ve atrofinin takip ettiği nadir görülen bir hastalıktır. Kırk yedi yaşında erkek hasta sol kol ve omuzda ani başlayan ve 2 aydır devam eden şiddetli ağrı şikayeti ile başvurdu. Ayrıca üst ekstremitede fizik muayene ile gösterilebilen ciddi kas güçsüzlüğü vardı. Manyetik rezonans görüntülemede C6 seviyesinde foraminal kanalda basısı mevcuttu. Bu bulgulara göre ön tanı cerrahi girişim gerektirebilecek servikal radikülopati idi. Ancak detaylı anamnez, fizik muayene bulguları ve elektronöromiyografi (ENMG) sonuçları konservatif tedavi ile yavaş ancak progresif iyileşme gösteren İBN ile uyumlu idi. İBN tanısında kilit noktalar detaylı anamnez ve fizik muayane olsa da gereksiz girişimleri engellemek amacıyla erken ve doğru tanı için ENMG en faydalı testtir.

PDF

___

1. Crag A, Richardson JK. Rehabilitation of patients with neuropathies. In: Braddom RL editor. Physical Medicine and Rehabilitation. 4th ed. : Elsevier Saunders; 2011: 1065-95.

2. Monteiro Dos Santos RB, Dos Santos SM, Carneiro Leal FJ, Lins OG, Magalhães C, Mertens Fittipaldi RB. Parsonage-Turner syndrome. Rev Bras Ortop 2015; 50: 336-41.

3. van Alfen N, van Eijk JJ, Ennik T, Flynn SO, Nobacht IEG, Groothuis JT, et al. Incidence of neuralgic amyotrophy (Parsonage Turner syndrome) in a primary care setting--a prospective cohort study. PLoS One 2015; 10: e0128361.

4. Miller JD, Pruitt S, McDonald TJ. Acute brachial plexus neuritis: an uncommon cause of shoulder pain. Am Fam Physician 2000; 62: 2067-72.

5. Van Eijk JJ, Groothuis JT, Van Alfen N. Neuralgic amyotrophy: An update on diagnosis, pathophysiology, and treatment. Muscle Nerve 2016; 53: 337-50.

6. Mamula CJ, Erhard RE, Piva SR. Cervical radiculopathy or Parsonage-Turner syndrome: differential diagnosis of a patient with neck and upper extremity symptoms. J Orthop Sports Phys Ther 2005; 35: 659-64.

7. Gonzalez-Alegre P, Recober A, Kelkar P. Idiopathic brachial neuritis. Iowa Orthop J 2002; 22: 81.

8. van Alfen N, van Engelen BG. The clinical spectrum of neuralgic amyotrophy in 246 cases. Brain 2006; 129: 438-50.

9. Dumitru D, Zwarts M. Brachial plexopathies and proximal mononeuropathies. In: Dumitru D, Amato A, Zwarts M. Electrodiagnostic medicine. 2nd ed. St Luis: Mosby; 2002: 623-4.

10. Moghekar AR, Moghekar AR, Karli N, Chaudhry V. Brachial plexopathies: etiology, frequency, and electrodiagnostic localization. Journal of clinical neuromuscular disease 2007; 9: 243-7.

11. van Alfen N. The neuralgic amyotrophy consultation. J Neurol 2007; 254: 695-704.

12. Fransz DP, Schönhuth CP, Postma TJ, van Royen BJ. ParsonageTurner syndrome following post-exposure prophylaxis. BMC Musculoskeletal Disord 2014; 15: 265.

13. Yang JS, Cho YJ, Kang SH, Choi EH. Neuralgic Amyotrophy Manifesting as Mimicking Posterior Interosseous Nerve Palsy. J Korean Neurosurg Soc 2015; 58: 491-3.

14. Simmons Z. Electrodiagnosis of brachial plexopathies and proximal upper extremity neuropathies. Physical medicine and rehabilitation clinics of North America 2013; 24: 13-32.

15. Saurez GA. Immune brachial plexus neuropathy. In: Dyck P, Thomas PK. editor. Peripheral Neuropathy. 4th ed. : Saunders; 2005: 2299-308.

16. Tjoumakaris FP, Anakwenze OA, Kancherla V, Pulos N. Neuralgic amyotrophy (Parsonage-Turner syndrome). J Am Acad Orthop Surg 2012; 20: 443-9.

17. van Alfen N. Clinical and pathophysiological concepts of neuralgic amyotrophy. Nat Rev Neurol 2011; 7: 315-22.