Complete Bilateral Brachial Plexus Injury from Rhabdomyolysis and Compartment Syndrome: Surgical Case Report

2018 ◽  
Vol 17 (2) ◽  
pp. E68-E72 ◽  
Author(s):  
Daniel A Tonetti ◽  
Ivan S Tarkin ◽  
Kiran Bandi ◽  
John J Moossy
Keyword(s):  
Brachial Plexus ◽  
Compartment Syndrome ◽  
Clinical Presentation ◽  
Brachial Plexus Injury ◽  
Laboratory Data ◽  
Surgical Decompression ◽  
Sensory Function ◽  
Resonance Imaging ◽  
Pectoralis Muscles ◽  
Prolonged Immobilization

Abstract BACKGROUND AND IMPORTANCE Acute bilateral brachial plexus injury is rare and usually a result of traction injury. Immediate operative intervention is reserved for rare cases of ongoing compression of the plexus; the role for acute decompression of the brachial plexus secondary to compartment syndrome has not been previously described. In this report, we describe the technique and role for urgent brachial plexus decompression. CLINICAL PRESENTATION A 32-yr-old man presented with acute complete bilateral brachial plexus palsy due to focal rhabdomyolysis and brachial plexus compression after a night of excess alcohol and methadone ingestion. He had complete loss of motor and sensory function from C5 to T1, with the exception of partial sensory sparing of the C5 dermatome. Magnetic resonance imaging demonstrated diffuse muscular edema of the supraclavicular and infraclavicular fossae in addition to the pectoralis muscles and the deltoids bilaterally. He underwent urgent surgical decompression of his supraclavicular and infraclavicular fossae with fasciotomies of the pectoral muscles and the anterior deltoids, allowing direct visualization and decompression of the entire brachial plexus resulting in a near-complete functional recovery. CONCLUSION Neurosurgeons should include brachial plexus compression due to compartment syndrome in the differential diagnosis of patients with acute upper extremity weakness, particularly when associated with prolonged immobilization and/or substance abuse. Prompt surgical decompression should be performed in these patients if imaging and laboratory data suggest compartment syndrome and resultant neurological deficit.

The Diagnostic Value of MRI in Traumatic Brachial Plexus Injury

1994 ◽  
Vol 19 (1) ◽  
pp. 55-59 ◽  
Author(s):  
M. OCHI ◽  
Y. IKUTA ◽  
M. WATANABE ◽  
K. KIMOR ◽  
K. ITOH
Keyword(s):  
Brachial Plexus ◽  
Nerve Root ◽  
Brachial Plexus Injury ◽  
Diagnostic Value ◽  
Resonance Imaging ◽  
Nerve Roots ◽  
Surgical Exploration ◽  
Nerve Root Avulsion ◽  
Magnetic Resonance Imaging Mri ◽  
The Individual

Findings in 34 patients with traumatic brachial plexus injury documented by surgical exploration and intra-operative somatosensory-evoked potentials were correlated with findings on myelography and magnetic resonance imaging (MRI) to determine whether MRI can identify nerve root avulsion. The coronal and sagittal planes were not able to demonstrate avulsion of the individual nerve roots. The axial and axial oblique planes did provide useful information to determine which nerve root was avulsed in the upper plexus, although it was difficult to clearly delineate the lower cervical rootlets. The accuracy of MRI was 73% for C5 and 64% for C6 and that of myelograpby 63% for C5 and 64% for C6. Thus, the diagnostic accuracy of MRI for upper nerve roots was slightly superior to myelography. Although its primary diagnostic value is limited to the upper nerve roots whose avulsion is relatively difficult to diagnose by myelography, MRI can provide useful guidance in the waiting period prior to surgical exploration after brachial plexus injury.

NEUROPATHIC PAIN IN BRACHIAL PLEXUS INJURY

Hand Surgery ◽  
2015 ◽  
Vol 20 (01) ◽  
pp. 39-45 ◽  
Author(s):  
Direk Tantigate ◽  
Saichol Wongtrakul ◽  
Torpon Vathana ◽  
Roongsak Limthongthang ◽  
Panupan Songcharoen
Keyword(s):  
Neuropathic Pain ◽  
Brachial Plexus ◽  
Upper Extremity ◽  
Brachial Plexus Injury ◽  
Traumatic Injury ◽  
Demographic Characteristics ◽  
Sensory Function ◽  
Sensory Deficit ◽  
Injured Patients

Background: In Thailand, brachial plexus injury is a common traumatic injury that affects the function of the upper extremity. The current treatments focus mainly on improving the motor and sensory function. Apart from the motor and sensory deficit, these patients usually suffer from pain. Objective: The purpose of this study was to determine the prevalence and factors that relate to neuropathic pain in patients with brachial plexus injury. Methods: We collected data from March 2008 to July 2011. The DN4 Questionnaire was used to diagnose neuropathic pain in 95 patients. Results: The prevalence of neuropathic pain was as high as 76%. Majority of patients presented with hypoesthesia to pin prick, hypoesthesia to touch and numbness. Severity of neuropathic pain was significantly correlated with the type of brachial plexus injury. There was no difference between demographic characteristics of patients. Conclusion: Our study showed that the prevalence of neuropathic pain was high in brachial plexus injured patients. Therefore, surgeons should be aware of this common, yet underestimated, problem in brachial plexus injured patients.

SPINAL CORD HERNIATION INTO ASSOCIATED PSEUDOMENINGOCELE AFTER BRACHIAL PLEXUS AVULSION INJURY

Neurosurgery ◽  
2007 ◽  
Vol 60 (1) ◽  
pp. E205-E205 ◽  
Author(s):  
Hiroshi Yokota ◽  
Kazuhiro Yokoyama ◽  
Hiroshi Noguchi ◽  
Yoshitomo Uchiyama
Keyword(s):  
Magnetic Resonance Imaging ◽  
Spinal Cord ◽  
Brachial Plexus ◽  
Clinical Presentation ◽  
Dural Defect ◽  
Intervertebral Foramen ◽  
Resonance Imaging ◽  
Avulsion Injury ◽  
Brachial Plexus Avulsion ◽  
Spinal Cord Herniation

Abstract OBJECTIVE Posttraumatic spinal cord herniation is a rare condition. We describe a case of spinal cord herniation into an associated pseudomeningocele after a brachial plexus avulsion injury. CLINICAL PRESENTATION A 33-year-old man began to develop progressive Horner's syndrome 14 years after a brachial plexus avulsion injury. At a clinical presentation 17 years after that injury, sensory disturbance and a unilateral pyramidal sign were also evident. In addition to myelography and computed tomographic myelography findings, coronal magnetic resonance imaging scans clearly demonstrated herniation of the spinal cord into a large pseudomeningocele inside the C7–T1 intervertebral foramen. Another pseudomeningocele inside the T1–T2 intervertebral foramen was also noted. INTERVENTION The patient underwent a C6–T2 laminectomy, during which the spinal cord was found to be herniated through a dural defect into a pseudomeningocele at the C8 root level, and a second dural defect was also shown, with an arachnoid outpouching that included an avulsed T1 root. The spinal cord herniation was reduced and the dural defects were repaired. After surgery, the patient showed no significant neurological changes, and his condition stabilized. CONCLUSION Brachial plexus root avulsions may result in the formation of pseudomeningoceles and can lead to spinal cord herniation. Coronal magnetic resonance imaging is useful to demonstrate spinal cord herniation as well as pseudomeningoceles. Surgical treatment is recommended for such cases with progressive symptoms to prevent further deterioration.

Magnetic resonance imaging in brachial plexus injury

2013 ◽  
Vol 97 (S2) ◽  
pp. 181-190 ◽  
Author(s):  
F. Caranci ◽  
F. Briganti ◽  
M. La Porta ◽  
G. Antinolfi ◽  
E. Cesarano ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Resonance Imaging

scholarly journals Amyotrophic Monoplegia Secondary to Posttraumatic Rupture of the Brachial Plexus’s Roots: A Case Report and Review of the Literature

2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
Oumniya Abouhanine ◽  
Hasnaa Belgadir ◽  
Vianney Ndayishimiye ◽  
Omar Amriss ◽  
Aicha Merzem ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Case Report ◽  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Review Of The Literature ◽  
Resonance Imaging ◽  
Left Limb ◽  
Limb Trauma ◽  
Cervical Magnetic Resonance Imaging ◽  
Magnetic Resonance Imaging Mri

Brachial plexus lesions most often occur in multiple trauma. We report a case of a 37-year-old patient who presented an upper left limb total sensitivomotor deficit and amyotrophy after a cervical and upper limb trauma. Cervical magnetic resonance imaging (MRI) was performed. It noted pseudomeningoceles at the levels of C6-C7, C7-D1, and D1-D2 in T1 hyposignal , T2 and STIR hypersignal , not enhanced by the injection of Gadolinium extending in foraminal and extraforaminal spaces without visualization of the corresponding rootlets. Traumatic brachial plexus injury is a potentially serious debilitating injury which can be well explored on MRI.

Rare Primary Embryonal Carcinoma in the Brachial Plexus: A Case Report and Literature Review

Neurosurgery ◽  
2019 ◽  
Vol 87 (2) ◽  
pp. E152-E155 ◽  
Author(s):  
Huihao Chen ◽  
Gang Yin ◽  
Na Cui ◽  
Haodong Lin
Keyword(s):  
Brachial Plexus ◽  
Embryonal Carcinoma ◽  
Clinical Presentation ◽  
Middle Part ◽  
Resonance Imaging ◽  
Primary Tumors ◽  
Nerve Sheath Tumors ◽  
Peripheral Nerve Sheath Tumors ◽  
Nerve Sheath ◽  
History Of

Abstract BACKGROUND AND IMPORTANCE Primary tumors of the brachial plexus are rare. Most are benign and characterized as Schwannoma and neurofibroma, whereas malignant peripheral nerve sheath tumors are less common. Here, we report a rare case of primary embryonal carcinoma in the brachial plexus. CLINICAL PRESENTATION A 17-yr-old male presented with a 3-mo history of a mass growing in the left supraclavicular region over the middle part of the clavicle. Magnetic resonance imaging revealed a well-defined mass (diameter 2.5 cm) straddling the brachial plexus. After surgical resection, and the mass was histologically confirmed to be an embryonal carcinoma. CONCLUSION Primary embryonal carcinoma in the brachial plexus has not been reported previously. This case highlights the importance of considering the possibility that some primary brachial plexus tumors may be malignant and should be treated promptly.

scholarly journals Toxic and metabolic encephalopathies: iconographic essay

2015 ◽  
Vol 48 (2) ◽  
pp. 121-125 ◽  
Author(s):  
Eric Mendonça Bimbato ◽  
Amanda Gontijo Carvalho ◽  
Fabiano Reis
Keyword(s):  
Metabolic Diseases ◽  
Clinical Presentation ◽  
Correct Diagnosis ◽  
Laboratory Data ◽  
Specific Treatment ◽  
Resonance Imaging ◽  
Pictorial Essay ◽  
The Central Nervous System ◽  
Metabolic Encephalopathies ◽  
Etiologic Diagnosis

Generally, toxic-metabolic diseases affecting the central nervous system can hardly be differentiated just on the basis of their clinical presentation. However, some typical neuroradiological features can guide the correct diagnosis. In this context, magnetic resonance imaging is an important tool which, in association with clinical and laboratory data, can establish an early and specific treatment. The present pictorial essay with selected cases from the archives of the authors' institution describes imaging findings which might help in the etiologic diagnosis of toxic-metabolic diseases.

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