Idiopathic brachial plexopathy after pacemaker implant

2021 ◽  
Author(s):  
Devesh Kumar ◽  
Aayush K Singal ◽  
Raghav Bansal ◽  
Animesh Das ◽  
Krithika Rangarajan ◽  
...  
Keyword(s):  
Brachial Plexopathy

scholarly journals Estimating the tolerance of brachial plexus to hypofractionated stereotactic body radiotherapy: a modelling-based approach from clinical experience

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Irina Kapitanova ◽  
Sharmi Biswas ◽  
Sabrina Divekar ◽  
Eric J. Kemmerer ◽  
Robert A. Rostock ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Dose Response ◽  
Medical Center ◽  
Probit Model ◽  
Brachial Plexopathy ◽  
Maximum Point ◽  
Response Model ◽  
Clinical Practices ◽  
Karolinska Institute ◽  
Human Dose

Abstract Background Brachial plexopathy is a potentially serious complication from stereotactic body radiation therapy (SBRT) that has not been widely studied. Therefore, we compared datasets from two different institutions and generated a brachial plexus dose–response model, to quantify what dose constraints would be needed to minimize the effect on normal tissue while still enabling potent therapy for the tumor. Methods Two published SBRT datasets were pooled and modeled from patients at Indiana University and the Richard L. Roudebush Veterans Administration Medical Center from 1998 to 2007, as well as the Karolinska Institute from 2008 to 2013. All patients in both studies were treated with SBRT for apically located lung tumors localized superior to the aortic arch. Toxicities were graded according to Common Terminology Criteria for Adverse Events, and a probit dose response model was created with maximum likelihood parameter fitting. Results This analysis includes a total of 89 brachial plexus maximum point dose (Dmax) values from both institutions. Among the 14 patients who developed brachial plexopathy, the most common complications were grade 2, comprising 7 patients. The median follow-up was 30 months (range 6.1–72.2) in the Karolinska dataset, and the Indiana dataset had a median of 13 months (range 1–71). Both studies had a median range of 3 fractions, but in the Indiana dataset, 9 patients were treated in 4 fractions, and the paper did not differentiate between the two, so our analysis is considered to be in 3–4 fractions, one of the main limitations. The probit model showed that the risk of brachial plexopathy with Dmax of 26 Gy in 3–4 fractions is 10%, and 50% with Dmax of 70 Gy in 3–4 fractions. Conclusions This analysis is only a preliminary result because more details are needed as well as additional comprehensive datasets from a much broader cross-section of clinical practices. When more institutions join the QUANTEC and HyTEC methodology of reporting sufficient details to enable data pooling, our field will finally reach an improved understanding of human dose tolerance.

Axillary Artery Dissection and Thrombosis after Closed Proximal Humerus Fracture – a Rare Interdisciplinary Challenge

2019 ◽  
Vol 158 (04) ◽  
pp. 406-413
Author(s):  
Sam Razaeian ◽  
Saad Rustum ◽  
Lena Sonnow ◽  
Rupert Meller ◽  
Christian Krettek ◽  
...  
Keyword(s):  
Early Diagnosis ◽  
Brachial Plexus ◽  
Functional Recovery ◽  
Proximal Humerus Fracture ◽  
Proximal Humerus ◽  
Axillary Artery ◽  
Low Energy ◽  
Artery Dissection ◽  
Brachial Plexopathy ◽  
Rare Injury

Abstract Background Proximal humerus fractures account for 4 – 6% of all fractures and are a common result of low-energy trauma in the elderly. Concomitant neurovascular injury of the neighboring axillary artery and brachial plexus is a rarity, but has enormous impact on therapy, rehabilitation and prognosis. Diagnosis of axillary artery injury may be delayed due to its varied clinical presentation and lead to prolonged ischemia, distal necrosis and even loss of limb. Thorough clinical examination, high suspicion and identification of known predictors can be helpful in early diagnosis of this rare injury. Patients/Material and Methods We report a case of an intoxicated 76-year-old male who sustained a dislocated proximal humerus fracture, resulting in concomitant brachial plexopathy and axillary artery dissection with secondary thrombosis after a low-energy fall from standing height. Due to mistriage as a neurological emergency the somnolent patient presented under delayed circumstances at our traumatological emergency department, demonstrating pain, paleness, paralysis, paresthesia and non-palpable wrist pulses. Diagnosis was made through high suspicion after clinical examination with the aid of CT angiography. Emergent open reduction and anatomic shoulder hemiarthroplasty was performed followed by axillobrachial interposition grafting using a reversed saphenous vein graft and brachial plexus exploration. Results The surgical treatments were uncomplicated. The affected limb remains viable at 6-week follow-up; however, active shoulder function is limited due to residual brachial plexopathy. Conclusion Despite early diagnosis and management of this rare injury, the prognosis for functional recovery is guarded and largely dictated by the extent of neurological injury in the setting of concomitant brachial plexopathy. Brachial plexopathy is highly associated with axillary artery injury and its impact often underestimated in comparison due to its non-limb-threatening nature in the acute setting. Future studies should focus on the long-term prognosis for functional recovery in patients with this rare injury pattern.

scholarly journals Brachial Plexopathy: A Rare Presentation of Metastatic Cholangiocarcinoma

HPB ◽  
2021 ◽  
Vol 23 ◽  
pp. S344
Author(s):  
A. Zainal Mokhtar ◽  
I. Chik ◽  
F. Fahmy ◽  
A. Azman ◽  
Z. Zuhdi
Keyword(s):  
Brachial Plexopathy ◽  
Rare Presentation

scholarly journals Neoplastic brachial plexopathy detected by ultrasonography in a patient with chronic cervicobrachialgia

2012 ◽  
Vol 44 (2) ◽  
pp. 181-183 ◽  
Author(s):  
S Kesikburun ◽  
Ö Omaç ◽  
MA Taşkaynatan ◽  
A Özgül ◽  
AK Tan
Keyword(s):  
Brachial Plexopathy

scholarly journals Endoscopic Sural Nerve Removal in Obstetric Brachial Plexopathy Using Basic Endoscopy Instruments: Technical Note

2017 ◽  
Vol 36 (02) ◽  
pp. 075-079
Author(s):  
José Malheiros ◽  
Sérgio Cançado ◽  
João Belo ◽  
Luiz Garcia ◽  
Marcelo Oliveira ◽  
...  
Keyword(s):  
Sural Nerve ◽  
Prospective Observational Study ◽  
Technical Note ◽  
Consecutive Series ◽  
Brachial Plexopathy ◽  
Technical Aspects ◽  
Scar Size ◽  
Belo Horizonte ◽  
Nerve Harvesting

Introduction The sural nerve (SN) is commonly used for grafting following resection of a neuroma-in-continuity in neonatal brachial plexus lesions (NBPL). The main drawbacks of the current open techniques are large scars and contractures in the late postoperative stage, which may, in severe cases, cause equinovarus contractures. Objective To describe the feasibility and the technical aspects of endoscopic SN harvesting with the use of basic endoscopy instruments and small incisions. Methods Prospective observational study of NBPL subjected to endoscopic nerve harvesting between February of 2012 and February of 2014 in a consecutive series. Patients were operated at the Felício Rocho Hospital (Hospital Felício Rocho) and the Clinical Hospital, Federal University of Minas Gerais (Hospital das Clínicas UFMG), Belo Horizonte/MG, in Brazil. The study outcomes assessed were: scar size, presence or absence of contractures in the calf, bleeding volume (measured by the number of gauzes used) and number of incisions. Only patients with a follow-up longer than 6 months were included. Results Seven patients were selected and twelve endoscopic nerves were endoscopically harvested. The average surgery time was 45 minutes. Nine SNs were harvested through two incisions, and three nerves through three incisions. The estimated bleeding was less than 5ml and there were no complications or contractures during the follow-up period of 6 months to 4 years. Conclusion Sural nerve harvesting in children with NBPL is feasible and it offers the advantage of needing only two or three small incisions using basic endoscopy instruments.

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