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Brachial Plexus Injury

BPI


Presentation

  • We present the case of a cervicothoracic epidural pseudomeningocele with spinal cord compression 18 years after a brachial plexus injury. PURPOSE: To present a case report of a patient and literature review on cases with epidural pseudomeningoceles.[ncbi.nlm.nih.gov]
  • A brief review of presentation and management of this condition is also presented.[ncbi.nlm.nih.gov]
  • We present a unique case of a low energy midshaft clavicle fracture in a paediatric patient in whom there was an acute BP injury and subclavian artery compression that has not been described previously.[ncbi.nlm.nih.gov]
  • Pain was present in 75.4% of the individuals and 79% presented with neuropathic pain, mostly located in the hands (30.41%). The use of auxiliary devices (p 0.05) and marital status (p 0.03) were both independent predictors of pain.[ncbi.nlm.nih.gov]
  • An unusual, previously unreported, case of late neurologic deterioration after BPI is presented.[ncbi.nlm.nih.gov]
Prolonged Immobilization
  • We report a case of bilateral brachial plexus injury resulting from prolonged immobilization of the arms in hyper-abducted position resulting in compression of the brachial plexus on both sides.[ncbi.nlm.nih.gov]
  • Abstract We report the case of a 36-year-old woman who developed right upper and lower limb paralysis with sensory deficit after sedative drug overdose with prolonged immobilization.[ncbi.nlm.nih.gov]
Hypoxemia
  • ., hypotension or hypoxemia). Our findings were inconclusive, but we postulated that 90 degrees abduction of the arms per se may have resulted in excessive stretching of the brachial nerves, causing his injuries.[ncbi.nlm.nih.gov]
Wheelchair Bound
  • The patient couldn't walk and was wheelchair bound. Magnetic resonance imaging (MRI) revealed an extensive multilocular extradural cyst posterior to the spinal cord ranging from the C4 to Th6 level, associated with severe spinal cord compression.[ncbi.nlm.nih.gov]
Chronic Infection
  • infection, nonunion fractures, full-thickness burns, chronic neck pain with arm weight, etc.).[ncbi.nlm.nih.gov]
Unilateral Arm Weakness
  • RESULTS: Five patients had unilateral arm weakness after the initiation of ECMO therapy. There was no neurological examination or electrophysiological testing data available for 3 patients.[ncbi.nlm.nih.gov]
Anhidrosis
  • […] comprised of fibers from C3 through C5, and the sympathetic fibers of T1 are affected commonly in brachial plexus injuries, resulting, respectively, in ipsilateral diaphragmatic paralysis and Horner syndrome (miosis, partial ptosis, slight enophthalmos and anhidrosis[pedsinreview.aappublications.org]
  • Review Topic QID: 4750 1 The injury has likely resulted in the avulsion of several nerve roots 2 Physical exam would likely reveal drooping of his left eyelid and anhidrosis 3 Intact paraspinal musculature on EMG is suggestive of a post-ganglionic lesion[orthobullets.com]
  • Avulsion or damage of the C8 and T1 nerve roots from which the cervical sympathetic chain arises cause Horner syndrome, which is characterized by ptosis, meiosis, anhidrosis of the cheek and enophthalmos.[thenerve.net]
Hyperhidrosis
  • KEYWORDS: Complication; hyperhidrosis/osmidrosis; microwave; neuropathy[ncbi.nlm.nih.gov]
  • We report a 44-year-old woman who developed brachial plexus injury of her left arm after thoracoscopic sympathicotomy for axillary hyperhidrosis. The lesion involved the whole arm.[ncbi.nlm.nih.gov]
  • We report on a 26-year-old man who developed weakness and numbness of the right arm after thoracoscopic sympathectomy for hyperhidrosis. Electromyographic study revealed evidence of denervation in the upper trunk of the right brachial plexus.[ncbi.nlm.nih.gov]
Monoplegia
  • The authors present a case of a 4-year-old boy with a traumatic extracranial vertebral artery dissection, who suffers from left arm monoplegia due to brachial plexus injury.[ncbi.nlm.nih.gov]
  • For example, the myopathy was not likely to be due to sudden unilateral monoplegia with sensory involvement without muscle atrophy and fasciculation.[academic.oup.com]
Mononeuropathy
  • It consists usually in a demyelinating polyneuropathy or mononeuropathy affecting mainly the lower limbs. Isolated involvement of both upper extremities has been described in only 4 patients related to root damage.[ncbi.nlm.nih.gov]
  • Herskovitz et al 10 reported the case of a patient with mononeuropathy of the median recurrent motor branch that elicited by manual compression.[academic.oup.com]
Areflexia
  • Neurological examination showed a brachial diplegia, distal vibratory, thermic and algic hypoesthesia, deep tendon areflexia in upper limbs. There was no sensory or motor deficit in lower extremities. No cognitive disturbances were detected.[ncbi.nlm.nih.gov]
Myokymia
  • Electromyography showed myokymia in three patients. With conservative therapy, only one patient was temporarily relieved of pain, while the conditions of others were not ameliorated.[ncbi.nlm.nih.gov]

Treatment

  • Conservative methods of treatment have changed over the years, without research on the outcome of these treatment changes.[ncbi.nlm.nih.gov]
  • The authors present the first cost-effectiveness model to directly compare the different treatment strategies available to a patient with PBPI.[ncbi.nlm.nih.gov]
  • The abduction muscle strength after treatment was 8.53 and 11.3 Nm for group A and group B, respectively. The external rotation muscle strength after treatment was 5.88 and 7.45 Nm for group A and group B, respectively.[ncbi.nlm.nih.gov]
  • At the same time, high-quality studies and new technology and techniques are needed to determine more effective treatments for this group.[ncbi.nlm.nih.gov]
  • This work aims to determine the effectiveness of operative treatment in patients with this type of injury.[ncbi.nlm.nih.gov]

Prognosis

  • The prognosis for postoperative brachial plexopathy is usually good with conservative management.[ncbi.nlm.nih.gov]
  • The differential diagnosis between brachial plexus neuropathy and other peripheral neuropathies is important, as the prognosis of brachial plexus neuropathy is generally better.[ncbi.nlm.nih.gov]
  • These authors describe their custom fabricated orthosis designed to balance shoulder growth and muscular function, and improve prognosis of long term functional outcomes for children with birth related brachial plexus injury. - Victoria Priganc, PhD,[ncbi.nlm.nih.gov]
  • Prognosis is commonly excellent without any sequelae.[ncbi.nlm.nih.gov]

Etiology

  • OBJECTIVE: Late neurologic deterioration after brachial plexus injury (BPI) is uncommon and may be caused by multiple etiologies. An unusual, previously unreported, case of late neurologic deterioration after BPI is presented.[ncbi.nlm.nih.gov]
  • When considering the etiology and treatment of such injuries, it is important to make a distinction between adult versus obstetric brachial plexus injury.[ncbi.nlm.nih.gov]
  • After carefully reviewing the surgical course and referring to the published literature, we tentatively concluded that compression or overstretching produced by wide and prolonged sternal separation of the brachial plexus was the most likely etiology.[ncbi.nlm.nih.gov]
  • This article will also discuss the etiology and pathogenesis of nerve injury after MVD and the means to prevent them. METHODS: Intraoperative SSEP monitorings for 485 patients who underwent MVD surgery were reviewed.[ncbi.nlm.nih.gov]
  • Although trauma remains the probable etiology for many brachial plexus injuries, other, nontraumatic etiologies need to be considered.[jaoa.org]

Epidemiology

  • Design: Observational epidemiological study. Setting: Hospital-based multicenter study. Subjects: One hundred seven prospectively enrolled patients with brachial plexus injury.[ncbi.nlm.nih.gov]
  • An original meta-analysis of primary nerve repair and review of Canadian epidemiology and burden were previously completed.[ncbi.nlm.nih.gov]
  • Although the ability to predict brachial plexus injury antenatally remains elusive, knowledge of its epidemiology, risk factors, variations in presentation, prognosis, and management can guide therapeutic decisions and potentially avoid lifelong disability[pedsinreview.aappublications.org]
  • Epidemiology Frequency United States Brachial plexus injuries are the most common peripheral nerve injuries seen in athletes. True rate of brachial plexus injuries is difficult to determine due to significant underreporting.[emedicine.medscape.com]
  • "Epidemiology of Brachial Plexus Injuries in a Multitrauma Population". Neurosurgery . 40 (6): 1182–8, discussion 1188–9. doi : 10.1097/00006123-199706000-00014 . PMID 9179891 . External links [ edit ][en.wikipedia.org]
Sex distribution
Age distribution

Pathophysiology

  • BACKGROUND: Assessment of muscle atrophy and fatty degeneration in brachial plexus injury (BPI) could yield valuable insight into pathophysiology and could be used to predict clinical outcome.[ncbi.nlm.nih.gov]
  • The pathomechanics, pathophysiology and prevention of cervical spinal cord and brachial plexus injuries in athletics. Sports Med . 2010. 40(1):59-75. [Medline] . Terzis JK, Kokkalis ZT.[emedicine.medscape.com]
  • Pathophysiology of the BPI Root injury is defined as root avulsion from the spinal cord and rupture in the preganglionic root zone or dorsal ganglion at the vertebral foramen.[thenerve.net]

Prevention

  • Abstract Somatosensory evoked potentials (SSEPs) are widely utilized for the intraoperative detection and prevention of nerve conduction injuries.[ncbi.nlm.nih.gov]
  • We discuss the mechanism of extensive SEMC development, surgical strategies, and preventive measures against SEMC after TBPI.[ncbi.nlm.nih.gov]
  • We present a case illustrating the benefit of utilizing both SSEPs and transcranial electrical motor evoked potentials (TCeMEPs) for preventing position-related injury during surgery.[ncbi.nlm.nih.gov]
  • This article will also discuss the etiology and pathogenesis of nerve injury after MVD and the means to prevent them. METHODS: Intraoperative SSEP monitorings for 485 patients who underwent MVD surgery were reviewed.[ncbi.nlm.nih.gov]
  • Further study is needed to better evaluate the effectiveness of current preventive measures.[ncbi.nlm.nih.gov]

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