1. Montefiore Medical Center –Department of PM&R
Recurrent Parsonage Turner Plexopathy Twice Bitten, Now At Arms Length Raghu Maddela, Pegah Dehghan, Sahitya Mallipeddi
Montefiore Medical Center –Department of PM&R
Case Description
Results
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Conclusion
47 year old female with past medical history of type II diabetes, depression, hypertension who was referred for progressive upper extremity pain and weakness. She states that she was involved in an MVA in 2005 when she was found to have C3-T5 herniations. In 2007, she developed right arm and leg weakness. She also reported dyspnea when lying flat. Following nerve conduction study (NCS) showed mononeuritis multiplex involving radial, median, femoral nerve and right phrenic nerve. She was referred to intensive physical and occupational therapy which significantly improved the pain and weakness. She reported that she had no issue except mild residual weakness of the right arm until She stated that she underwent sigmoid resection with terminal ileostomy for diverticulitis with fistulization in August In October, the iliostomy revision was preformed which took 7 hours long. Four days after procedure, she developed pain and numbness in the lateral and posterior right arm, followed by left hand weakness the next day. She also reported worsening of right hand weakness associated with sever pain in the proximal arm.
The NCS study was preformed which revealed absence of bilateral median and left radial sensory response . The amplitude of left ulnar right radial sensory were low.
The amplitude of left median motor response. The left ulnar motor response was normal except for diffuse slowing but the amplitude of the right ulnar motor response was low. The right median and left radial motor response were absent. The EMG showed extensive spontaneous activity in multiple muscles with no recruitment in the left biceps, first dorsal interosseous and extensor digitorum communis.
Parsonage Turner Syndrome is an immune mediated brachial plexus neuropathy first described in 1948, still obscure and often confused with cervical radiculopathy. Sudden onset of pain associated with weakness preceded by stress. These symptoms along with the patchy, multifocal, bilateral asymmetrical involvment muscles and nerves of bilateral upper extremities on EMG and NCS should always prompt the differential diagnosis of immune mediated plexopathy. Early diagnosis and treatment can significantly change the out come.
Plexus
References
Discussion
Parsonage-Turner syndrome-Case Report and Literature Review A.J.Hussey, C.P.O’Brien and P.J.Regan Springer HSS Journal 2007 Dec;2(4):
Parsonage-Turner Syndrome
Joseph H. Feinberg,MD and Jeffrey Radecki, MD Springer HSS Journal 2010 Spe;6920:
Electromyography and Neuromuscular Disorders
David C. Preston and Barbara E. Shapiro
The electrodiagnostic study demonstrated bilateral brachial plexopathy with sever degree of axonal loss involving multiple nerves. Subsequently, she was admitted for recurrent immune mediated brachial plexus neuropathy, given the history of mononeuritis multiplex in The Plus steroid therapy was given. After she became medically stable, she was discharged to acute inpatient rehabilitation to optimize independence.