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1/51. Chronic demyelinating hypertrophic brachial plexus neuropathy.

    A patient with unilateral, painless, chronic progressive upper limb sensorimotor deficit showed electrophysiological evidence of a focal demyelinating neuropathy with almost complete conduction block across the brachial plexus. magnetic resonance imaging disclosed marked brachial plexus hypertrophy. Intravenous immunoglobulin led to fast and complete recovery, maintained by intermittent perfusions. Hypertrophic brachial plexus neuropathy can be a presentation of focal chronic inflammatory demyelinating polyradiculoneuropathy. Objective and quantitative assessment of hand function is useful to evaluate treatment results and to optimize treatment regimens.
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ranking = 1
keywords = block
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2/51. Spontaneous brachial plexus hemorrhage-case report.

    BACKGROUND: Shoulder hemorrhage resulting in brachial plexus neuropathy is a rare occurrence most often seen in cases of traumatic injury or anticoagulation therapy. We report a unique case of spontaneous brachial plexus hemorrhage. CASE DESCRIPTION: This is the first report of a spontaneous shoulder hemorrhage in which a 48-year-old jackhammer operator presented to the emergency department with a sudden onset of right shoulder pain and upper extremity pain and numbness. Imaging studies revealed a hematoma in the right axilla and chest wall. Without evidence of active bleeding or worsening neurologic deficit, this patient was treated conservatively with pain control and observation and eventually experienced a full recovery. Had there been persistent neurologic deficit, however, surgical evacuation would have been indicated. CONCLUSIONS: Cases of nerve compression caused by a hematoma should be analyzed on the basis of the severity of the neurologic deficit and not on the underlying cause of bleeding. Conservative treatment may be indicated in cases of mild or improving neurologic deficit, but regardless of its etiology, a hematoma that results in severe or worsening neurologic symptoms must be surgically evacuated to prevent permanent nerve damage.
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ranking = 83.647428227787
keywords = nerve
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3/51. Complete brachial plexus palsy after total shoulder arthroplasty done with interscalene block anesthesia.

    BACKGROUND AND OBJECTIVES: This report illustrates that brachial plexus palsy can result from either interscalene block or total shoulder arthroplasty. It is often impossible to determine which procedure caused the deficit; therefore, we believe the focus should be placed on treatment of the neurologic deficit. This report provides a suggested algorithm for diagnosis and treatment of postprocedure brachial plexus palsy. methods: Interscalene block was used as the operative anesthetic for our patient's total shoulder arthroplasty. Complete brachial plexus palsy was diagnosed postoperatively. RESULTS: The patient's postoperative treatment and recovery are described. CONCLUSIONS: Proper diagnosis and treatment of postprocedure brachial plexus palsy may improve recovery of function. Several precautions may reduce the likelihood of brachial plexus palsy following interscalene block for total shoulder arthroplasty.
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ranking = 7
keywords = block
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4/51. Brachial plexopathy associated with diffuse edematous scleroderma.

    peripheral nervous system (PNS) involvement is rare in systemic sclerosis (SSc), usually restricted to peripheral nerve entrapment. To our knowledge, only one case of scleroderma with brachial plexus involvement has been reported previously. We report here on a 61-year-old woman with past history of limited cutaneous SSc who developed motor deficiency in the left arm concomitant with diffuse edematous scleroderma without evidence for trauma or compression of the brachial plexus. After six months intravenous pulse cyclophosphamide therapy, dramatic improvement of skin and neurological involvement was observed.
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ranking = 41.823714113893
keywords = nerve
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5/51. Recurring brachial plexus neuropathy in a diabetic patient after shoulder surgery and continuous interscalene block.

    IMPLICATIONS: The performance of regional blockade on a patient with a preexisting neurologic condition or a history of neurologic complications after regional anesthesia is controversial. We present a case of recurring brachial plexus neuropathy in a diabetic patient after two shoulder procedures performed 4 mo apart. In both cases, the patient underwent intensive physical therapy with continuous postoperative interscalene analgesia.
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ranking = 5
keywords = block
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6/51. Cervical schwannoma: a case report and eight years review.

    Schwannomas are peripheral nerve tumours of nerve sheath origin. We report one case of cervical schwannoma originating from the brachial plexus. A 56-year-old man presented with a slow-growing mass on the right side of his neck that had been noted for more than 10 years. During operation, a well-encapsulated mass was seen beneath the brachial plexus with adhesion to the plexus element. It was reported as a schwannoma. Three days after surgery, the patient had a motor deficit of the right upper arm and neurological examination showed a CV nerve deficit. The neurological function recovered completely after three months. In addition, the other five cases of cervical schwannoma seen in our hospital between March 1990 and June 1998 are also reviewed. All patients had surgery. The pre-operative symptoms, impressions, and post-operative neurological status were shown and discussed. Only two cases were diagnosed as neurogenic tumour pre-operatively. Post-operatively, one patient had transient neurological deficit and another one had permanent deficit.
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ranking = 125.47114234168
keywords = nerve
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7/51. Axillary nerve injuries in children.

    Isolated axillary nerve injury is uncommon, particularly in children. The motor deficit of shoulder abduction may not recover spontaneously and can be a substantial handicap. Detection may be difficult initially, as the injury is masked by trauma such as head injury, and concomitant shoulder injury requiring immobilization. After mobilization, patients learn to partially compensate by using alternate muscles. There are few reports of surgical management of this nerve injury. Most concern predominantly adults, and the results are mixed with on average slightly greater than half having a good recovery (defined as grade 4-5 Medical research Council muscle power). We present our experience with 4 pediatric patients who had axillary nerve injury. Three patients had an interposition nerve graft, and 1 patient underwent neurolysis. All patients recovered to grade 4-5 deltoid muscle power. Children with an axillary nerve injury which fails to recover spontaneously by 4-6 months should strongly be considered for surgical exploration.
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ranking = 376.41342702504
keywords = nerve
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8/51. Lesion of the anterior branch of axillary nerve in a patient with hereditary neuropathy with liability to pressure palsies.

    We report the case of a 30-year-old woman affected by hereditary neuropathy with liability to pressure palsies (HNPP), who developed a painless left axillary neuropathy after sleeping on her left side, on a firm orthopaedic mattress, in her eighth month of pregnancy. electromyography (EMG) showing neurogenic signs in the left anterior and middle deltoid, and normal findings in the left teres minor, posterior deltoid and other proximal upper limb muscles, demonstrated that the lesion was at the level of the axillary anterior branch. A direct compression of this branch against the surgical neck of the humerus seems the most likely pathogenic mechanism. This is the first documented description of an axillary neuropathy in HNPP. knowledge of its possible occurrence may be important for prevention purposes.
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ranking = 167.29485645557
keywords = nerve
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9/51. Mediastinal mass and brachial plexopathy caused by subclavian arterial aneurysm in Behcet's disease.

    Vascular involvement in Behcet's disease is divided into venous and arterial thrombosis and arterial aneurysmal formation. Subclavian arterial aneurysm rarely occurs in Behcet's disease; however, when it does occur, it causes serious aneurysmal rupture and local complications such as nerve compression and arterial ischemia. We describe the case of a 39-year-old male who presented with neurologic symptoms and signs of brachial plexopathy and mediastinal mass caused by Behcet's subclavian arterial aneurysm. This case shows that the occurrence of brachial plexopathy should be considered a manifestation of Behcet's disease, and that Behcet's aneurysm should be considered in the differential diagnosis of upper mediastinal mass.
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ranking = 41.823714113893
keywords = nerve
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10/51. Schwannoma of the suprascapular nerve presenting with atypical neuralgia: case report and review of the literature.

    Compressive lesions of the suprascapular nerve produce weakness and atrophy of the supra- and infraspinatus muscles and a poorly defined aching pain along the posterior aspect of the shoulder joint and the adjacent scapula. Entrapment neuropathy of the suprascapular nerve is fairly common whereas tumorous lesions are rare; among the latter ganglion cysts are frequently seen. An isolated solitary schwannoma of the suprascapular nerve presenting with atypical neuralgic pain is exceptional. The location of a schwannoma under the firm deep cervical fascia in the posterior triangle of the neck is implicated in the genesis of neuralgic pains mimicking the suprascapular entrapment syndrome. One such case is reported with discussion of the relevant clinical features.
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ranking = 292.76599879725
keywords = nerve
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