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1/12. Neoplasm as a cause of brachial plexus palsy in neonates.

    Two patients with neonatal onset of arm weakness resulting from neoplastic involvement of the brachial plexus who were initially considered to have obstetric brachial plexus palsies are reported. The first patient was a 7-day-old female who presented with a left supraclavicular mass that was first detected at 2 days of age and left proximal arm weakness. The weakness involved the whole arm within 3 days. The mass was a malignant rhabdoid tumor. The second patient was a 28-month-old male who presented with slowly progressive right arm weakness, which began at 3 weeks of age, and episodes of scratch marks on the arm that began at 4 months of age. magnetic resonance imaging revealed a plexiform neurofibroma of the brachial plexus. The features that are suggestive of a brachial plexus palsy caused by a neoplasm rather than of obstetric brachial plexus palsy include the following: the onset of weakness after the first day of age, with a progressive course; a history of a normal delivery and birth weight; the absence of signs of a traumatic injury or injuries; the appearance before 7 days of age of a growing supraclavicular mass without radiographic evidence of a clavicular fracture; and recurrent scratch marks on the weak arm.
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ranking = 1
keywords = neoplasm
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2/12. brachial plexus neoplastic lesions assessed by conduction study of medial antebrachial cutaneous nerve.

    Two cases of neoplastic involvement of the lower brachial plexus are reported. This condition was due to recurrence of lymphoma in one case and to axillary node spread of breast cancer in the other. The neuropathic origin and the location of the lesion in the lower brachial plexus between the T-1 root and the axilla was demonstrated by the presence of abnormalities on testing of the medial antebrachial cutaneous nerve in the symptomatic upper limb and comparing it to the healthy one. All other electrodiagnostic tests were normal. Such a finding suggests the need for imaging of the lower brachial plexus region by computed tomography or magnetic resonance imaging.
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ranking = 1.0515922036312
keywords = cancer
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3/12. Intraneural nerve metastasis with multiple mononeuropathies.

    Although cancer is a frequent condition, neoplastic involvement of the peripheral nervous system is rare. The mechanisms are heterogeneous and include lesions within the cerebrospinal fluid (CSF) space, local invasion (e.g. brachial plexus), compression, rarely direct infiltration, perineurial spread and even rarer intranerval metastasis. A 47-year-old woman had been treated for a carcinoid 10 years earlier and had received axillar irradiation. At presentation she suffered from weakness of the biceps brachii and was experiencing pain radiating from the axilla into the forearm and thumb. MR scans of the brachial plexus were negative and her symptoms were primarily considered to stem from a postradiation brachial plexopathy, Because of increasing pain, the brachial plexus was explored and a metastasis in the left musculocutaneous nerve was resected. Several months later, numbness and pain appeared in the ulnar nerve and another intrafascicular metastasis in the ulnar nerve was discovered. Resection with preservation of remaining fascicles was performed. This rare case report demonstrates that multiple mononeuropathies, resembling multiplex neuropathy, may be caused by intranerval metastasis.
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ranking = 1.0515922036312
keywords = cancer
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4/12. arteritis and brachial plexus neuropathy as delayed complications of radiation therapy.

    radiation-induced arteritis of large vessels and brachial plexus neuropathy are uncommon delayed complications of local radiation therapy. We describe a 66-year-old woman with right arm discomfort, weakness, and acrocyanosis that developed 21 years after local radiation for breast adenocarcinoma. Arteriography revealed arteritis, with ulcerated plaque formation at the subclavian-axillary artery junction, consistent with radiation-induced disease, and diffuse irregularity of the axillary artery. electromyography showed a chronic brachial plexopathy. The patient's acrocyanosis, thought to be due to digital embolization from her vascular disease, improved with antiplatelet therapy. The concurrent combination of radiation-induced arteritis and brachial plexopathy is uncommon but should be considered in patients presenting with upper extremity pain or weakness after radiation therapy.
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ranking = 1492.3318351727
keywords = radiation-induced
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5/12. A case of multiple schwannomas of the trigeminal nerves, acoustic nerves, lower cranial nerves, brachial plexuses and spinal canal: schwannomatosis or neurofibromatosis?

    In most cases, while schwannoma is sporadically manifested as a single benign neoplasm, the presence of multiple schwannomas in one patient is usually indicative of neurofibromatosis 2. However, several recent reports have suggested that schwannomatosis itself may also be a distinct clinical entity. This study examines an extremely rare case of probable schwannomatosis associated with intracranial, intraspinal and peripheral involvements. A 63-year-old woman presented with a seven-year history of palpable lumps on both sides of the supraclavicular area and hearing impairment in both ears. On physical examination, no skin manifestations were evident. Facial sensory change, deafness in the left ear and decreased gag reflex were revealed by neurological examination. magnetic resonance imaging revealed multiple lesions of the trigeminal nerves, acoustic nerves, lower cranial nerves, spinal accessory nerve, brachial plexuses, and spinal nerves. Pathological examination of tumors from the bilateral brachial plexuses, the spinal nerve in the T8 spinal position and the neck mass revealed benign schwannomas. Following is this patient case report of multiple schwannomas presenting with no skin manifestations of neurofibromatosis.
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ranking = 1
keywords = neoplasm
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6/12. A rare association between malignant mediastinal seminoma and other malignant neoplasms.

    Primary malignant mediastinal seminomas (PMMS) are rare tumors accounting for 1-6% of all mediastinal tumors. PMMS mostly affect young men, arising from primordial germ cells that abnormally migrate from the ectoderm of the yolk sac to the gonadal region. They are clinically and biologically distinct from primary testicular tumors and seem to have a worse prognosis. Due to the rarity of the disease, the choice of treatment is a matter of debate. literature data do not show any association between this kind of tumor and malignant Schwannoma or thyroid carcinoma. In this report we describe the case of a patient affected by PMMS and 12 yr later by a malignant brachial plexus Schwannoma and papillary thyroid carcinoma (PTC). Since both mediastinal seminoma and Schwannoma were treated with surgery followed by local radiotherapy, we were not able to ascertain if either PTC or Schwannoma had been induced by radiotherapy or represented a casual neoplastic association.
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ranking = 4
keywords = neoplasm
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7/12. Metastatic breast cancer delayed brachial plexopathy. A brief case report.

    Metastatic involvement of brachial plexopathy is a rare condition that is often associated with advanced systemic breast cancer and the role of surgeon appears to be restricted because radio-chemotherapy is better recommended in this setting. We report a case of a 64-year-old woman that presented a very delayed breast cancer metastatic lower trunks lesions without associated radiation injury, treated by surgery. MRI of plexus and CT of chest and axilla are methods of choice in preoperative radiological evaluation. Neurosurgeon effort is restricted to provide pathologic diagnosis (confirm of metastasis), adequate pain control and improvement of neurological function. So that surgical exploration and neurolysis should be performed as soon as possible after appearance of neurological deficits before denervation signs occurs. General surgeon presence should be warranted for more radical removal of remain lymph nodes and metastatic nodal infiltration of adjacent anatomical structures (vessels and so on) when detected by preoperative radiological work-up.
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ranking = 6.3095532217871
keywords = cancer
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8/12. Amyloidoma of the brachial plexus.

    BACKGROUND: Amyloidomas of the peripheral nervous system are rare lesions. Most commonly, they involve the gasserian ganglion and the branches of the fifth cranial nerve. No association with systemic amyloidosis has been reported. CASE DESCRIPTION: We describe an amyloidoma of the lower trunk of the right brachial plexus. At the age of 34 years, this 71-year-old female had undergone radical right mastectomy for breast cancer with axillary lymph node dissection followed by radiotherapy. On admission, she presented with burning pain to the right hand and mild motor deficit to the ulnar-innervated intrinsic hand muscles. A palpable lesion was found in the supraclavicular region. On surgical inspection, the lesion appeared to originate from the lower trunk of the right brachial plexus. The middle and upper trunks were dislocated. Histologically, fibrous connective tissue embedded small nerve bundles featuring perineurial and endoneurial fibrosis as well as amyloid. Amyloid featured immunoreactivity for both lambda and kappa chains. DISCUSSION: Localized amyloidoma of brachial plexus has never been reported. Because of compressive rather than infiltrative growth of the present lesion, a conservative surgery was achieved. Our immunohistochemical findings indicated that peripheral nerve amyloidomas are not, by definition, monoclonal in nature.
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ranking = 1.0515922036312
keywords = cancer
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9/12. radiation-induced conduction block: resolution following anticoagulant therapy.

    Neurophysiologic studies documented proximal conduction blocks in a patient harboring a delayed radiation-induced brachial plexopathy. Since anticoagulants have been reported to be beneficial in radiation-induced neuropathies, the patient was started on acenocumarol. After 3 months of treatment there was significant improvement of clinical deficits, which correlated with resolution of conduction blocks. This observation suggests that ischemic nerve injury leading to disruption of the conduction properties of motor axons contributes to the pathogenesis of delayed radiation-induced peripheral nerve injuries.
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ranking = 2238.497752759
keywords = radiation-induced
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10/12. Levetiracetam as an adjunctive analgesic in neoplastic plexopathies: case series and commentary.

    Certain types of pain associated with cancer may be difficult to treat with standard therapies, often resulting in intractable pain and suffering for the patient. The use of an opioid as analgesic monotherapy can lead to poorly controlled pain as well as multiple side effects. Non-opioid adjunctive analgesics, such as antidepressants and antiepileptic drugs (AEDs) often improve both pain control, and side effect prevalence. Levetiracetam is an AED with unique mechanisms of action that may have analgesic properties in various pain syndromes. Seven patients with neoplasms involving neural structures (four invading the brachial plexus, and three the lumbosacral plexus) had severe pain of 8 to 9 out of 10 on a visual analog scale (VAS), despite the use of parenteral opioids and various adjunctive therapies. These patients were treated with oral levetiracetam titrated over days to two weeks, depending on the location of pain, drug response, and tolerance to tapering of opioid analgesics. Opioid and adjunctive analgesic use and VAS scores were recorded periodically. The maximum levetiracetam dose ranged from 500 mg to 1500 mg BID. All patients experienced pain control improvement after the addition of levetiracetam, with VAS scores decreasing from 8-9 out of 10 to 0-3 out of 10 within two to 14 days of therapy initiation. overall opioid use decreased by at least an estimated 70%, without drug related adverse events. In this small series of patients, levetiracetam effectively and safely improved pain relief in patients with neoplastic plexopathies previously resistant to standard analgesic approaches.
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ranking = 2.0515922036312
keywords = cancer, neoplasm
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