Matsuda Nozomu, Kobayashi Shunsuke, Otani Kouji, Hasegawa Osamu, Ugawa Yoshikazu
Department of Neurology, Fukushima Medical University, Japan.
Rinsho Shinkeigaku. 2013;53(8):650-3. doi: 10.5692/clinicalneurol.53.650.
Neuralgic amyotrophy has been attributed to lesions in the brachial plexus. However, recent studies suggest mononeuropathy multiplex as an underlying pathology at least in a group of patients with neuralgic amyotrophy. We report a man who developed weakness of finger extensors following severe shoulder pain. Neurological examination revealed weakness in the muscles innervated by the left posterior interosseus nerve and the ulnar nerve. We diagnosed him with neuralgic amyotrophy based on the typical clinical course and the neurological and neurophysiological findings. A skeletal muscle MRI revealed abnormal high T2 and STIR signals in the left triceps brachialis muscle, which is innervated by a proximal branch of the radial nerve, and in the muscles innervated by the posterior interosseous and ulnar nerves. The distribution of the denervated muscles suggested that our patient had combined lesions of the peripheral nerve branches rather than the brachial plexopathy. Our report highlights the potential of MRI for detecting denervated muscles in neuralgic amyotrophy.
神经性肌萎缩被认为与臂丛神经损伤有关。然而，最近的研究表明，至少在一组神经性肌萎缩患者中，多灶性单神经病是其潜在的病理机制。我们报告了一名男性，在经历严重肩部疼痛后出现手指伸肌无力。神经学检查发现，由左骨间后神经和尺神经支配的肌肉存在无力症状。基于典型的临床病程以及神经学和神经生理学检查结果，我们诊断他患有神经性肌萎缩。骨骼肌磁共振成像显示，由桡神经近端分支支配的左肱三头肌以及由骨间后神经和尺神经支配的肌肉在T2加权像和短T1反转恢复序列成像上呈现异常高信号。失神经支配肌肉的分布情况表明，我们的患者存在周围神经分支的联合损伤，而非臂丛神经病变。我们的报告强调了磁共振成像在检测神经性肌萎缩中失神经支配肌肉方面的潜力。
