D'Amore A, Conte G, Viglianesi A, Chiaramonte R, Pero G, Chiaramonte I
Department of Neurosciences, University of Catania; Catania, Italy -
Neuroradiol J. 2010 Jun;23(3):325-8. doi: 10.1177/197140091002300312. Epub 2010 Jun 30.
Klumpke's palsy is a rare form of paralysis involving the muscles of the forearm and hand, resulting from a brachial plexus injury in which the eighth cervical (C8) and first thoracic (Th1) nerves are injured either before or after they have joined to form the lower trunk. We report a case of a 45 years-old woman with post-traumatic left cervical-brachial pain afflicted by obstetric brachial plexus palsy on the right side. Magnetic Resonance Imaging (MRI) examination of the cervical spine revealed a meningeal stretch in the left side at C7-Th1 level, responsible for pain, and also multiple intraforaminal pseudomeningoceles at C5-C6, C6-C7 and C7-Th1 intersomatic spaces in the right side, due to the perinatal trauma that had determined the obstetric brachial plexus palsy. Spinal pseudomeningocele is an extradural collection of CSF in the surrounding soft tissues due to a dural breach and can represent a predictive finding of injury of the brachial plexus. We obtained clinical and electrophysiological findings of Klumpke's palsy, but MRI examination showed the lack of visualization of C8 and the integrity of Th1 nerve roots and to our knowledge there is no evidence in literature about the possibility to have a partial Klumpke's palsy without Th1 avulsion. The aim of this article was to underline that for the correct assessment of patients with brachial plexus palsy the only use of MRI is insufficient: it is necessary an integration of the information obtained from clinical, electromyographic and MRI study.
克伦佩克麻痹是一种罕见的麻痹形式，累及前臂和手部肌肉，由臂丛神经损伤引起，即第八颈神经（C8）和第一胸神经（Th1）在合并形成下干之前或之后受到损伤。我们报告一例45岁女性，右侧患有产伤性臂丛神经麻痹，伴有创伤后左颈臂疼痛。颈椎磁共振成像（MRI）检查显示，C7-Th1水平左侧有脑膜牵张，这是疼痛的原因，右侧C5-C6、C6-C7和C7-Th1椎间孔内有多个假性脑脊膜膨出，这是由导致产伤性臂丛神经麻痹的围产期创伤引起的。脊髓假性脑脊膜膨出是由于硬脑膜破裂导致脑脊液在周围软组织中的硬膜外积聚，可提示臂丛神经损伤。我们获得了克伦佩克麻痹的临床和电生理检查结果，但MRI检查显示未发现C8，Th1神经根完整，据我们所知，文献中没有证据表明存在无Th1撕脱的部分性克伦佩克麻痹。本文的目的是强调，对于臂丛神经麻痹患者的正确评估，仅使用MRI是不够的：有必要整合从临床、肌电图和MRI研究中获得的信息。
