Nakhate Vihang, McInnis Robert P, Sy Albert, Matiello Marcelo
Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.
Department of Neurology, University of California San Francisco, San Francisco, CA, USA.
Neurohospitalist. 2023 Oct;13(4):399-402. doi: 10.1177/19418744231174688. Epub 2023 May 8.
Brachial plexopathy is a common consideration in the differential diagnosis of upper extremity sensory and motor deficits, and neoplasms signify one possible etiology of brachial plexopathy. Of the neoplastic brachial plexopathies, hemangiomas involving the brachial plexus are rare. Most reported cases describe extraneural brachial plexus hemangiomas that present as a palpable, tender neck mass associated with pain and sensory disturbance, with minimal motor deficits. Here we share the case of a 48 year-old man with intraneural epithelioid hemangioma of the brachial plexus who presented with prominent motor weakness and no palpable mass. The patient presented with subacute onset of left arm pain, numbness and progressive weakness. Neurologic exam revealed lower motor neuron signs and weakness spanning multiple nerve root and peripheral nerve distributions. Dedicated brachial plexus MRI showed two mass lesions involving the cords of the brachial plexus, with corresponding FDG-avidity on PET/CT. Biopsy revealed intraneural atypical epithelioid hemangioma. After nerve transfer surgery, he had moderate improvement in left arm strength. This case serves to: emphasize the importance of both clinical localization and dedicated brachial plexus imaging in the evaluation of brachial plexopathy; introduce to the literature a new clinical presentation of brachial plexus hemangiomas; encourage consideration of neoplastic brachial plexopathy even when faced with an illness script resembling Parsonage-Turner Syndrome, to avoid delays in diagnosis and treatment.
臂丛神经病变是上肢感觉和运动功能障碍鉴别诊断中常见的考虑因素，肿瘤是臂丛神经病变的一种可能病因。在肿瘤性臂丛神经病变中，累及臂丛神经的血管瘤很罕见。大多数报道的病例描述的是神经外臂丛神经血管瘤，表现为可触及的、压痛的颈部肿块，伴有疼痛和感觉障碍，运动功能障碍轻微。在此，我们分享一例48岁男性臂丛神经内上皮样血管瘤的病例，该患者表现为明显的运动无力且无可触及的肿块。患者以亚急性起病的左臂疼痛、麻木和进行性无力为表现。神经系统检查发现下运动神经元体征以及累及多个神经根和周围神经分布区的无力。专门的臂丛神经磁共振成像显示两个肿块病变累及臂丛神经束，在正电子发射断层显像/计算机断层扫描（PET/CT）上有相应的氟代脱氧葡萄糖（FDG）摄取。活检显示为神经内非典型上皮样血管瘤。神经移植手术后，他的左臂力量有中度改善。该病例旨在：强调临床定位和专门的臂丛神经成像在臂丛神经病变评估中的重要性；向文献中介绍臂丛神经血管瘤的一种新的临床表现；即使面对类似 Parsonage-Turner 综合征的疾病情况，也鼓励考虑肿瘤性臂丛神经病变，以避免诊断和治疗的延误。
