Bang Mi-Hyeon, Song Ha-Lim, Hahn Seok, Kim Wanil, Do Hwan-Kwon
Department of Physical Medicine and Rehabilitation, Haeundae Paik Hospital, Inje University College of Medicine, Busan 48108, South Korea.
Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan 48108, South Korea.
World J Clin Cases. 2024 Dec 6;12(34):6728-6735. doi: 10.12998/wjcc.v12.i34.6728.
Neuralgic amyotrophy (NA) is a rare disease with sudden upper limb pain followed by affected muscle weakness. The most commonly affected area in NA is the upper part of the brachial plexus, and the paraspinal muscles are rarely affected (1.5%), making these cases difficult to distinguish from cervical radiculopathy.
A 76-year-old male presented to the emergency department with left hip pain post-fall. After undergoing left femoral neck fracture surgery, he experienced sudden left shoulder pain for 10 days with subsequent left arm weakness. Cervical spine computed tomography revealed mild right asymmetric intervertebral disc bulging with a decreased C5-6disc space. Three weeks later, an electrodiagnostic study confirmed brachial plexopathy findings involving the cervical root. Magnetic resonance neurography was performed for a differential diagnosis. Contrast enhancement was identified at the upper trunk of the brachial plexus, including the C5 nerve root. A suprascapular nerve hourglass-like focal constriction (HLFC) was also identified, confirming NA. After being diagnosed with NA, the patient received 15 mg prednisolone, twice daily, for 3 weeks. Physical therapy was initiated, including left arm strengthening exercises and electrical stimulation therapy. Left shoulder muscle strength significantly improved one month after comprehensive rehabilitation.
NA's unique features like HLFC and paraspinal involvement are crucial for accurate diagnosis, avoiding confusion with cervical radiculopathy.
神经性肌萎缩（NA）是一种罕见疾病，表现为上肢突发疼痛，随后出现受累肌肉无力。NA最常受累的部位是臂丛神经上部，椎旁肌很少受累（1.5%），这使得这些病例难以与神经根型颈椎病相鉴别。
一名76岁男性因跌倒后左髋部疼痛就诊于急诊科。在接受左股骨颈骨折手术后，他突发左肩疼痛10天，随后出现左臂无力。颈椎计算机断层扫描显示右侧轻度不对称椎间盘膨出，C5 - 6椎间盘间隙变窄。三周后，电诊断研究证实为涉及颈神经根的臂丛神经病变。进行了磁共振神经造影以进行鉴别诊断。在臂丛神经上干，包括C5神经根处发现了对比增强。还发现了肩胛上神经沙漏样局灶性狭窄（HLFC），确诊为NA。确诊NA后，患者接受泼尼松龙15毫克，每日两次，共3周。开始进行物理治疗，包括左臂强化锻炼和电刺激治疗。综合康复治疗1个月后，左肩肌肉力量明显改善。
NA的独特特征如HLFC和椎旁受累对于准确诊断至关重要，可避免与神经根型颈椎病混淆。
