Mata Robin, Eng Emma M, Alessia Christopher, Aviles Xavier, Lastra Angie
Physical Medicine and Rehabilitation, University of Miami/Jackson Memorial Hospital, Miami, USA.
Physical Medicine and Rehabilitation, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA.
Cureus. 2025 May 6;17(5):e83599. doi: 10.7759/cureus.83599. eCollection 2025 May.
Neuralgic amyotrophy (NA), or Parsonage-Turner syndrome, describes a spectrum of relatively rare peripheral neuropathies characterized by acute pain followed by patchy, multifocal sensory disturbances, weakness, and atrophy, predominantly in the upper extremity. While typically affecting the upper brachial plexus, NA can also present with selective involvement of distal nerve branches. This case report details a unique presentation of NA in a 39-year-old male bodybuilder who developed isolated weakness and atrophy of the left pectoralis major and a single head of the left triceps following a painful prodrome without preceding trauma. Electrodiagnostic studies confirmed active denervation in these muscles, while imaging revealed no cervical pathology or brachial plexus abnormalities. The patient was diagnosed with NA, specifically affecting the lateral pectoral nerve, and a branch of the radial nerve. Our case is compared to existing literature, including isolated reports of pectoralis major and branch-specific radial nerve involvement in NA. While these less common deficits have been described as separate entities, our case uniquely demonstrates them co-occurring. It highlights the potential for NA to affect less common nerves (lateral pectoral and motor branches of the radial nerve) and specific nerve branches. Differential diagnoses included mononeuritis multiplex, compressive neuropathy, and infectious or inflammatory neuropathies. Mononeuritis multiplex was less likely due to the absence of sensory deficits and systemic symptoms. Infectious and inflammatory neuropathies were ruled out based on clinical presentation and lack of relevant markers. Compressive neuropathy was considered, however the acute painful prodrome, electrodiagnostic findings, and natural history favored NA. This case contributes to understanding the variable clinical spectrum of NA. It also underscores the importance of clinical history and comprehensive work-up in atypical presentations for prompt diagnosis and effective management. While the prognosis for NA is generally favorable, the long-term outcome for highly selective presentations requires further investigation.
神经痛性肌萎缩（NA），即帕森吉 - 特纳综合征，描述了一系列相对罕见的周围神经病变，其特征为急性疼痛，随后出现片状、多灶性感觉障碍、无力和萎缩，主要累及上肢。虽然NA通常影响臂丛神经上部，但也可表现为远端神经分支的选择性受累。本病例报告详细介绍了一名39岁男性健美运动员NA的独特表现，该患者在无前驱创伤的疼痛前驱症状后，出现了左侧胸大肌和左侧三头肌单头的孤立性无力和萎缩。电诊断研究证实这些肌肉存在活动性失神经支配，而影像学检查未发现颈椎病变或臂丛神经异常。该患者被诊断为NA，具体影响胸外侧神经和桡神经的一个分支。我们的病例与现有文献进行了比较，包括NA中胸大肌和桡神经分支特异性受累的孤立报告。虽然这些不太常见的缺陷已被描述为独立的实体，但我们的病例独特地展示了它们同时出现的情况。它强调了NA影响不太常见神经（胸外侧神经和桡神经运动分支）和特定神经分支的可能性。鉴别诊断包括多发性单神经炎、压迫性神经病变以及感染性或炎性神经病变。由于没有感觉缺陷和全身症状，多发性单神经炎的可能性较小。根据临床表现和缺乏相关标志物排除了感染性和炎性神经病变。考虑过压迫性神经病变，然而急性疼痛前驱症状、电诊断结果和自然病程支持NA。本病例有助于理解NA的可变临床谱。它还强调了临床病史和全面检查在非典型表现中对于及时诊断和有效管理的重要性。虽然NA的预后通常良好，但高度选择性表现的长期结果需要进一步研究。
