Fink G R, Haupt W F
Klinik für Neurologie, Universität Köln.
Dtsch Med Wochenschr. 1995 Jul 7;120(27):959-62. doi: 10.1055/s-2008-1055432.
A 61-year-old man was given short-term thrombolytic treatment with streptokinase (1.5 million IU) 6 hours after the onset of anginal symptoms. Ten days later he complained of severe pain in the right upper arm and right shoulder, and also on the left 3 days later. Simultaneously there occurred severe atrophic pareses of the supra- and infraspinatus, deltoid and rhomboid muscles bilaterally, without sensory component.
When admitted to the neurological department 3 weeks later laboratory tests, immunological parameters, electrophoresis and cerebrospinal fluid were unremarkable. Radiological examinations of the cervical and thoracic vertebrae demonstrated moderate degenerative changes. Computed tomography and magnetic resonance imaging of the cervical vertebrae showed small disc protrusion and narrowing of the intervertebral foramina, but they could not explain the clinical picture. Electromyography demonstrated a bilateral peripheral neurogenic lesion without evidence of radicular distribution or any lesion of individual peripheral nerves. These findings led to the diagnosis of neuralgic amyotrophy (Parsonage-Turner syndrome).
With analgesics and physiotherapy the pareses slowly regressed over the following months.
The infusion of streptokinase was the only probable cause found to explain the neuralgic amyotrophy, a connection that has never been reported until now.
一名61岁男性在心绞痛症状发作6小时后接受了链激酶（150万国际单位）的短期溶栓治疗。10天后，他抱怨右上臂和右肩部剧痛，3天后左侧也出现疼痛。同时，双侧冈上肌、冈下肌、三角肌和菱形肌出现严重萎缩性麻痹，无感觉成分。
3周后入住神经科时，实验室检查、免疫参数、电泳和脑脊液均无异常。颈椎和胸椎的放射学检查显示有中度退行性改变。颈椎计算机断层扫描和磁共振成像显示有小的椎间盘突出和椎间孔狭窄，但无法解释临床表现。肌电图显示双侧周围神经源性病变，无神经根分布证据或任何单个周围神经病变。这些发现导致诊断为神经性肌萎缩（帕森奇-特纳综合征）。
使用镇痛药和物理治疗后，麻痹在接下来的几个月里逐渐缓解。
链激酶输注是发现的唯一可能解释神经性肌萎缩的原因，这种关联此前从未有过报道。
