Usability of Magnetic Resonance Neurography for Diagnosis of Neuralgic Amyotrophy in Acute Stage

Jin-Seo Yang; Yong-Jun Cho; Dong-Kun Yu; Dong-Hwa Heo; Seung-Hoon Sheen; Gyojun Hwang; Se-Hyuck Park

doi:10.13004/jknts.2010.6.2.106

Journal List > J Korean Neurotraumatol Soc > v.6(2) > 1097517

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Yang, Cho, Yu, Heo, Sheen, Hwang, and Park: Usability of Magnetic Resonance Neurography for Diagnosis of Neuralgic Amyotrophy in Acute Stage

Clinical Article

Journal of Korean Neurotraumatology Society 2010; 6(2): 106-109.

Published online: 31 December 2010

DOI: https://doi.org/10.13004/jknts.2010.6.2.106

Usability of Magnetic Resonance Neurography for Diagnosis of Neuralgic Amyotrophy in Acute Stage

Jin-Seo Yang, MD, Yong-Jun Cho, MD, Dong-Kun Yu, MD, Dong-Hwa Heo, MD, Seung-Hoon Sheen, MD, Gyojun Hwang, MD, Se-Hyuck Park

Department of Neurosurgery, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon, Korea.

Address for correspondence: Yong-Jun Cho, MD. Department of Neurosurgery, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, 153 Gyo-dong, Chuncheon 200-704, Korea. Tel: +82-33-240-5173, Fax: +82-33-242-9970, nssur771@hallym.or.kr

Received 15 August 2010 Revised 18 August 2010 Accepted 15 September 2010

Abstract

Objective

Neuralgic amyotrophy (NA) is a distinct clinical syndrome of unknown etiology involving the brachial plexus, which is characterized by the acute onset of shoulder and arm pain followed by weakness, and sensory loss. Diagnosis with neurophysiologic studies and a conventional MRI of brachial plexus is very difficult in acute stage. The magnetic resonance neurography (MRN) is considered to be more sensitive than MRI for the peripheral neuropathies. The objective of this study is to describe the MRN findings and its usability for patients with neuralgic amyotrophy in acute stage.

Methods

The authors have treated 10 patients with NA between 2006 and 2009. All the patients had clinical and neurophysiologic evidence of acute brachial plexopathy without a definable cause. Recently, three patients were evaluated in acute stage using a MRN with a 1.5-T scanner and had positive findings for NA. Imaging sequences for brachial plexus included axial, sagittal, and coronal conventional spin echo sequences, and gadolinium was administered for axial and coronal images, employing short tau inversion recovery sequences.

Results

All patients were checked the brachial plexus MRN within 3 weeks after onset. In conventional MRI, the authors did not find any evidences of plexopathy, mass lesion, muscle atrophy or rotator cuff tear. However, brachial plexus MRN of all the patients showed thickened and hyperintense trunks of the brachial plexus in lesion site consistent with plexitis.

Conclusion

MRN is the most specific diagnostic modality especially in acute stage of NA. It can help early diagnosis and prevent unnecessary studies.

Keywords: Neuralgic amyotrophy, Brachial plexus, Diagnosis, Magnetic resonance imaging

Figures and Tables

FIGURE 1

These pictures of No. 1 patient show weakness of deltoid and biceps in the right side and normal motor function of palmar interossei.

FIGURE 2

Short tau inversion recovery image of the magnetic resonance neurography of patient No. 3 shows a diffuse thickening and increased signal intensity in the right lower trunk of the brachial plexus (white arrow).

TABLE 1

Clinical manifestations

No.: number, SP: shoulder pain, SW: shoulder weakness, Gr: grade, E: extensor

TABLE 2

Neurophysiologic findings

no.: number, NCS: nerve conduction study, CMAP: compound muscle action potential, SNAP: sensory nerve action potential, UTP: upper trunk plexopathy, LTP: lower trunk plexopathy

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