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Spinal Cord Disease
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Classes of disease that can mimic syringomyelia: Inflammatory myelopathy.Chronic infectious myelopathy.Heredodegenerative myelopathies (hereditary spastic paraparesis [HSP], ALS, etc.).With predominantly LMN findings: Radiculopathy.Brachial plexopathy.Motor neuron disease (MND).
Pathogenesis of normal tissue side effects
Published in Michael C. Joiner, Albert J. van der Kogel, Basic Clinical Radiobiology, 2018
The brachial plexus is often included in treatments of the axillary and supraclavicular nodes in breast cancer patients. Clinically, plexopathy is characterized by mixed sensory and motor deficits, developing after a latent period ranging from 6 months to several years. The pathogenesis involves progressive vascular degeneration, fibrosis and demyelination with loss of nerve fibres.
Cancer Rehabilitation
Published in K. Rao Poduri, Geriatric Rehabilitation, 2017
Susan Maltser, B. Allyn Behling-Rosa
Brachial plexopathy has also been commonly associated with breast cancer treatment, as well as has been induced by radiation treatments for other malignancies occurring in proximity to the brachial plexus.126 Radiation plexopathy presents with upper extremity weakness without pain, originating within the upper trunk of the brachial plexus. Lymphedema is often secondary in onset, with most patients developing these symptoms within 3 years of radiotherapy, although later presentations may occur.127 Physical examination will initially reveal shoulder girdle weakness and then subsequent involvement of the entire arm as the disorder progresses.128 Management of radiation-induced brachial plexopathy is largely supportive. Pain should be controlled, and weakness mediated with bracing.129 Neoplastic brachial plexopathy presents with sensory loss and pain that originates in the lower trunk and progresses to the entire plexus. The presence and severity of the pain help distinguish this particular condition from radiation-induced plexopathy.116 MRI and electrodiagnostic studies may also help differentiate between neoplastic and radiation-induced plexopathy. For instance, myokymic discharges on electromyography are suggestive of radiation plexopathy, though its presence does not rule out tumor recurrence.130 Neoplastic brachial plexopathy is best managed by treating the underlying malignancy with radiation and chemotherapy.116
Diabetic lumbosacral plexopathy: an unpredictable clinical entity
Published in Disability and Rehabilitation, 2023
Muhammad Faraz Jeddi, Roger Zebaze, Isabelle Urbano, Sarah Skinner, Vinamra Jain, Marc Budge
Persistence or worsening of symptoms such as pain, fatigue, and loss of function with inability to perform activities of daily living in a patient with diabetes should raise the possibility of plexopathy. Lack of early recognition of this condition can have serious consequences. The loss of function in this case resulted in falls which combined with weakness and paralysis likely contributed to the deep vein thrombosis leading to the massive, life-threatening saddle PE. To the best of our knowledge, thromboembolisms, especially complicated with severe thromboembolic events such as saddle PE have never been reported in the setting of diabetic plexopathy. The pathogenesis is likely multifactorial. Stasis due to reduced mobility, vessel wall injury as may occur with recurrent falls, are two elements of Virchow’s triad likely to have contributed to embolism in this patient. Screening for antiphospholipid syndrome (APS) showed an isolated elevation of Lupus anticoagulant (about three times the normal) raising the possibility of a type IIa APS as a contributor to thromboembolic events in this patient. The clinical presentation of this patient including lymphocytosis suggests that an infective process, in particular an acute viral infection, may have triggered the plexopathy. Infection with an inflammatory process associated with micro-vasculitis is risk factors for DLSP [12].
Two-year toxicity of hypofractionated breast cancer radiotherapy in five fractions
Published in Acta Oncologica, 2020
Hans Van Hulle, Vincent Vakaet, Kathleen Deckmyn, Chris Monten, Leen Paelinck, Annick Van Greveling, Giselle Post, Max Schoepen, Arthur Fonteyne, Bruno Speleers, Pieter Deseyne, Marc Mareel, Wilfried De Neve, Liv Veldeman
About one-third of patients received LNI. None of the patients reported symptoms of brachial plexopathy, but longer follow-up is needed to rule out the possibility of plexopathy. In contrast to our data, the UK FAST trial observed no differences in 3-year rates of toxicity between 28.5 and 50 Gy [3]. The FAST trial only reported on moderate to marked toxicity, while we report on presence of any toxicity, including mild toxicity. This explains the higher rates of breast retraction and fibrosis in our cohort. An approach comparable to the FAST trial was not possible with our dataset due to different toxicity scoring systems. Other differences between the FAST trial and this study are the number of patients receiving a boost and patient age. In the FAST trial no boost was administered, while 90% of our patients received a boost. The mean age of the FAST group was 63 years compared to 73 years in our HF5 group. However, it was only 65 years in the HF15 group.
MR neurography of the brachial plexus in adult and pediatric age groups: evolution, recent advances, and future directions
Published in Expert Review of Medical Devices, 2020
Alexander T. Mazal, Ali Faramarzalian, Jonathan D. Samet, Kevin Gill, Jonathan Cheng, Avneesh Chhabra
The signs and symptoms of brachial plexopathies are highly variable depending on the lesion location and etiology (Table 1). Due to its anatomic complexity, accurate localization of lesions within the brachial plexus can be challenging. Furthermore, among patients with scarring or fibrosis secondary to prior surgery or irradiation to the axilla, physical examination findings can be quite difficult to interpret. Diagnosis of brachial plexopathy is generally multi-modal, and may involve any combination of electromyography (EMG), nerve conduction studies, MR imaging, or CT myelography, in association with clinical exam findings. F wave indices using nerve conduction studies have recently shown some promise in facilitating early detection of peripheral neuropathy; however, due to the deep location of the brachial plexus, an inability to characterize regional anatomy, and challenges in differentiating radiculopathy from brachial plexopathy, this technique suffers from several limitations [10].