Abstract:IntroductionHepatitis E virus (HEV) represents the main cause of enterically transmitted hepatitis worldwide. It is known that neuralgic amyotrophy (NA) is one of the most frequent neurological manifestations of HEV. However, clinical, electrodiagnostic (EDX) and MRI characteristics, as well as long-term follow-up of HEV-related NA have not been fully described yet.Case reportsWe describe longitudinally clinical, EDX, biological and MRI results of six cases of HEV-associated NA, diagnosed from 2012 to 2017. Pa… Show more
“…In addition, the lumbosacral plexus and the anterior and posterior interosseous, cranial, and phrenic nerves are peripheral nerves that are frequently involved. [6][7][8][9][10] Approximately 70% to 80% of patients manifest sensory deficits during episodes of NA; however, these deficits are usually mild compared with the degree of weakness. 14 Hyperesthesia and/or paresthesia are the most common sensory symptoms of NA, and hypoesthesia can also occur.…”
Section: Clinical Presentationmentioning
confidence: 99%
“…However, gadolinium-enhanced MRI can be helpful for the diagnosis of NA because inflammatory sites in the involved nerves show high signal intensity. 7,33 Before confirming a diagnosis of NA, MRI of the spine and ultrasound or MRI of the shoulder should be performed to rule out radiculopathy caused by a herniated disc or spinal stenosis and rotator cuff tear, respectively. 13 In addition, high-resolution magnetic resonance neurography is helpful for the diagnosis of hourglass-like constriction neuropathy (a subtype of NA).…”
Section: Diagnostic Investigationsmentioning
confidence: 99%
“…In addition, the lumbosacral plexus and the anterior and posterior interosseous, cranial, and phrenic nerves are peripheral nerves that are frequently involved. 6–10…”
Section: Clinical Presentationmentioning
confidence: 99%
“…[2][3][4][5] Although NA affects the brachial plexus, this disorder also affects various other peripheral nerves, such as the suprascapular, long thoracic, phrenic, anterior interosseous, and radial nerves. [6][7][8][9][10] In many studies, NA has been described as a rare disorder. However, recent reports suggest that NA is significantly underdiagnosed in clinical practice and has an actual incidence rate of about 1 in 1000 per year.…”
Section: Introductionmentioning
confidence: 99%
“…2–5 Although NA affects the brachial plexus, this disorder also affects various other peripheral nerves, such as the suprascapular, long thoracic, phrenic, anterior interosseous, and radial nerves. 6–10…”
Neuralgic amyotrophy (NA) is markedly underdiagnosed in clinical practice, and its actual incidence rate is about 1 per 1000 per year. In the current article, we provide an overview of essential information about NA, including the etiology, clinical manifestations, diagnostic investigations, differential diagnosis, treatment, and prognosis. The causes of NA are multifactorial and include immunological, mechanical, or genetic factors. Typical clinical findings are a sudden onset of pain in the shoulder region, followed by patchy flaccid paralysis of muscles in the shoulder and/or arm. A diagnosis of NA is based on a patient’s clinical history and physical examination. Gadolinium-enhanced magnetic resonance imaging and high-resolution magnetic resonance neurography are useful for confirming the diagnosis and choosing the appropriate treatment. However, before a diagnosis of NA is confirmed, other disorders with similar symptoms, such as cervical radiculopathy or rotator cuff tear, need to be ruled out. The prognosis of NA depends on the degree of axonal damage. In conclusion, many patients with motor weakness and pain are encountered in clinical practice, and some of these patients will exhibit NA. It is important that clinicians understand the key features of this disorder to avoid misdiagnosis.
“…In addition, the lumbosacral plexus and the anterior and posterior interosseous, cranial, and phrenic nerves are peripheral nerves that are frequently involved. [6][7][8][9][10] Approximately 70% to 80% of patients manifest sensory deficits during episodes of NA; however, these deficits are usually mild compared with the degree of weakness. 14 Hyperesthesia and/or paresthesia are the most common sensory symptoms of NA, and hypoesthesia can also occur.…”
Section: Clinical Presentationmentioning
confidence: 99%
“…However, gadolinium-enhanced MRI can be helpful for the diagnosis of NA because inflammatory sites in the involved nerves show high signal intensity. 7,33 Before confirming a diagnosis of NA, MRI of the spine and ultrasound or MRI of the shoulder should be performed to rule out radiculopathy caused by a herniated disc or spinal stenosis and rotator cuff tear, respectively. 13 In addition, high-resolution magnetic resonance neurography is helpful for the diagnosis of hourglass-like constriction neuropathy (a subtype of NA).…”
Section: Diagnostic Investigationsmentioning
confidence: 99%
“…In addition, the lumbosacral plexus and the anterior and posterior interosseous, cranial, and phrenic nerves are peripheral nerves that are frequently involved. 6–10…”
Section: Clinical Presentationmentioning
confidence: 99%
“…[2][3][4][5] Although NA affects the brachial plexus, this disorder also affects various other peripheral nerves, such as the suprascapular, long thoracic, phrenic, anterior interosseous, and radial nerves. [6][7][8][9][10] In many studies, NA has been described as a rare disorder. However, recent reports suggest that NA is significantly underdiagnosed in clinical practice and has an actual incidence rate of about 1 in 1000 per year.…”
Section: Introductionmentioning
confidence: 99%
“…2–5 Although NA affects the brachial plexus, this disorder also affects various other peripheral nerves, such as the suprascapular, long thoracic, phrenic, anterior interosseous, and radial nerves. 6–10…”
Neuralgic amyotrophy (NA) is markedly underdiagnosed in clinical practice, and its actual incidence rate is about 1 per 1000 per year. In the current article, we provide an overview of essential information about NA, including the etiology, clinical manifestations, diagnostic investigations, differential diagnosis, treatment, and prognosis. The causes of NA are multifactorial and include immunological, mechanical, or genetic factors. Typical clinical findings are a sudden onset of pain in the shoulder region, followed by patchy flaccid paralysis of muscles in the shoulder and/or arm. A diagnosis of NA is based on a patient’s clinical history and physical examination. Gadolinium-enhanced magnetic resonance imaging and high-resolution magnetic resonance neurography are useful for confirming the diagnosis and choosing the appropriate treatment. However, before a diagnosis of NA is confirmed, other disorders with similar symptoms, such as cervical radiculopathy or rotator cuff tear, need to be ruled out. The prognosis of NA depends on the degree of axonal damage. In conclusion, many patients with motor weakness and pain are encountered in clinical practice, and some of these patients will exhibit NA. It is important that clinicians understand the key features of this disorder to avoid misdiagnosis.
Introduction The causes of diaphragmatic paresis are manifold. An association between neuralgic amyotrophy (NA) and hepatitis E virus (HEV) infection has been reported. We wondered about the prevalence of diaphragmatic disfunction and hepatitis E infection in our clinic.
Methods From July 1st, 2020 to August 31st, 2023, patients presenting with diaphragmatic dysfunction and simultaneous clinical symptoms of an acute NA, or a history of NA, as well as patients with previously unexplained diaphragmatic dysfunction were examined for HEV infection.
Results By August 31st, 2023, 13 patients with diaphragmatic dysfunction and HEV infection were diagnosed (4 women, 9 men). Mean age was 59 ± 10 years. Liver values were normal in all patients. The median latency to diagnosis was five months (range: 1–48 months); nine patients, 4 of them with typical symptoms of NA, presented with acute onset three patients showed bilateral diaphragmatic dysfunction. All patients had a positive IgG immunoblot. Seven patients, three with NA, had an elevated hepatitis E IgM titer and six of them also a positive IgM immunoblot. In all cases, O2C hepatitis genotype 3 was identified. In eight cases, all those with a high IgG titer >125, the O2 genotype 1 was also detected.
Conclusion NA that shows involvement of the phrenic nerve resulting in diaphragmatic dysfunction and dyspnoea, may be associated with HEV infection. The observation of 13 patients with diaphragmatic dysfunctions and HEV infection within a period of three years indicates a high number of undetected HEV-associated diaphragmatic dysfunction in the population, especially in the absence of NA symptoms. Therefore, even in diaphragmatic dysfunction without NA symptoms and causative damaging event, HEV infection should be considered, as it may represent a subform of NA with only phrenic nerve involvement. Therapy of HEV-associated diaphragmatic dysfunction in the acute phase is an open question. In view of the poor prognosis for recovery, antiviral therapy should be discussed. However, no relevant data are currently available.
Objectives The exact etiology of Parsonage–Turner syndrome is unknown, but it is known to be preceded by infection, vaccination, or surgical intervention. In this review, we describe associations of Parsonage–Turner syndrome with COVID-19 infection and vaccination. Methods A systematic literature search was conducted using PubMed/MEDLINE, ScienceDirect, and Google Scholar. Microsoft Excel was used for data extraction and statistical analysis. The quality of case reports and case series was assessed using the Joanna Briggs Institute Critical Appraisal Tool. Results We selected 44 case reports and 10 case series, including 68 patients (32 post-vaccination and 36 with post-COVID-19 infection Parsonage–Turner syndrome). Middle-aged males were predominantly affected in both groups. The most frequently administered vaccine was Comirnaty (Pfizer) (53%). The mean latency was 11.7 days in the post-vaccination group and 20.3 days in the post-infection group. The most affected nerves in both groups were the axillary, suprascapular, and musculocutaneous nerves; and 78.1% and 38.9% of patients showed partial amelioration of their symptoms in the post-vaccination and post-infection groups, respectively. Conclusion Post-vaccination Parsonage–Turner syndrome presents earlier than post-infection disease. Pain and sensorimotor deficits of the upper limb are common in both situations. Complete or partial recovery occurs in most cases.
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