6.2 Options and results of neurotization of the musculocutaneous nerve in posttraumatic brachial plexus lesions of the adult (original) (raw)
Related papers
PubMed, 2011
A 41-year-old man with injury of right half of the thorax, fractures of the left crural bones and paralysis of the right upper limb was admitted to our hospital. A CT examination at admission revealed bilateral pulmonary contusion and bilateral fluid- and pneumothorax. In addition pneumomediastinum, pneumopericardium, subcutaneous emphysema and pneumorrhachis at the cervicothoracic transition was demonstrated. Abnormal findings in the skull and brain were not revealed. The fifth day after admission repeated CT examination demonstrated extensive frontal pneumocephalus on the right, presence of air in several cisterns and in the right optic nerve sheaths (pneumoopticus). Right frontal craniotomy was performed, dura mater was incised and air was evacuated. Rapid regression of pneomocephalus was evident postoperatively. The tenth day after admission MRI of the cervical spine and brachial plexus was performed. At the level of the C7 and C8, nerve roots pneumomenigocele and a nerve retracting ball indicating the presence of a nerve root injury were discernible. This case demonstrated that severe thoracic blunt trauma leads to acute increase of intrathoracic pressure with concomitant fluid- and pneumothorax, pneumomediastinum and pneumopericard. From the mediastinum air propagated subcutaneously. Disrupted cervical dural sheaths resulted in leakage of cerebrospinal fluid and entry of air from mediastinum to subdural and subarachnoid spinal and cranial space and to the subarachnoid space of the optic nerve.
Post-Traumatic Brachial Plexus Root Avulsion: A Case Report
EAS journal of radiology and imaging technology, 2023
Root avulsion corresponds to the tearing of the roots of the spinal cord by stretching during a trauma. The most incriminated etiologies are road accidents and obstetric trauma. It results clinically in total or partial paralysis of the limb concerned or neuropathic pain. MRI is the key diagnostic test. Here we report a case of post-traumatic brachial plexus root avulsion in a 61-year-old patient following a road accident. The MRI of the cervical plexus, performed one month after the trauma, revealed a pre-foraminal fluid-like lesion on the left next to the D1 conjugation hole, suggestive of a pseudomeningocele. MRI is the key diagnostic imaging tool. In fact, it establishes the lesion topography, whether pre or post-nodal, and enables the search for associated lesions.
Post-traumatic brachial plexus MRI in practice
Diagnostic and Interventional Imaging, 2013
Injuries are separated into spinal nerve root avulsions (pre-ganglionic lesions) and more distal rupture (post-ganglionic lesions). The lesions may be associated with different nerve root levels. Spinal MRI is used to diagnose pre-ganglionic lesions, which may be present in the absence of pseudomeningoceles. The other sequences described are used to diagnose post-ganglionic lesions, regardless of the type of lesion. Knowledge that a graftable C5 nerve root is present is important in the treatment strategy. Contrast enhancement in the scalene triangle does not predict the quality of the nerve root (continuous injury with response to peroperative stimulation or division of the root needing grafting). Understanding post-traumatic neuronal injuries to the brachial plexus. Knowing how to look for spinal MRI abnormalities and post-ganglionic abnormalities.
Journal of Neurosurgery: Spine, 2002
Object. The authors describe a new magnetic resonance (MR) imaging technique to demonstrate the status of the cervical nerve roots involved in brachial plexus injury. They discuss the accuracy and reproducibility of a MR imaging—derived classification for diagnosis of nerve root avulsion compared with those of myelography combined with computerized tomography (CT) myelography. Methods. The overlapping coronal—oblique slice MR imaging procedure was performed in 35 patients with traumatic brachial plexus injury and 10 healthy individuals. The results were retrospectively evaluated and classified into four major categories (normal rootlet, rootlet injuries, avulsion, and meningocele) after confirming the diagnosis by surgical exploration with or without spinal evoked potential (EP) measurements and by referring to myelography and CT myelography findings. The reliability and reproducibility of the MR imaging—based classification was prospectively assessed by eight independent observers,...
Brachial plexus injury during axillary thoracotomy
Formosan Journal of Surgery, 2012
Brachial plexus injury is a severe neurologic injury that results in functional impairment of the affected upper limb, and it can be difficult to diagnose and manage. We report a woman aged 51 years who developed brachial plexus injury of the right arm after axillary thoracotomy with removal of a mediastinal tumor. Aggressive rehabilitation was promptly neurologic instituted, and the impairment of her arm recovered completely 69 days after surgery.
Magnetic Resonance Imaging in Traumatic Brachial Plexopathy: A Guiding Light for Surgeons
2021
Background: The brachial plexus is a group of major neural structures providing sensory and motor innervations to the upper limb. The brachial plexus originates from four cervical (C5-C8) and the first thoracic root (T1). Objectives: The aim of the current study was to evaluate the role of MRI in the diagnosis and localization of traumatic brachial plexopathies and co-relate MRI findings with intraoperative findings wherever possible. Methods: A total of 40 patients with traumatic brachial plexitis underwent a dedicated MRI at our institution. Clinical and electrodiagnostic tests were done in all patients. The findings of MR imaging were correlated with surgical findings as concordant (CR), partially concordant (PC), or nonconcordant (NC). Patients who were not operated were followed over a period of six months to one year. Results: Road traffic accidents (n=32) were the most common cause of brachial plexopathy in our study. Clinical evaluation revealed sensory symptoms in 28 (70 %)...
Radiology, 2019
Background: Traumatic brachial plexus injuries affect 1% of patients involved in major trauma. MRI is the best test for traumatic brachial plexus injuries, although its ability to differentiate root avulsions (which require urgent reconstructive surgery) from other types of nerve injury remains unknown. Purpose: To evaluate the accuracy of MRI for diagnosing root avulsions in adults with traumatic brachial plexus injuries. Materials and Methods: For this systematic review, MEDLINE and Embase were searched from inception to August 20, 2018. Studies of adults with traumatic nonpenetrating unilateral brachial plexus injuries were included. The target condition was root avulsion. The index test was preoperative MRI, and the reference standard was surgical exploration. A bivariate meta-analysis was used to estimate summary sensitivities and specificities of MRI for avulsion. Results: Eleven studies of 275 adults (mean age, 27 years; 229 men) performed between 1992 and 2016 were included. Most par- ticipants had been injured in motorcycle collisions (84%). All studies were at risk of bias, and there were high applicability concerns for the index test (ie, MRI) in four studies given the lack of diagnostic criteria, inadequate descriptions of pulse sequences, and mul- tiplicity of reporting radiologists. Overall, 72% of patients with brachial plexus injuries had at least one root avulsion (interquartile range [IQR]: 53%–86%); meta-analysis of patient-level data was not performed because of sparse and heterogeneous data. With the nerve root as the unit of analysis, 583 of 918 roots were avulsed (median, 55%; IQR: 38%–71%); the mean sensitivity of MRI for root avulsion was 93% (95% confidence interval [CI]: 77%, 98%) with a mean specificity of 72% (95% CI: 42%, 90%). Conclusion: On the basis of limited data, MRI offers modest diagnostic accuracy for traumatic brachial plexus root avulsion(s), and early surgical exploration should remain as the preferred method of diagnosis.