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1.
BMC Surg ; 21(1): 337, 2021 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-34488725

RESUMO

BACKGROUND: Open reduction and internal fixation (ORIF) is the preferred choice for treating clavicle fractures. The brachial plexus injury caused by ORIF of a clavicle fracture is very rare. If it is not treated in time, the function of the brachial plexus will be challenging to recover, which will eventually lead to upper limb dysfunction and seriously affect the patient's quality of life. Our team recently used ORIF to treat a patient with a clavicle fracture, who developed brachial plexus injury symptoms after surgery. CASE PRESENTATION: A 34-year-old female patient was admitted to the hospital for 13 h due to the right shoulder movement restriction after a fall. Due to the significant displacement of the fracture, we used ORIF to treat the fracture. The surgery went well. When the anaesthesia effect subsided 12 h after the operation, the patient developed right brachial plexus injury symptoms, decreased right upper limb muscle strength, dysfunction, and hypoesthesia. Symptomatic treatments, such as nourishing nerve and electrical stimulation, were given immediately. Sixty days after the operation, the patient's brachial plexus injury symptoms disappeared, and the function of the right upper limb returned to the preoperative state. CONCLUSIONS: Patients with clavicle fractures usually need to undergo a careful physical examination before surgery to determine whether symptoms of brachial plexus injury have occurred. Anaesthesia puncture requires ultrasound guidance to avoid direct damage to the brachial plexus. When the fracture end is sharp, reset should be careful to prevent nerve stump stabbed. When using an electric drill to drill holes, a depth limiter should be installed in advance to prevent the drill from damaging the subclavian nerve and blood vessels. When measuring the screw depth, the measuring instrument should be close to the bone surface and sink slowly to avoid intense hooks and damage to the brachial plexus. Try to avoid unipolar electrosurgical units to prevent heat conduction from damaging nerves, and bipolar electrocoagulation should be used instead. If symptoms of brachial plexus injury occur after surgery, initial symptomatic treatment is drugs and functional exercise, and if necessary, perform surgical exploration.


Assuntos
Plexo Braquial , Fraturas Ósseas , Procedimentos Cirúrgicos Reconstrutivos , Adulto , Clavícula/cirurgia , Feminino , Fraturas Ósseas/cirurgia , Humanos , Qualidade de Vida
2.
ACS Chem Neurosci ; 12(17): 3148-3156, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34465091

RESUMO

Artemisinin (ART), a well-known antimalarial medicine originally isolated from the plant Artemisia annua, exerts neuroprotective effects in the nervous system owing to an antioxidant effect. Here, we determined whether ART is capable of inhibiting the oxidative stress to enhance motoneuronal (MN) survival to promote motor function recovery of rats following brachial plexus root avulsion (BPRA) with reimplantation surgery. Rats following BPRA and reimplantation were subcutaneously injected with 500 µL of PBS or 16 mg/mL ART once daily for 7 days after surgery. Terzis grooming test (TGT), histochemical staining, real-time polymerase chain reaction, and Western blot were conducted to determine the recovery of motor function of the upper limb, the survival rate of MNs, the oxidative stress levels in the ventral horn of the spinal cord, the morphology of abnormal musculocutaneous nerve fibers, the remyelination of axons in musculocutaneous nerves, and the degree of bicep atrophy. ART significantly increased TGT score, improved the survival of MNs, inhibited the oxidative stress, ameliorated the abnormal morphology of fibers in the musculocutaneous nerve, promoted the remyelination of axons, and alleviated muscle atrophy. Take together, ART can improve the survival of MNs and axonal remyelination to promote the motor function recovery via inhibiting oxidative stress, suggesting that ART may represent a new approach to the therapy of spinal root avulsion.


Assuntos
Artemisininas , Plexo Braquial , Remielinização , Animais , Axônios , Regeneração Nervosa , Ratos , Recuperação de Função Fisiológica
3.
Ann Plast Surg ; 87(4): 446-450, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34559713

RESUMO

BACKGROUND: The timing of nerve recovery after nerve grafting in obstetrical brachial plexus palsy patients has not been well reported. One prior study reported a return to baseline function at 3 to 6 months postoperatively. However, there is a paucity of studies to corroborate this timing, and there have been no studies delineating the timeline to obtain clinically meaningful function. METHODS: OBPP patients with upper trunk neuromas-in-continuity who were treated with resection and sural nerve grafting at a single institution were studied. Time to return to baseline function was assessed by Active Movement Scale (AMS) scores preoperatively and postoperatively. Time to clinically meaningful function, defined as an AMS score of ≥6, was also assessed. RESULTS: Eleven patients with isolated upper trunk neuromas-in-continuity underwent excision and reversed sural nerve grafting. Three of 11 patients also underwent spinal accessory to suprascapular nerve transfers. Average age at surgery was 9.8 ± 1.9 months. One patient did not have follow-up data and was excluded. Average follow-up was 37.1 ± 16.8 months. Average return to baseline AMS score was approximately 4 to 8 months for shoulder abduction, shoulder flexion, shoulder external rotation, elbow flexion, and forearm supination. Clinically meaningful function was obtained in most patients between 9 and 15 months. The remaining patients who did not achieve clinically meaningful function had all obtained scores of 5, which reflects less than one half normal range of motion against gravity. CONCLUSIONS: Nerve recovery after surgical intervention in OBPP patients who undergo resection of an upper trunk neuroma-in-continuity and nerve grafting is more rapid than in adults but longer than previously reported in OBPP literature. This study provides an important data point in delineating the timeline of nerve recovery.


Assuntos
Neuropatias do Plexo Braquial , Plexo Braquial , Paralisia do Plexo Braquial Neonatal , Transferência de Nervo , Neuroma , Adulto , Plexo Braquial/cirurgia , Neuropatias do Plexo Braquial/cirurgia , Humanos , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Resultado do Tratamento
4.
Georgian Med News ; (316-317): 30-35, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34511440

RESUMO

Posttraumatic brachial plexopathy - is an actual problem, which is usually seen after shoulder area trauma and is often accompanied with intraarticular pathology. In case of failed conservative treatment, open brachial plexus decompression is an effective procedure, however, it is pretty traumatic and is accompanied by number of complications and recurrences, what explains the necessity of development of low-traumatic, miniinvasive alternative techniques. Purpose - develop a new mini-invasive endoscopic technique of brachial plexus decompression. The new technique of fully endoscopic brachial plexus decompression was developed and presented in a 60-years old male patient with posttraumatic plexopathy and rotator cuff tear. Short-term clinical results were followed-up. The patient had a severe neuropathic pain syndrome in shoulder area before the surgery, there were neurologic impairments in upper extremity. The aspects of surgical technique are represented step-by-step. According to VAS scale the severity of pain syndrome in the patient before the surgery was 9 points, 6 months after surgery decreased to 2 points. Patient underlines the regression of neurologic problems, increasing of strength in the hand. The preliminary results do let us characterize the developed technique of endoscopic brachial plexus decompression as a low-traumatic and effective alternative to open decompression, which eliminates pain syndrome and promotes early restoration of normal function of arm in patients with post-traumatic brachial plexus pathology, and which can be easily combined with intra-articular pathology treatment - rotator cuff rupture suturing.


Assuntos
Plexo Braquial , Lesões do Manguito Rotador , Plexo Braquial/cirurgia , Descompressão , Endoscopia , Humanos , Masculino , Pessoa de Meia-Idade , Manguito Rotador , Lesões do Manguito Rotador/complicações , Lesões do Manguito Rotador/cirurgia
5.
BMJ Case Rep ; 14(9)2021 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-34518178

RESUMO

The late-onset variant of radiation-induced brachial plexopathy is most often seen after treatment for breast or lung cancers. It has an insidious onset, with symptoms noted years after receiving radiotherapy, and the condition gradually continues to deteriorate with time. We present the case of an elderly man who we saw in view of worsening paraesthesias and weakness of his left arm with associated prominent muscle wasting along the left shoulder girdle. Fifteen years prior to this, he had received radiotherapy for the treatment of nasopharyngeal carcinoma.


Assuntos
Neuropatias do Plexo Braquial , Plexo Braquial , Neoplasias Pulmonares , Neoplasias Nasofaríngeas , Lesões por Radiação , Idoso , Neuropatias do Plexo Braquial/etiologia , Humanos , Neoplasias Pulmonares/radioterapia , Masculino
6.
Br J Hosp Med (Lond) ; 82(8): 1-10, 2021 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-34431339

RESUMO

The upper limb consists of four major parts: a girdle formed by the clavicle and scapula, the arm, the forearm and the hand. Peripheral nerve lesions of the upper limb are divided into lesions of the brachial plexus or the nerves arising from it. Lesions of the nerves arising from the brachial plexus are further divided into upper (proximal) or lower (distal) lesions based on their location. Peripheral nerves in the forearm can be compressed in various locations and by a wide range of pathologies. A thorough understanding of the anatomy and clinical presentations of these compression neuropathies can lead to prompt diagnosis and management, preventing possible permanent damage. This article discusses the aetiology, anatomy, clinical presentation and surgical management of compressive neuropathies of the upper limb.


Assuntos
Neuropatias do Plexo Braquial , Plexo Braquial , Neuropatias do Plexo Braquial/diagnóstico , Neuropatias do Plexo Braquial/etiologia , Neuropatias do Plexo Braquial/terapia , Antebraço , Mãos , Humanos , Extremidade Superior
9.
Pain Med ; 22(Suppl 1): S2-S8, 2021 07 25.
Artigo em Inglês | MEDLINE | ID: mdl-34308959

RESUMO

Shoulder pain is prevalent, burdensome, and functionally limiting, with diverse pathology and associated treatments. This narrative review provides a summary of relevant neuroanatomy, proposed ablation targets, safety and efficacy concerns for ablation targets, and current research gaps. Radiofrequency ablation (RFA) of peripheral sensory nerves is a well-established treatment for chronic joint and spine pain, but it is relatively nascent for shoulder pain. Cadaveric studies demonstrate the shoulder joint is innervated by articular branches of the suprascapular nerve, axillary nerve, lateral pectoral nerve, and upper and lower subscapular nerves. Shoulder articular branch RFA appears to be a safe and effective treatment for chronic shoulder pain, but there are currently no widely accepted protocols for ablation targets. There are also no randomized controlled trials (RCT) assessing safety and efficacy of proposed targets or the prognostic value of articular blocks. Future research studies should prioritize categorical data, use appropriate functional measures as primary endpoints, and would ideally include a large-scale RCT.


Assuntos
Plexo Braquial , Bloqueio Nervoso , Articulação do Ombro , Humanos , Ombro/cirurgia , Dor de Ombro/cirurgia
10.
Childs Nerv Syst ; 37(9): 2865-2871, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34196747

RESUMO

PURPOSE: This study aimed to investigate the gross motor functions including head control, midline crossing, and rolling, and the relationship between these developmental skills and upper extremity skill quality in children with neonatal brachial plexus palsy (NBPP). METHODS: A total of 106 children with NBPP, aged 10-18 months, were included in this study. Injury severity was determined with the Narakas Classification. The gross motor function measurement lying and rolling sub-scale was used to evaluate gross motor functions including head control, midline crossing, and rolling, while the Quality of Upper Extremity Skills Test was applied to assess the upper extremity skill quality. The assessments were performed only once during routine physiotherapy controls. RESULTS: As the severity of injury increased, developmental skill capacity decreased and upper extremity skill quality deteriorated (ps = 0.0001). There was a strong positive correlation between these developmental skills and upper extremity skill quality (ps = 0.0001). CONCLUSION: Developmental skills are affected by NBPP. Rehabilitation programs aimed at increasing the quality of upper extremity skills should be included in neurodevelopmental treatment approaches.


Assuntos
Neuropatias do Plexo Braquial , Plexo Braquial , Paralisia do Plexo Braquial Neonatal , Criança , Humanos , Recém-Nascido , Paralisia , Extremidade Superior
11.
BMJ Open ; 11(7): e044797, 2021 07 30.
Artigo em Inglês | MEDLINE | ID: mdl-34330851

RESUMO

OBJECTIVE: To identify what outcomes have been assessed in traumatic brachial plexus injury (TBPI) research to inform the development of a core outcome set for TBPI. DESIGN: Systematic review. METHOD: Medline (OVID), EMBASE, CINAHL and AMED were systematically searched for studies evaluating the clinical effectiveness of interventions in adult TBPIs from January 2013 to September 2018 updated in May 2021. Two authors independently screened papers. Outcome reporting bias was assessed. All outcomes were extracted verbatim from studies. Patient-reported outcomes or performance outcome measures were extracted directly from the instrument. Variation in outcome reporting was determined by assessing the number of unique outcomes reported across all included studies. Outcomes were categorised into domains using a prespecified taxonomy. RESULTS: Verbatim outcomes (n=1491) were extracted from 138 studies including 32 questionnaires. Unique outcomes (n=157) were structured into 4 core areas and 11 domains. Outcomes within the musculoskeletal domain were measured in 86% of studies, physical functioning in 25%, emotional functioning in 25% and adverse events in 33%. We identified 63 different methods for measuring muscle strength, 16 studies for range of movement and 63 studies did not define how they measured movement. More than two-thirds of the outcomes were incompletely reported in prospective studies. CONCLUSION: This review of outcome reporting in TBPI research demonstrated an impairment focus and heterogeneity. A core outcome set would ensure standardised and relevant outcomes are reported to facilitate future systematic review and meta-analysis. PROSPERO REGISTRATION NUMBER: CRD42018109843.


Assuntos
Plexo Braquial , Adulto , Humanos , Força Muscular , Avaliação de Resultados em Cuidados de Saúde , Estudos Prospectivos , Resultado do Tratamento
13.
J Pediatr Orthop ; 41(6): 374-378, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34096554

RESUMO

INTRODUCTION: The transfer of intraplexal and extraplexal nerves for restoration of function in children with traumatic and birth brachial plexus palsies has become well accepted. Little has been written about using the long thoracic nerve (LTN) as a donor in reanimation of the upper extremity. The authors present a case series of nerve transfers using the LTN as a donor in brachial plexus injury. METHODS: A retrospective chart review was performed over a 10-year period at a single institution. The primary outcome measure was the active movement scale. RESULTS: Fourteen patients were included in the study: 10 birth injury patients and 4 blunt trauma patients. Average follow-up time was 21.3 and 10.75 months, respectively. The best outcomes were seen when the LTN was used for reinnervation of the obturator nerve in free functioning muscle transfers. The next most successful recipients were the musculocutaneous and axillary nerves. Outcomes were poor in transfers to the posterior interosseous fascicles of the radial nerve and the radial nerve branches to the triceps. DISCUSSION: The LTN may be a potential nerve donor for musculocutaneous or axillary nerve reinnervation in patients with brachial plexus injuries when other donors are not available during a primary plexus reconstruction. However, the best use may be for delayed neurotization of a free functioning muscle transfer after the initial plexus reconstruction has failed and no other donors are available. LEVEL OF EVIDENCE: Level IV-therapeutic study.


Assuntos
Traumatismos do Nascimento/complicações , Neuropatias do Plexo Braquial/cirurgia , Plexo Braquial/cirurgia , Transferência de Nervo , Ferimentos não Penetrantes/complicações , Adolescente , Plexo Braquial/lesões , Neuropatias do Plexo Braquial/etiologia , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Masculino , Movimento , Nervo Musculocutâneo/lesões , Nervo Musculocutâneo/cirurgia , Nervo Obturador/lesões , Nervo Obturador/cirurgia , Nervo Radial/lesões , Nervo Radial/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Extremidade Superior/lesões , Adulto Jovem
15.
Molecules ; 26(9)2021 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-34064330

RESUMO

Several genetic studies have identified a rare variant of triggering receptor expressed on myeloid cells 2 (TREM2) as a risk factor for Alzheimer's disease (AD). However, findings on the effects of TREM2 on Aß deposition are quite inconsistent in animal studies, requiring further investigation. In this study, we investigated whether elevation of TREM2 mitigates Aß pathology in TgCRND8 mice. We found that peripheral nerve injury resulted in a robust elevation of TREM2 exclusively in reactive microglia in the ipsilateral spinal cord of aged TgCRND8 mice at the age of 20 months. TREM2 expression appeared on day 1 post-injury and the upregulation was maintained for at least 28 days. Compared to the contralateral side, neither amyloid beta plaque load nor soluble Aß40 and Aß42 levels were attenuated upon TREM2 induction. We further showed direct evidence that TREM2 elevation in reactive microglia did not affect amyloid-ß pathology in plaque-bearing TgCRND8 mice by applying anti-TREM2 neutralizing antibody to selectively block TREM2. Our results question the ability of TREM2 to ameliorate established Aß pathology, discouraging future development of disease-modifying pharmacological treatments targeting TREM2 in the late stage of AD.


Assuntos
Doença de Alzheimer/metabolismo , Doença de Alzheimer/patologia , Peptídeos beta-Amiloides/metabolismo , Glicoproteínas de Membrana/metabolismo , Microglia/metabolismo , Microglia/patologia , Receptores Imunológicos/metabolismo , Envelhecimento/patologia , Animais , Plexo Braquial , Proteínas de Ligação ao Cálcio/metabolismo , Modelos Animais de Doenças , Masculino , Camundongos Transgênicos , Proteínas dos Microfilamentos/metabolismo , Nervos Periféricos/patologia , Medula Espinal/metabolismo , Medula Espinal/patologia , Corno Dorsal da Medula Espinal/patologia
16.
J Hand Surg Am ; 46(7): 575-583, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34020842

RESUMO

PURPOSE: Hand function outcomes of primary nerve reconstruction for total brachial plexus birth injury (BPBI) are confounded by nerve roots left in continuity, inclusion of secondary procedures, and no assessment of the ability to perform activities of daily living. The purpose of this study was to evaluate the long-term hand function outcomes in a cohort of patients with a complete BPBI who had no nerve root in continuity prior to primary nerve reconstruction targeting the lower trunk. METHODS: This single-center retrospective case series of complete BPBI included patients who underwent primary nerve reconstruction. The outcomes were assessed using the active movement scale (AMS) and brachial plexus outcome measure preoperatively and at the age of 4 and 8 years. RESULTS: Fifty patients with a complete BPBI, of whom 82% (41/50) had an avulsion of C8-T1, underwent primary nerve reconstruction at a mean age of 4.1 months. Compared with the preoperative AMS scores, a statistically significant increase of AMS scores was observed at 4 and 8 years of age for all movements except forearm pronation. Between 4 and 8 years of age, there was a statistically significant improvement of external rotation of the shoulder and elbow flexion as well as diminution of thumb flexion. In the brachial plexus outcome measure assessment, there were 83% (24/29) at 4 years and 81% (21/26) at 8 years who had sufficient functional movement to perform wrist, finger, and thumb activities. CONCLUSIONS: Functional hand outcome was restored to sufficiently perform bimanual activity tasks in 81% (21/26) of patients with a complete BPBI at 8 years of age. This affirmed that primary nerve reconstruction reinnervating the lower trunk can result in a functional extremity. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.


Assuntos
Traumatismos do Nascimento , Neuropatias do Plexo Braquial , Plexo Braquial , Transferência de Nervo , Atividades Cotidianas , Traumatismos do Nascimento/cirurgia , Plexo Braquial/lesões , Plexo Braquial/cirurgia , Neuropatias do Plexo Braquial/cirurgia , Criança , Pré-Escolar , Humanos , Lactente , Estudos Retrospectivos
17.
Br J Anaesth ; 127(1): 153-163, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34006377

RESUMO

BACKGROUND: Nerve damage is consistently demonstrated after subepineural injection in animal studies, but not after purposeful injection in patients participating in clinical studies. There is a need to better visualise nerves in order to understand the structural changes that occur during subepineural injection. METHODS: We scanned the brachial plexuses of three anaesthetised pigs using micro-ultrasound imaging (55-22 MHz probe), inserted 21 gauge block needles into the radial, median, and axillary nerves, and injected two 0.5 ml boluses of saline into nerves at a rate of 12 ml min-1. Our objectives were to measure the area and diameter of nerves and fascicles, and to describe changes in nerve anatomy, comparing our findings with histology. RESULTS: Images were acquired at 42 sites across 18 nerves in three pigs and compared dimensions (geometric ratio; 95% confidence interval; P value). As expected, the nerve cross-sectional area was greater in the proximal brachial plexus compared with the mid-plexus (2.10; 1.07-4.11; P<0.001) and the distal plexus (2.64; 1.42-4.87; P<0.001). Nerve area expanded after 0.5 ml injection (2.13; 1.48-3.08; P<0.001). Using microultrasound, subepineural injection was characterised by nerve and fascicle rotation, uniform, or localised swelling and epineural rupture. Micro-ultrasound revealed a unique pattern suggestive of subperineural injection after a median nerve injection, and good face validity with histology. Histology showed epineural trauma and inflammation to the perineurium. CONCLUSION: We accurately identified fascicles and real-time structural changes to peripheral nerves using micro-ultrasound. This is the first study to visualise in vivo and in real-time the motion of nerves and fascicles in response to anaesthetic needle insertion and fluid injection.


Assuntos
Bloqueio do Plexo Braquial/métodos , Plexo Braquial/diagnóstico por imagem , Sistemas Computacionais , Transdutores , Ultrassonografia de Intervenção/métodos , Adjuvantes Anestésicos/administração & dosagem , Anestésicos Dissociativos/administração & dosagem , Animais , Plexo Braquial/efeitos dos fármacos , Masculino , Nervos Periféricos/diagnóstico por imagem , Nervos Periféricos/efeitos dos fármacos , Suínos
19.
Diagn Interv Radiol ; 27(3): 450-457, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34003131

RESUMO

PURPOSE: Children with brachial plexus birth injury (BPBI) may eventually develop glenohumeral instability due to development of unbalanced muscular strength. Our major goal in this study is to compare the accuracy of physical examination and ultrasonography (US) in determination of glenohumeral instability in infants with BPBI compared with magnetic resonance imaging (MRI) as a gold standard, and to investigate the role and value of US as a screening modality for assessing glenohumeral instability. METHODS: Forty-two consecutive patients (mean age, 2.3±0.8 months) with BPBI were enrolled into this prospective study. Patients were followed up with physical examination and US with dynamic evaluation in 4-6 weeks intervals. Patients who developed glenohumeral instability based on physical examination and/or US (n=21) underwent MRI. Glenohumeral instability was defined as alpha angle >30° and percentage of posterior humeral head displacement >50%. Diagnostic accuracy of physical examination and US was calculated and quantitative parameters were compared with Wilcoxon test. RESULTS: Glenohumeral instability was confirmed with MRI in 15 of 21 patients. Accuracy and sensitivity of physical examination and US were 47%, 66% and 100%, 100%, respectively in determination of glenohumeral instability. No significant difference was found for the alpha angle (p = 0.173) but the percentage of posterior humeral head displacement was statistically significant between US and MRI (p = 0.028). CONCLUSION: Our results indicate that US with dynamic evaluation is a good alternative for MRI in assessment of glenohumeral instability in infants with BPBI, since it is highly accurate and specific, and quantitative measurements used for glenohumeral instability were comparable to MRI. US can be used as a screening method to assess glenohumeral instability in infants with BPBI.


Assuntos
Plexo Braquial , Articulação do Ombro , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Imageamento por Ressonância Magnética , Paralisia , Gravidez , Estudos Prospectivos , Ombro , Articulação do Ombro/diagnóstico por imagem , Ultrassonografia
20.
Eur J Neurol ; 28(8): 2716-2726, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33934438

RESUMO

BACKGROUND: The immunological pathophysiologies of chronic inflammatory demyelinating polyneuropathy (CIDP) and multifocal motor neuropathy (MMN) differ considerably, but neither has been elucidated completely. Quantitative magnetic resonance imaging (MRI) techniques such as diffusion tensor imaging, T2 mapping, and fat fraction analysis may indicate in vivo pathophysiological changes in nerve architecture. Our study aimed to systematically study nerve architecture of the brachial plexus in patients with CIDP, MMN, motor neuron disease (MND) and healthy controls using these quantitative MRI techniques. METHODS: We enrolled patients with CIDP (n = 47), MMN (n = 29), MND (n = 40) and healthy controls (n = 10). All patients underwent MRI of the brachial plexus and we obtained diffusion parameters, T2 relaxation times and fat fraction using an automated processing pipeline. We compared these parameters between groups using a univariate general linear model. RESULTS: Fractional anisotropy was lower in patients with CIDP compared to healthy controls (p < 0.001), patients with MND (p = 0.010) and MMN (p < 0.001). Radial diffusivity was higher in patients with CIDP compared to healthy controls (p = 0.015) and patients with MND (p = 0.001) and MMN (p < 0.001). T2 relaxation time was elevated in patients with CIDP compared to patients with MND (p = 0.023). Fat fraction was lower in patients with CIDP and MMN compared to patients with MND (both p < 0.001). CONCLUSION: Our results show that quantitative MRI parameters differ between CIDP, MMN and MND, which may reflect differences in underlying pathophysiological mechanisms.


Assuntos
Plexo Braquial , Doença dos Neurônios Motores , Polineuropatias , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica , Plexo Braquial/diagnóstico por imagem , Imagem de Tensor de Difusão , Humanos , Imageamento por Ressonância Magnética , Doença dos Neurônios Motores/diagnóstico por imagem , Polineuropatias/diagnóstico por imagem , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/diagnóstico por imagem
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