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Extradural malignancy simulating brachial neuritis.

P C Gates, P A Kempster, D Rischin

    Clinical and Experimental Neurology
    |January 1, 1986
    PubMed
    Summary
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    Brachial neuritis symptoms can be misleading. An extradural tumor at C5-C6 was found, highlighting that serratus anterior sparing doesn't always rule out nerve root pathology.

    Area of Science:

    • Neurology
    • Neurosurgery
    • Oncology

    Background:

    • Brachial neuritis, also known as Parsonage-Turner syndrome, presents with acute, severe shoulder pain followed by muscle weakness and atrophy.
    • Diagnosis often relies on clinical presentation and electrodiagnostic studies, which can help localize the lesion within the brachial plexus.

    Observation:

    • A 57-year-old male presented with symptoms indicative of brachial neuritis.
    • Clinical examination and electromyography revealed sparing of the serratus anterior muscle.
    • This finding initially suggested a lesion distal to the nerve roots within the brachial plexus.

    Findings:

    • Further investigation identified an extradural tumor compressing the spinal cord at the C5-C6 level.
    • The tumor's location explained the patient's symptoms, challenging the initial diagnostic assumption.

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    Implications:

    • Sparing of the serratus anterior muscle, while often indicative of a distal brachial plexus lesion, does not definitively exclude pathology at the nerve root level.
    • This case underscores the importance of comprehensive diagnostic workup, including advanced imaging, in cases of suspected brachial neuritis.
    • Extradural tumors should be considered in the differential diagnosis of brachial plexus-like syndromes, even with seemingly localized electrodiagnostic findings.