Neuralgic amyotrophy with hourglass-like constrictions: A case report

Area of Science:

• Neurology
• Medical Diagnostics

Background:

• Neuralgic amyotrophy (NA) is a rare neurological disorder characterized by sudden upper limb pain and subsequent muscle weakness.
• It typically affects the brachial plexus, but rare paraspinal muscle involvement can mimic cervical radiculopathy.

Observation:

• A 76-year-old male with hip pain post-fall developed sudden left shoulder pain and arm weakness after surgery.
• Initial imaging suggested cervical disc bulging, but electrodiagnostic studies indicated brachial plexopathy.
• Magnetic resonance neurography revealed brachial plexus inflammation and a characteristic suprascapular nerve hourglass-like focal constriction (HLFC).

Findings:

• The patient was diagnosed with NA based on clinical presentation and imaging findings, including HLFC.
• Treatment involved corticosteroids and physical therapy, leading to significant improvement in shoulder muscle strength.

Implications:

• Recognizing unique NA features, such as HLFC and potential paraspinal involvement, is vital for accurate diagnosis.
• Distinguishing NA from cervical radiculopathy prevents misdiagnosis and ensures appropriate treatment.
• This case highlights the utility of advanced imaging in diagnosing rare neurological conditions.