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Pseudoneurogenic thoracic outlet syndrome

¹Department of Neurology, Mount Sinai Medical Center, New York, New York.

|February 1, 1994

Summary

A stroke affecting the right brain caused left-hand weakness and numbness, mimicking brachial plexopathy. This highlights how cerebral lesions can present with symptoms typically seen in peripheral nerve conditions.

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Area of Science:

Neurology
Vascular Neurology
Neuroimaging

Background:

Peripheral nerve disorders like brachial plexopathy can present with focal weakness and sensory changes.
Vascular conditions, such as subclavian artery stenosis, can cause exercise-induced symptoms in the upper extremities.

Observation:

A 61-year-old man presented with progressive left hand weakness, numbness, and exercise-induced vascular symptoms.
Physical examination revealed left thenar wasting and a supraclavicular bruit.
Initial vascular and electrophysiological studies suggested subclavian artery stenosis but ruled out brachial plexopathy.

Findings:

Neuroimaging revealed multifocal cerebral infarction in the right hemisphere.
The patient's symptoms were ultimately attributed to a cerebral lesion rather than a peripheral nerve issue.

Implications:

Focal neurological deficits, including weakness and atrophy, can arise from central nervous system lesions.
Cerebral lesions should be considered in the differential diagnosis of apparent peripheral nerve disorders.
This case underscores the importance of comprehensive neuroimaging in diagnosing complex neurological presentations.

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