Plexopathy

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Sensory loss due to a lesion of the brachial plexus will appear in the distribution of two or more peripheral nerves if the lesion is infraclavicular and in the distribution of multiple cervical dermatomes if the lesion is supraclavicular. All sensory modalities may be involved.

In radiation-induced plexopathy, 77 percent of patients have upper trunk involvement predominantly that generally occurs 3 months to 26 years after irradiation of the chest. It is quite characteristic to find myokymia on the needle electrode examination in these patients. [4?] Metastatic plexopathy has a predilection for the lower trunk, possibly owing to its proximity to the axillary lymph nodes. Pain is a predominant and early symptom in metastatic plexopathy.

Other causes of brachial plexopathy include traction, obstetrical paralysis, surgical injury, neuralgic amyotrophy, true neurogenic thoracic outlet syndrome, and trauma.

In the lumbar region a pattern of weakness, loss of reflexes, and sensory disturbance is found that cannot be

localized to a single lumbosacral root or peripheral nerve. Pain is a prominent early manifestation when secondary to neoplasm. The differential diagnosis includes idiopathic plexitis, vasculitis, diabetic polyradiculopathy, infection (e.g., with herpes zoster or Schistosoma japonicum) hereditary liability to pressure palsies, hemorrhage, trauma, obstetrical complications, and tumor irradiation.

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