Parsonage-Turner Syndrome Following SARS-CoV-2 Infection: A Systematic Review

[Therapeutic options in patients with neuralgic amyotrophy]

OBJECTIVE

To evaluate the outcomes of patients with neuralgic amyotrophy (NA) depending on the type of treatment received - surgical or glucocorticosteroid administration.

MATERIAL AND METHODS

The outcome of 101 patients with verified NA was analyzed. The mean age of NA patients was 38.21±16.09 years (8 to 76 years), of which 69.3% were males (n=70) and 30.7% were females (n=31). The diagnosis was confirmed by electromyography, cervical spine MRI, and clinical data evaluation: pain according to VAS, duration of pain, timing of diagnosis from the disease onset, and severity of muscle weakness using the MRC scale. Most patients had a classic form (50.5%, n=51), followed by a distal form (39.6%, n=40), and nerve damage above the elbow joint or cranial nerves (9.9%, n=10). Most patients were examined during the phase of pain and muscle weakness (59.4%, n=60) and in the recovery phase (40.6%, n=41). 48.5% (n=49) of patients received steroids. Surgical treatment was performed in 15.8% of cases (n=16). The median follow-up of all patients was 12 months (Q1-Q3 6.00-20.00).

RESULTS

Patients who received GCS recovered better - 67.7% had a complete recovery compared to patients who did not receive pathogenetic therapy. Regardless of the GCS use, the outcome also depended on the NA form and the initial severity of muscle weakness (p<0.001 and p=0.001, respectively). Comparing the outcomes in the groups with and without surgery showed no statistically significant differences. However, in the non-surgery group, a higher percentage of non-recovery was found (71.4%) compared to the group receiving surgical treatment (28.6%). In 97.4% (n=38) of cases of distal NA, ultrasound revealed focal changes in the nerves, which initially indicated a poor prognosis for recovery.

CONCLUSION

Steroid therapy affects muscle strength recovery in patients with NA. The NA form and the initial severity of motor deficit also affect the outcome. Surgical treatment is indicated for patients with distal NA.

Immune triggers preceding neuralgic amyotrophy

BACKGROUND AND PURPOSE

Infections and vaccinations have been identified as potential immunological triggers of neuralgic amyotrophy (NA), but the exact type and frequency of the preceding agents is unknown.

METHODS

This was a multicentre, prospective, observational, matched case-control study. NA was diagnosed by neuromuscular experts according to validated clinical criteria and electrodiagnostic studies. Clinical data and biological samples of NA patients were collected within 90 days from disease onset between June 2018 and December 2023. All NA patients were asked about prior infection and vaccination in the month before disease onset. Serological tests for hepatitis E virus, human immunodeficiency virus, severe acute respiratory syndrome coronavirus 2, Epstein-Barr virus, cytomegalovirus, parvovirus B19, varicella-zoster virus, Borrelia burgdorferi, Mycoplasma pneumoniae and Bartonella henselae were performed in a central laboratory. Each case was matched with a healthy control for age, sex, place of residence and time of blood collection.

RESULTS

Fifty-seven patients and corresponding controls were included. The mean age was 45 years for both groups. NA onset was preceded by a symptomatic infectious trigger confirmed by microbiological tests in 15/57 (26.3%) patients. Coronavirus disease 2019 vaccination was considered a potential trigger in 7/57 (12.3%) subjects. An acute viral infection was associated with a bilateral involvement of the brachial plexus (p = 0.003, Cramèr's V = 0.43).

CONCLUSIONS

Confirmed immune triggers (infection or vaccination) preceded disease onset in 22/57 (38.6%) NA cases. We suggest to test NA patients in the acute phase for intracellular antigens, especially in the case of concomitant bilateral involvement and hepatitis.

Unraveling the mysteries of parsonage turner syndrome: A journey towards optimal management. A systematic review

Aims

Parsonage Turner Syndrome (PTS) is a peripheral neuropathy manifesting as sudden onset pain, muscle weakness, and atrophy. This review aims to analyse long-term outcomes reported in adult patients with PTS, and establish an optimised management approach.

Methods

A comprehensive literature search was performed using MEDLINE, PubMed, and the Cochrane Library. Articles that met the eligibility criteria were included. Analysis on time to presentation, presentation, interventions and long-term functional outcomes was conducted. All relevant information was collected by two independent reviewers.

Results

Twenty-five studies, comprising 950 PTS patients, were identified. Patients averaged 43.8 years in age, with a F:M ratio of 0.6:1, and presented symptoms spanning 1-24 months prior to seeking medical attention. Management details were elucidated for 402 patients (42 ​%), with 87 ​% managed conservatively. Among conservatively managed patients, over 50 ​% exhibited no improvement. 62/402 (15 ​%) necessitated surgical interventions, including neurolysis, decompression, nerve transfers, and diaphragmatic plication. 25/31 (80.6 ​%) neurolysis cases demonstrated full functional recovery, including pain resolution and full muscle strength, between 1 day and 13 months (average 2.9 months). 2 nerve transfer cases achieved full forward flexion at 2.5 months. Overall, long-term outcomes of PTS, reported at 5-25 months, revealed residual neuropathic pain in 60 ​% and incomplete motor function return in 70 ​% of patients.

Conclusions

PTS recognition and referral challenges persist, impeding timely management. While surgical interventions are advocated after three months for incomplete recovery, long-term surgical outcomes are inadequately reported. An optimal surgical strategy for stagnant nerve recovery needs to be devised for this challenging cohort of patients.

Peripheral neuropathy following monkeypox infection: an unexpected diagnosis of Parsonage-Turner syndrome

Parsonage-Turner syndrome following monkeypox infection is a rare form of peripheral neuropathy seen in orthopaedic practice and described only once in the literature. We present the case of a man in his 30s with severe shoulder pain and subsequent amyotrophy 2 weeks after monkeypox infection. Our report encompasses the initial findings, radiographic examinations and follow-up over a 6-month period. To confirm the diagnosis, MRI and electrostimulation conduction studies were conducted, highlighting their importance as valuable diagnostic tools in conjunction with a thorough physical examination. Supportive treatment, including physical therapy and pain management, forms the cornerstone of management, while surgical intervention is reserved for refractory cases or when mechanical complications arise. Prognosis varies among individuals. This case report expands the understanding of neurological complications of monkeypox infection. Clinicians should include Parsonage-Turner syndrome in their differential diagnosis for patients presenting with symptoms of peripheral brachial plexus neuropathy following viral infections, including monkeypox.

Parsonage-Turner Syndrome and SARS-CoV-2 Infection: A Literature Review With Case Presentation

Neuralgic amyotrophy, also known as Parsonage-Turner syndrome (PTS), is characterized by severe pain and muscle wasting affecting the anterior body, including the head, shoulder, upper limb, and chest wall. Often triggered by an antecedent event, such as infection, PTS encompasses various conditions historically identified as separate entities. In 1948, Parsonage and Turner unified these conditions under the term neuralgic amyotrophy based on shared features of intense pain and muscular atrophy. Recent studies have highlighted PTS as a spectrum disorder with diverse manifestations, including pure sensory neuropathy, extensive neuropathy, spinal accessory nerve involvement, and diaphragmatic palsy. We reviewed 26 documented cases of PTS following SARS-CoV-2 infection, emphasizing the importance of considering PTS in individuals with a history of COVID-19 due to varied clinical presentations. Standardized diagnostic methods and comprehensive evaluations are crucial for accurate diagnosis and management. Future research should focus on consistent evaluation methods and employing a comprehensive differential diagnosis approach.

The Utility of an Epidural Steroid Injection for the Treatment of Idiopathic Brachial Neuritis

Idiopathic brachial neuritis is an uncommon disorder that predominately affects the superior and middle trunks of the brachial plexus. Severe throbbing and aching shoulder pain is initially present for a period of days to weeks, followed by severe weakness and atrophy that can develop for an extended period of months to years. There are currently no known treatments for brachial neuritis, with the standard of care consisting of analgesics and corticosteroids, which typically provide minimal to no benefit in most cases. In this case, we will present a case of a patient who was diagnosed with idiopathic brachial neuritis and underwent an interlaminar epidural steroid injection (ESI) for treatment. Following treatment with the ESI, the patient had a subsequent resolution of symptoms. This case underscores the value of early recognition for the diagnosis of brachial neuritis and the utility of an ESI as a treatment option, thus preventing long-term pathological sequalae. To our knowledge, this is the first known reported case to have successfully cured brachial neuritis.

Emerging Trends in Complications Associated with SARS-CoV-2 Infection

The coronavirus disease 2019 (COVID-19) pandemic has presented a remarkable challenge to global health, sparking a surge in research aimed at understanding the multifaceted impacts of the virus [...].