To ascertain the etiology of non-traumatic plexopathy and clarify the clinical, electrophysiological characteristics according to its etiology.
We performed a retrospective analysis of 63 non-traumatic plexopathy patients that had been diagnosed by nerve conduction studies (NCS) and needle electromyography (EMG). Clinical, electrophysiological, imaging findings were obtained from medical records.
We identified 36 cases with brachial plexopathy (BP) and 27 cases with lumbosacral plexopathy (LSP). The causes of plexopathy were neoplastic (36.1%), thoracic outlet syndrome (TOS) (25.0%), radiation induced (16.7%), neuralgic amyotrophy (8.3%), perioperative (5.6%), unknown (8.3%) in BP, while neoplastic (59.3%), radiation induced (22.2%), neuralgic amyotrophy (7.4%), psoas muscle abscess (3.7%), and unknown (7.4%) in LSP. In neoplastic plexopathy, pain presented as the first symptom in most patients (82.8%), with the lower trunk of the brachial plexus predominantly involved. In radiation induced plexopathy (RIP), pain was a common initial symptom, but the proportion was smaller (50%), and predominant involvements of bilateral lumbosacral plexus and whole trunk of brachial or lumbosacral plexus were characteristic. Myokymic discharges were noted in 41.7% patients with RIP. Abnormal NCS finding in the medial antebrachial cutaneous nerve was the most sensitive to diagnose TOS. Neuralgic amyotrophy of the brachial plexus showed upper trunk involvement in all cases.
By integrating anatomic, pathophysiologic knowledge with detailed clinical assessment and the results of ancillary studies, physicians can make an accurate diagnosis and prognosis.
Citations
Method: We did the recognition survey using 12-item self administrated questionnaire over 2 months in 2001. The questionnaires were sent to 613 physiatrists. Eighty-eight physiatrists of the 613 completed the questionnaires.
Results: Eighty-three of 88 completed the questionnaires were performing their procedure under roentgen environment. The mean procedure time per week was 2.1 hours. Their common procedures doing under roentgen environment were as follows: swallowing videofluoroscopic study (60.2%), voiding cystourethrography (49.3%), arthrography (37.3%), epidurography 25.3%, and so on. 8.5 % of the 83 physiatric interventionists wore the radiation dosimeter and received regular assessment of radiation safety. 62.7% of the participants were wearing one piece apron, and 24.1% wore one piece apron and thyroid shield. Of the radiation related symptoms, fatigue was most common.
Conclusion: We concluded that the special concern and education program to reduce radiation risk are required because of gradual increase of radiation exposure for physiatrists and lack about recognition of radiation exposure. (J Korean Acad Rehab Med 2003; 27: 265-268)
The radiation exposure has multiple complication of various organs. Especially, the Food and Drug Administration has recently issued a bulletin warning of the risks of acute skin injury occurring during fluoroscopically guided procedures. Physicians need information about typical radiation doses during fluoroscopically guided various procedures and estimates of entrance skin dose must be monitored using thermoluminescent dosimetry, film badge dosimetry, pocket dosimetry and on-line computer system. Current National Council on Radiation Protection and Measurements recommended are that yearly total body dose should not exceed 50 mSv (5 rem) and that life time dose measured in millisieverts should not exceed one's age in years multiplied by 10.
Types of skin injury are erythema, alopecia, dry desquamation, invasive fibrosis, dermal atropy, telangiectasia, moist desquamation, skin necrosis and secondary ulcer. Also, long-term exposure caused skin cancer.
We experienced personally pigmentation on the finger nail and the hand after repeated fluoroscopically guided procedures. Thus, we report this case for giving warning to the physiatrist by the complications due to frequent exposure during procedures.
Chronic progressive radiation myelopathy(CPRM) is a rare but serious complication of radiation therapy. It's exact cause is unknown and the diagnosis is usually made based on the exclusion of other causes of myelopathy. Magnetic resonance imaging(MRI) with gadolinium- diethylenetriamine pentaacetic acid(DTPA) enhancement seems to be useful for the diagnosis of CPRM. There is no known effective treatment and the complication is irreversible.
We report a case of CPRM after radiation therapy for subglottic cancer which was not respond to high-dose steroid therapy with review of literature.
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