I would appreciate input from community in helping with this interesting case. Both explanation of path and suggestion of treatment.
50 yo, 8 yrs out from mva where she suffered unknown injury to right arm. Did not undergo pt or treatment at time. She had complete numbness and weakness of arm. It came back to where she now has some feeling and motor movement in upper arm. Distal arm is numb, no strength, has color changes, no sudomotor changes, very cold to touch, no allodynia or hypersensitivity, no nail changes (she has fresh manicure). She states she has pain in entire distal arm but I cannot elicit anything. She isnt taking anything for it, and is not seeking any opioids.
Mri of cspine: c4-c5 mild anterolisthesis w prominent facet hypertrophy and uncovertebral hypertrophy on right.
Non enhancing extradural fluid w mild flattening of thecal sac with extension into pseudomeningocoeles within right side of spinal canal and neural foramen at c6-t1. Consistent with nerve root avulsions and pseudomeningocele. No impingement of cord.
Along course of right brachial plexus there is prominent soft tissue that represents underlying neuroma formation with retraction of nerve roots. Vascular injury with pseudoaneurysm could have simial appearance.
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I read that typical mva brachial plexus injury could cause avulsion injury to lower cervical roots resulting jn pseudomeningocele. What do people make of this case. Mri findings suggest central injury? Peripheral injury? Would you do facets, cesi, scs, peripheral blocks, leave it alone?
50 yo, 8 yrs out from mva where she suffered unknown injury to right arm. Did not undergo pt or treatment at time. She had complete numbness and weakness of arm. It came back to where she now has some feeling and motor movement in upper arm. Distal arm is numb, no strength, has color changes, no sudomotor changes, very cold to touch, no allodynia or hypersensitivity, no nail changes (she has fresh manicure). She states she has pain in entire distal arm but I cannot elicit anything. She isnt taking anything for it, and is not seeking any opioids.
Mri of cspine: c4-c5 mild anterolisthesis w prominent facet hypertrophy and uncovertebral hypertrophy on right.
Non enhancing extradural fluid w mild flattening of thecal sac with extension into pseudomeningocoeles within right side of spinal canal and neural foramen at c6-t1. Consistent with nerve root avulsions and pseudomeningocele. No impingement of cord.
Along course of right brachial plexus there is prominent soft tissue that represents underlying neuroma formation with retraction of nerve roots. Vascular injury with pseudoaneurysm could have simial appearance.
----------
I read that typical mva brachial plexus injury could cause avulsion injury to lower cervical roots resulting jn pseudomeningocele. What do people make of this case. Mri findings suggest central injury? Peripheral injury? Would you do facets, cesi, scs, peripheral blocks, leave it alone?
