Plexopathy

B.C. Bowen; D.J. Seidenwurm

Brachial plexopathy causes weakness, sensory loss, and loss of tendon reflexes in body regions innervated by nerves in the C5-T1 segmental distribution. The clinical diagnosis is confirmed by electrodiagnostic studies (EMG). Lumbar plexopathy produces weakness, sensory loss, and reflex changes in the distribution of spinal segments L1-L4, resulting in weakness and sensory loss in obturator- and femoral-innervated territories. Sacral plexopathy causes the same abnormalities in segments L5-S3, causing weakness and sensory loss in the gluteal (motor only), and peroneal, and tibial nerve territories.

Typical findings include mass lesion infiltrating perineural fat and abnormal MR imaging features of nerves on short tau inversion recovery (STIR) or fat-saturated T2-weighted fast-spin-echo (FSE) images, abnormal appearance of the intraneural fascicular pattern, and/or abnormal contrast enhancement on fat-saturated T1-weighted images.¹ If MR imaging is of diagnostic quality, an accompanying CT study or positron emission tomography (PET) study is only rarely necessary, except in post-traumatic brachial plexopathy, for which MR imaging and postmyelographic CT are complementary.

MR Techniques and Image Contrast

For brachial plexus imaging (Table 1), high resolution unilateral imaging in two or three planes is preferred, though bilateral examination may also be employed. MR imaging includes the roots, located in the supraclavicular region, to the cords, located in the infraclavicular region.

View this table:

Table 1:

Clinical Condition—Brachial Plexopathy

The lumbosacral plexus² is formed from the lumbar plexus [L1-L3 ventral rami, with contributions from T12 and L4] (Table 2) and the sacral plexus [ventral rami of L4/L5 (lumbosacral trunk) and S1-S4] (Table 3). A unilateral or bilateral study may be performed.

View this table:

Table 2:

Clinical Condition—Lumbar Plexopathy

View this table:

Table 3:

Clinical Condition—Sacral Plexopathy

Pulse Sequences

T1-weighted images display regional anatomy best.^2,3 T2-weighted images usually FSE are useful to detect pathologic changes within components of the plexus. Fat suppression is used because abnormal intraneural signal intensity may be obscured by adjacent fat signal intensity.

Gadolinium contrast is useful for suspected neoplasm, radiation injury, inflammation, or abscess, and following peripheral nerve surgery. Gadolinium is useful in nerve entrapment and stretch injury.

MR Imaging: Normal versus Abnormal Plexus

Abnormal findings include loss of fat planes around all or part of a plexus component, diffuse or focal enlargement of a component (especially, the presence of an eccentric or nodular mass), marked hyperintensity on T2-weighted images and/or enhancement on T1-weighted images with fat suppression. An altered fascicular pattern is also abnormal.¹

Indications for MR Imaging of the Brachial Plexus

Bilbey et al⁴ found SE MR imaging without gadolinium to be 63% sensitive, 100% specific, and 77% accurate compared with clinicopathologic results in 43 patients with suspected brachial plexopathy. Accuracy increased to 88% in patients (n = 34) with neoplastic or traumatic disorders.

Mass Involving the Plexus

MR imaging often determines whether a mass is intrinsic or extrinsic to the plexus and, for extrinsic masses, determines the site of the displaced and compressed nerve fibers before surgical intervention.⁵ Such information is valuable for neoplastic processes (such as nerve sheath tumors, metastases, direct extension of non-neurogenic primary tumor, and lymphoma) and for benign processes (such as fibromatosis [most common], lipoma, myositis ossificans, ganglioneuroma, hemangioma, and lymphangioma).⁶ The information from MR imaging aids in preoperative planning.^6-8

Brachial plexopathy caused by metastatic disease is most often seen in patients with breast or lung carcinoma. Metastases from breast are most common and involve the plexus mainly by lymphatic spread. Other primary malignancies (eg, melanoma, gastrointestinal or genitourinary carcinomas), that metastasize to lymph nodes, soft tissue, or bone and result in plexopathy, have been reported.^4,9-11 Soft tissue tumors, such as sarcomas and aggressive fibromatosis also infiltrate the plexus.^9,12

The most common neurogenic tumors of the plexus are the benign nerve sheath tumors: neurofibroma (50%–65%), and Schwannoma (18%–20%).^13,14 The roots are the most frequent site of involvement.¹¹ Malignant peripheral nerve sheath tumors (MPNSTs) account for 14% of the neurogenic tumors and are found mainly in patients with neurofibromatosis or a history of previous radiation therapy to the plexus region.^13,15-17

Traumatic Injury

Traumatic injury to a peripheral nerve can range from disruption of axonal conduction with preservation of anatomical continuity to severed nerve with complete loss of continuity.^18,19 Trauma can result in compression, stretching, or laceration of plexal components, perineural fibrosis, or avulsion of nerve roots from the spinal cord.

It is important to distinguish intraspinal nerve root avulsion (preganglionic lesion) from brachial plexus interruption (postganglionic lesion) since the surgical treatment differs.²⁰ Somatosensory evoked potentials do not enable one to discriminate between incomplete avulsion and intact roots, or between intraforminal root avulsion and rootlet avulsion from the spinal cord. Hence imaging studies are recommended in the evaluation of post traumatic plexopathies.^21-25

Overall, MR imaging has an advantage over CT and myelography, because it is better able to show both pseudomeningocele and peripheral postganglionic lesions. MR imaging demonstrates post-traumatic neuromas (tangles of regenerating nerve fibers), focal or diffuse fibrosis, and masses that compress or stretch the plexus, such as hematoma, clavicular fracture, and humeral dislocation.^2,4,11,26

Entrapment Syndromes

Guided to the location of entrapment/compression by the clinical, neurologic and electrodiagnostic examination, MR imaging directly depicts nerve compression.²⁷ The brachial plexus and/or the subclavian/axillary artery or vein encounter three possible sites of compression along their course: the interscalene triangle, the costoclavicular space between the first thoracic rib and the clavicle, and the retropectoralis minor space. The value of MR imaging in diagnosing thoracic outlet syndrome is debated.^28,29

Post-Treatment Evaluation

In patients with cancer and plexopathy following radiation therapy, imaging features that favor recurrent tumor are nonuniform, asymmetric, diffuse or focal enlargement, especially the presence of an eccentric mass with postcontrast enhancement.^30,31 Imaging features that favor postradiation plexopathy are diffuse, uniform, symmetric swelling and T2 hyperintensity of the plexus within the radiation field. Diffuse, uniform postcontrast enhancement for months to years after treatment may also result from radiation injury.^31,32 Radiation fibrosis often has low signal intensity on T1-weighted and T2-weighted images,³³ and this may represent the more common appearance for chronic radiation injury.

Differentiation between radiation injury and recurrent cancer with axillary/supraclavicular metastases may not be possible for patients with diffusely abnormal signal intensity and enhancement of the plexus and surrounding tissues. FDG PET helps confirm metastases in patients with indeterminate MR imaging findings and is useful for depicting metastases elsewhere.³⁴

Miscellaneous

When the clinical examination does not reveal an etiology for the patient's neuropathy, MR imaging may identify a focal or diffuse peripheral nerve or plexus structural abnormality, as in acquired and hereditary neuropathies.^35-40 Idiopathic brachial plexus neuritis, or plexitis, presents with sudden onset of severe, constant pain in the lateral neck, shoulder, scapula, or upper arm.⁴¹ Involvement is bilateral in 10%–30% of cases.^42,43 Reported MR imaging findings range from normal⁴ to diffusely enlarged and hyper intense nerves of the plexus on T2-weighted images, hypothesized to represent intraneural inflammation and edema.¹¹

Conclusion

High-resolution MR imaging of brachial and lumbosacral plexuses aids careful treatment planning by peripheral nerve specialists.⁴⁴

Appendix

Expert Panel on Neurologic Imaging: Brian C. Bowen, MD, PhD, Co-Author, University of Miami, Miami, Fla; David J. Seidenwurm, MD, Co-Author and Panel Chair, Radiologic Associates of Sacramento, Sacramento, Calif; Patricia C. Davis, MD, Panel Vice-chair; James A. Brunberg, MD; Robert L. De La Paz, MD; Pr. Didier Dormont; David B. Hackney, MD; John E. Jordan, MD; John P. Karis, MD; Suresh Kumar Mukherji, MD; Patrick A. Turski, MD; Franz J. Wippold II, MD; Robert D. Zimmerman, MD; Michael W. McDermott, MD, American Association of Neurologic Surgeons; Michael A. Sloan, MD, MS, American Academy of Neurology.

Footnotes

This article is a summary of the complete version of this topic, which is available on the ACR Website at www.acr.org/ac. Practitioners are encouraged to refer to the complete version.
Reprinted with permission of the American College of Radiology.

References

↵
Maravilla KR, Bowen BC. Imaging of the peripheral nervous system: evaluation of peripheral neuropathy and plexopathy. AJNR Am J Neuroradiol 1998;19:1011–23
PubMed
↵
Collins JD, Shaver ML, Disher AC, et al. Compromising abnormalities of the brachial plexus as displayed by magnetic resonance imaging. Clin Anat 1995;8:1–16
CrossRef PubMed
↵
Van Es HW, Witkamp TD, Ramos LM, et al. MR imaging of the brachial plexus using aT1-weighted three-dimensional volume acquisition. Int J Neuroradiol 1996;2:264–73
↵
Bilbey JH, Lamond RG, Mattrey RF. MR imaging of disorders of the brachial plexus. J Magn Reson Imaging 1994;4:13–18
CrossRef PubMed
↵
Bowen BC, Maravilla KR. Imaging of the Peripheral Nervous System. In: Latchaw RE, Kucharcyk J, Moseley ME, eds. Advanced imaging and image-guided therapy of the nervous system. Philadelphia, Pa: Mosby2003
↵
Saifuddin A. Imaging tumours of the brachial plexus. Skeletal Radiol 2003;32:375–87
CrossRef PubMed
Aagaard BD, Maravilla KR, Kliot M. MR neurography. MR imaging of peripheral nerves. Magn Reson Imaging Clin N Am 1998;6:179–94
PubMed
↵
Britz G, West G, Daily A, et al. Magnetic resonance imaging in evaluation and treating peripheral nerve problems. Perspect Neuro 1995;6:53–66
↵
de Verdier HJ, Colletti PM, Terk MR. MRI of the brachial plexus: a review of 51 cases. Comput Med Imaging Graph 1993;17:45–50
CrossRef PubMed
Kori SH, Foley KM, Posner JB. Brachial plexus lesions in patients with cancer: 100 cases. Neurology 1981;31:45–50
Abstract/FREE Full Text
↵
Posniak HV, Olson MC, Dudiak CM, et al. MR imaging of the brachial plexus. AJR Am J Roentgenol 1993;161:373–79
PubMed
↵
Chui M. Fibromatosis of the brachial plexus and shoulder girdle. Can Assoc Radiol J 1989;40:28–31
PubMed
↵
Dart LH, Jr., MacCarty CS, Love JG, Dockerty MB. Neoplasms of the brachial plexus. Minn Med 1970;53:959–64
PubMed
↵
Lusk MD, Kline DG, Garcia CA. Tumors of the brachial plexus. Neurosurgery 1987;21:439–53
CrossRef PubMed
↵
Foley KM, Woodruff JM, Ellis FT, et al. Radiation-induced malignant and atypical peripheral nerve sheath tumors. Ann Neurol 1980;7:311–18
CrossRef PubMed
Pierce SM, Recht A, Lingos TI, et al. Long-term radiation complications following conservative surgery (CS) and radiation therapy (RT) in patients with early stage breast cancer. Int J Radiat Oncol Biol Phys 1992;23:915–23
PubMed
↵
Varma DG, Moulopoulos A, Sara AS, et al. MR imaging of extracranial nerve sheath tumors. J Comput Assist Tomogr 1992;16:448–53
CrossRef PubMed
↵
Seddon HJ. Three types of nerve injuries. Brain 1943;66:238–83
↵
Sunderland S. A classification of peripheral nerve injuries producing loss of function. Brain 1951;74:491–516
FREE Full Text
↵
Millesi H. Brachial plexus injuries: management and results. In: Terzis JK, ed. Microreconstruction of nerve injuries. Philadelphia: WB Saunders1987;347–59
↵
Carvalho GA, Nikkhah G, Matthies C, et al. Diagnosis of root avulsions in traumatic brachial plexus injuries: value of computerized tomography myelography and magnetic resonance imaging. J Neurosurg 1997;86:69–76
CrossRef PubMed
Doi K, Otsuka K, Okamoto Y, et al. Cervical nerve root avulsion in brachial plexus injuries: magnetic resonance imaging classification and comparison with myelography and computerized tomography myelography. J Neurosurg 2002;96:277–84
PubMed
Gasparotti R, Ferraresi S, Pinelli L, et al. Three-dimensional MR myelography of traumatic injuries of the brachial plexus. AJNR Am J Neuroradiol 1997;18:1733–42
Abstract
Ochi M, Ikuta Y, Watanabe M, et al. The diagnostic value of MRI in traumatic brachial plexus injury. J Hand Surg [Br] 1994;19:55–59
CrossRef PubMed
↵
Walker AT, Chaloupka JC, de Lotbiniere AC, et al. Detection of nerve rootlet avulsion on CT myelography in patients with birth palsy and brachial plexus injury after trauma. AJR Am J Roentgenol 1996;167:1283–87
PubMed
↵
Sherrier RH, Sostman HD. Magnetic resonance imaging of the brachial plexus. J Thorac Imaging 1993;8:27–33
PubMed
↵
Beltran J, Rosenberg ZS. Diagnosis of compressive and entrapment neuropathies of the upper extremity: value of MR imaging. AJR Am J Roentgenol 1994;163:525–31
PubMed
↵
Cherington M, Wilbourn AJ, Schils J, et al. Thoracic outlet syndromes and MRI. Brain 1995;118 (Pt 3):819–21
FREE Full Text
↵
Panegyres PK, Moore N, Gibson R, et al. Thoracic outlet syndromes and magnetic resonance imaging. Brain 1993;116 (Pt 4):823–41
Abstract/FREE Full Text
↵
Thyagarajan D, Cascino T, Harms G. Magnetic resonance imaging in brachial plexopathy of cancer. Neurology 1995;45:421–27
Abstract/FREE Full Text
↵
Wittenberg KH, Adkins MC. MR imaging of nontraumatic brachial plexopathies: frequency and spectrum of findings. Radiographics 2000;20:1023–32
CrossRef PubMed
↵
Bowen BC, Verma A, Brandon AH, et al. Radiation-induced brachial plexopathy: MR and clinical findings. AJNR Am J Neuroradiol 1996;17:1932–36
Abstract
↵
Wouter van Es H, Engelen AM, Witkamp TD, et al. Radiation-induced brachial plexopathy: MR imaging. Skeletal Radiol 1997;26:284–88
CrossRef PubMed
↵
Hathaway PB, Mankoff DA, Maravilla KR, et al. Value of combined FDG PET and MR imaging in the evaluation of suspected recurrent local-regional breast cancer: preliminary experience. Radiology 1999;210:807–14
PubMed
↵
Duggins AJ, McLeod JG, Pollard JD, et al. Spinal root and plexus hypertrophy in chronic inflammatory demyelinating polyneuropathy. Brain 1999;122 (Pt 7):1383–90
Abstract/FREE Full Text
Masuda N, Hayashi H, Tanabe H. Nerve root and sciatic trunk enlargement in Dejerine-Sottas disease: MRI appearances. Neuroradiology 1992;35:36–37
CrossRef PubMed
Tachi N, Kozuka N, Ohya K, et al. MRI of peripheral nerves and pathology of sural nerves in hereditary motor and sensory neuropathy type III. Neuroradiology 1995;37:496–99
CrossRef PubMed
Van den Bergh PY, Thonnard JL, Duprez T, et al. Chronic demyelinating hypertrophic brachial plexus neuropathy. Muscle Nerve 2000;23:283–88
CrossRef PubMed
Van Es HW, Van den Berg LH, Franssen H, et al. Magnetic resonance imaging of the brachial plexus in patients with multifocal motor neuropathy. Neurology 1997;48:1218–24
Abstract/FREE Full Text
↵
Weiland TL, Scheithauer BW, Rock MG, et al. Inflammatory pseudotumor of nerve. Am J Surg Pathol 1996;20:1212–18
CrossRef PubMed
↵
Parsonage M, Turner J Neuralgic amyotrophy: the shoulder-girdle syndrome. Lancet 1948;1:973–78
CrossRef PubMed
↵
Dyck PJ, Chance P, Lebo R, et al. Peripheral neuropathy. In: Dyck PJ, Thomas PK, Griffen JW, et al., eds. 3rd ed. Philadelphia, Pa: Saunders; 1993
↵
Pezzimenti JF, Bruckner HW, DeConti RC. Paralytic brachial neuritis in Hodgkin's disease. Cancer 1973;31:626–29
PubMed
↵
Spinner RJ, Kline DG. Surgery for peripheral nerve and brachial plexus injuries or other nerve lesions. Muscle Nerve 2000;23:680–95
CrossRef PubMed

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Show more ACR APPROPRIATENESS CRITERIA

[1] ↵
Maravilla KR, Bowen BC. Imaging of the peripheral nervous system: evaluation of peripheral neuropathy and plexopathy. AJNR Am J Neuroradiol 1998;19:1011–23
PubMed

[2] ↵
Collins JD, Shaver ML, Disher AC, et al. Compromising abnormalities of the brachial plexus as displayed by magnetic resonance imaging. Clin Anat 1995;8:1–16
CrossRef PubMed

[3] ↵
Van Es HW, Witkamp TD, Ramos LM, et al. MR imaging of the brachial plexus using aT1-weighted three-dimensional volume acquisition. Int J Neuroradiol 1996;2:264–73

[4] ↵
Bilbey JH, Lamond RG, Mattrey RF. MR imaging of disorders of the brachial plexus. J Magn Reson Imaging 1994;4:13–18
CrossRef PubMed

[5] ↵
Bowen BC, Maravilla KR. Imaging of the Peripheral Nervous System. In: Latchaw RE, Kucharcyk J, Moseley ME, eds. Advanced imaging and image-guided therapy of the nervous system. Philadelphia, Pa: Mosby2003

[6] ↵
Saifuddin A. Imaging tumours of the brachial plexus. Skeletal Radiol 2003;32:375–87
CrossRef PubMed

[7] Aagaard BD, Maravilla KR, Kliot M. MR neurography. MR imaging of peripheral nerves. Magn Reson Imaging Clin N Am 1998;6:179–94
PubMed

[8] ↵
Britz G, West G, Daily A, et al. Magnetic resonance imaging in evaluation and treating peripheral nerve problems. Perspect Neuro 1995;6:53–66

[9] ↵
de Verdier HJ, Colletti PM, Terk MR. MRI of the brachial plexus: a review of 51 cases. Comput Med Imaging Graph 1993;17:45–50
CrossRef PubMed

[10] Kori SH, Foley KM, Posner JB. Brachial plexus lesions in patients with cancer: 100 cases. Neurology 1981;31:45–50
Abstract/FREE Full Text

[11] ↵
Posniak HV, Olson MC, Dudiak CM, et al. MR imaging of the brachial plexus. AJR Am J Roentgenol 1993;161:373–79
PubMed

[12] ↵
Chui M. Fibromatosis of the brachial plexus and shoulder girdle. Can Assoc Radiol J 1989;40:28–31
PubMed

[13] ↵
Dart LH, Jr., MacCarty CS, Love JG, Dockerty MB. Neoplasms of the brachial plexus. Minn Med 1970;53:959–64
PubMed

[14] ↵
Lusk MD, Kline DG, Garcia CA. Tumors of the brachial plexus. Neurosurgery 1987;21:439–53
CrossRef PubMed

[15] ↵
Foley KM, Woodruff JM, Ellis FT, et al. Radiation-induced malignant and atypical peripheral nerve sheath tumors. Ann Neurol 1980;7:311–18
CrossRef PubMed

[16] Pierce SM, Recht A, Lingos TI, et al. Long-term radiation complications following conservative surgery (CS) and radiation therapy (RT) in patients with early stage breast cancer. Int J Radiat Oncol Biol Phys 1992;23:915–23
PubMed

[17] ↵
Varma DG, Moulopoulos A, Sara AS, et al. MR imaging of extracranial nerve sheath tumors. J Comput Assist Tomogr 1992;16:448–53
CrossRef PubMed

[18] ↵
Seddon HJ. Three types of nerve injuries. Brain 1943;66:238–83

[19] ↵
Sunderland S. A classification of peripheral nerve injuries producing loss of function. Brain 1951;74:491–516
FREE Full Text

[20] ↵
Millesi H. Brachial plexus injuries: management and results. In: Terzis JK, ed. Microreconstruction of nerve injuries. Philadelphia: WB Saunders1987;347–59

[21] ↵
Carvalho GA, Nikkhah G, Matthies C, et al. Diagnosis of root avulsions in traumatic brachial plexus injuries: value of computerized tomography myelography and magnetic resonance imaging. J Neurosurg 1997;86:69–76
CrossRef PubMed

[22] Doi K, Otsuka K, Okamoto Y, et al. Cervical nerve root avulsion in brachial plexus injuries: magnetic resonance imaging classification and comparison with myelography and computerized tomography myelography. J Neurosurg 2002;96:277–84
PubMed

[23] Gasparotti R, Ferraresi S, Pinelli L, et al. Three-dimensional MR myelography of traumatic injuries of the brachial plexus. AJNR Am J Neuroradiol 1997;18:1733–42
Abstract

[24] Ochi M, Ikuta Y, Watanabe M, et al. The diagnostic value of MRI in traumatic brachial plexus injury. J Hand Surg [Br] 1994;19:55–59
CrossRef PubMed

[25] ↵
Walker AT, Chaloupka JC, de Lotbiniere AC, et al. Detection of nerve rootlet avulsion on CT myelography in patients with birth palsy and brachial plexus injury after trauma. AJR Am J Roentgenol 1996;167:1283–87
PubMed

[26] ↵
Sherrier RH, Sostman HD. Magnetic resonance imaging of the brachial plexus. J Thorac Imaging 1993;8:27–33
PubMed

[27] ↵
Beltran J, Rosenberg ZS. Diagnosis of compressive and entrapment neuropathies of the upper extremity: value of MR imaging. AJR Am J Roentgenol 1994;163:525–31
PubMed

[28] ↵
Cherington M, Wilbourn AJ, Schils J, et al. Thoracic outlet syndromes and MRI. Brain 1995;118 (Pt 3):819–21
FREE Full Text

[29] ↵
Panegyres PK, Moore N, Gibson R, et al. Thoracic outlet syndromes and magnetic resonance imaging. Brain 1993;116 (Pt 4):823–41
Abstract/FREE Full Text

[30] ↵
Thyagarajan D, Cascino T, Harms G. Magnetic resonance imaging in brachial plexopathy of cancer. Neurology 1995;45:421–27
Abstract/FREE Full Text

[31] ↵
Wittenberg KH, Adkins MC. MR imaging of nontraumatic brachial plexopathies: frequency and spectrum of findings. Radiographics 2000;20:1023–32
CrossRef PubMed

[32] ↵
Bowen BC, Verma A, Brandon AH, et al. Radiation-induced brachial plexopathy: MR and clinical findings. AJNR Am J Neuroradiol 1996;17:1932–36
Abstract

[33] ↵
Wouter van Es H, Engelen AM, Witkamp TD, et al. Radiation-induced brachial plexopathy: MR imaging. Skeletal Radiol 1997;26:284–88
CrossRef PubMed

[34] ↵
Hathaway PB, Mankoff DA, Maravilla KR, et al. Value of combined FDG PET and MR imaging in the evaluation of suspected recurrent local-regional breast cancer: preliminary experience. Radiology 1999;210:807–14
PubMed

[35] ↵
Duggins AJ, McLeod JG, Pollard JD, et al. Spinal root and plexus hypertrophy in chronic inflammatory demyelinating polyneuropathy. Brain 1999;122 (Pt 7):1383–90
Abstract/FREE Full Text

[36] Masuda N, Hayashi H, Tanabe H. Nerve root and sciatic trunk enlargement in Dejerine-Sottas disease: MRI appearances. Neuroradiology 1992;35:36–37
CrossRef PubMed

[37] Tachi N, Kozuka N, Ohya K, et al. MRI of peripheral nerves and pathology of sural nerves in hereditary motor and sensory neuropathy type III. Neuroradiology 1995;37:496–99
CrossRef PubMed

[38] Van den Bergh PY, Thonnard JL, Duprez T, et al. Chronic demyelinating hypertrophic brachial plexus neuropathy. Muscle Nerve 2000;23:283–88
CrossRef PubMed

[39] Van Es HW, Van den Berg LH, Franssen H, et al. Magnetic resonance imaging of the brachial plexus in patients with multifocal motor neuropathy. Neurology 1997;48:1218–24
Abstract/FREE Full Text

[40] ↵
Weiland TL, Scheithauer BW, Rock MG, et al. Inflammatory pseudotumor of nerve. Am J Surg Pathol 1996;20:1212–18
CrossRef PubMed

[41] ↵
Parsonage M, Turner J Neuralgic amyotrophy: the shoulder-girdle syndrome. Lancet 1948;1:973–78
CrossRef PubMed

[42] ↵
Dyck PJ, Chance P, Lebo R, et al. Peripheral neuropathy. In: Dyck PJ, Thomas PK, Griffen JW, et al., eds. 3rd ed. Philadelphia, Pa: Saunders; 1993

[43] ↵
Pezzimenti JF, Bruckner HW, DeConti RC. Paralytic brachial neuritis in Hodgkin's disease. Cancer 1973;31:626–29
PubMed

[44] ↵
Spinner RJ, Kline DG. Surgery for peripheral nerve and brachial plexus injuries or other nerve lesions. Muscle Nerve 2000;23:680–95
CrossRef PubMed

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