Brachial plexus tuberculosis: A unique neurological variant of a common clinical disease

Isolated primary tuberculous involvement of the brachial plexus has not been reported in the past. Here, we report the case of a 29-year-old male who developed neck pain and radiculopathy for 3 months. Weakness in the left shoulder-elbow (2/5 MRC grade) and wrist (4/5 MRC grade) was present with numbness to pain and temperature along the C4–C5 dermatome. Magnetic resonance imaging (MRI) revealed a T2 hyperintense heterogeneously contrast-enhancing lesion involving the upper trunk of the brachial plexus. Under suspicion of malignancy, surgical exploration was undertaken. Intraoperatively, pus was noticed with unhealthy granulation tissue extending along the left-sided C4–5 lamina and transverse process. The frozen section suggested granulomatous infection and histopathology confirmed tuberculosis (TB). After 18 months of antituberculous treatment, the patient gradually recovered complete strength in the left upper limb. Follow-up brachial plexus MRI showed near-complete resolution of the lesion. We describe a unique case of a young patient clinically suggestive of the rapid progressive lesion (mimicking malignancy) affecting brachial plexus, turning out as TB on histopathology.

Case Report: Bionic Reconstruction in an Adult With Obstetric Brachial Plexus Injury

Introduction: Many adults who had a severe Narakas IV obstetric brachial plexus injury (OBPI) suffer from extensive impairments in daily living due to limited hand-arm function. The dramatic loss of axonal support at this very early age of development often render the entire extremity a biologic wasteland and reconstructive methods and therapies often fail to recover any functional hand use. In this scenario bionic reconstruction, including an elective amputation and a subsequent prosthetic fitting, may enable functional improvement in adults suffering from the consequences of such severe brachial plexus injuries. We here describe our experience in treating such patients and lay out the surgical rational and rehabilitation protocol exemplified in one patient.Case Presentation/Methods: A 27-year-old adult with a unilateral OBPI contacted our center. He presented with globally diminished function of the affected upper extremity with minimal hand activity, resulting in an inability to perform various tasks of daily living. No biological reconstructive efforts were available to restore meaningful hand function. An interdisciplinary evaluation, including a psychosocial assessment, was used to assess eligibility for bionic reconstruction. Before the amputation and after the prosthetic fitting functional assessments and self-reported questionnaires were performed.Results: One month after the amputation and de-rotation osteotomy of the humerus the patient was fitted with a myoelectric prosthesis. At the 1.5 year-follow-up assessment, the patient presented with a distinct improvement of function: the ARAT improved from 12 to 20 points, SHAP score improved from 8 to 29, and the DASH value improved from 50 to 11.7. The average wearing times of the prosthesis were 5 to 6 h per day (on 4–5 days a week).Discussion: The options for adults suffering from the consequences of severe OBPIs to improve function are limited. In selected patients in whom the neurological deficit is so severe that biologic hand function is unsatisfactory, an elective amputation and subsequent restoration of the hand with mechatronic means may be an option. The follow-up results indicate that this concept can indeed lead to solid hand function and independence in daily activities after amputation, subsequent prosthetic fitting, and rehabilitation.

The Structure of the Brachial Plexus of the Djungarian Hamster (Phodopus sungorus)

Hamsters are often chosen as companion animals but are also a group of animals frequently subjected to laboratory tests. As there are no scientific publications providing information on the anatomical architecture of the brachial plexus of the Djungarian hamster, this study analyses the structure of this part of the nervous system of this species. It is important to know the details of this structure not only for cognitive reasons, but also due to the increasing clinical significance of rodents, which are often used in scientific research. The study was conducted on 55 specimens. Like in humans, the brachial plexus of the Djungarian hamster has three trunks. The following individual nerves innervating the thoracic limb of the Djungarian hamster: the radial nerve, median nerve, ulnar nerve, musculocutaneous nerve, axillary nerve, suprascapular nerve, thoracodorsal nerve, cranial pectoral nerves, caudal pectoral nerve, lateral thoracic nerve, long thoracic nerve, and subscapular nerves. Similarly to other mammals of this order, the brachial plexus of the Djungarian hamster ranges widely (C5-T1). However, its nerves are formed from different ventral branches of the spinal nerves than in other mammals.