Coinstantaneous Brachial Plexus Injuries in a 55-year-old Man with Traumatic Spinal Cord Injury: A Case Report and Literature Review

一名創傷性脊髓損傷病人同時合併臂神經叢損傷：病例報告及文獻回顧

林紘毅(Hong-Yi Lin) ； 郭佳茵(Jia-Yin Guo) ； 蔡素如(Su-Ju Tsai)

《台灣復健醫學雜誌》 48卷2期 (2020/12) Pp. 163-166

https://doi.org/10.6315/TJPMR.202012_48(2).0011

摘要

Combined injuries of the spinal cord and brachial plexus are difficult to detect and treat. According to previous literature, the incidence of brachial plexus injuries (BPI) in patients with spinal cord injuries (SCI) is 0.6%-1.8%. Here we report a 55-year-old male patient who suffered a traffic accident. Diagnosis of C3-C6 in-tervertebral disc herniation was confirmed by medical image findings, clinical presentation, and physical examination. His American Spinal Injury Association (ASIA) impairment scale was ASIA-C with a neurological level of C4. The significant difference in muscle power and deep tendon reflex of the right and left upper extremity are both indications of concurrent BPI, which was confirmed by a comprehensive examination of nerve conduction study and electromyography. Early detection and proper treatment are essential for upper extremity recovery in subjects with concurrent BPI and SCI. The electrodiagnostic studies are most helpful to diagnose BPI in SCI subjects. There might be some undiagnosed injury in coinstantaneous BPI and SCI.Thus, we need to be cautious and further cope with it with an optimal plan specific to that kind of injury, which is combined with upper motor neurons (UMNs) and lower motor neurons (LMNs).

關鍵字

spinal cord injury ； brachial plexus injury ； electrodiagnosis

並列摘要

脊髓損傷合併臂神經叢損傷臨床上少見且不易診斷與處置。過去研究的報告發生率約為0.6％到1.8％。在脊髓損傷的病人處置時，通常優先處理危及生命的傷害，且臂神經叢損傷的臨床表現也可能歸因於脊髓損傷而被忽略。本文報告一名55歲因車禍意外導致第四節脊髓損傷的男性病人，根據病人的身體檢查、神經學檢查發現右上肢深肌腱反射無反應，以及明顯不對稱的右上肢與左上肢肌力，經過神經傳導檢查及肌電圖檢查，確定該名病人為脊髓損傷合併臂神經叢損傷。同時罹患脊髓損傷及臂神經叢損傷的病人數量可能被低估，治療計畫及復健也更為複雜，早期診斷與適當治療是此類病人上肢功能恢復的重要關鍵。除了詳細探查脊髓損傷病人的臨床症狀、身體檢查、神經學檢查之外，電學診斷對於合併臂神經叢損傷的確診最有效益。

並列關鍵字

脊髓損傷（spinal cord injury） ； 臂神經叢損傷（brachial plexus injury） ； 電學診斷（electrodiagnosis）

參考文獻

Peter C. Rhee, Elena Pirola, Marie-No¨elle H´ebert-Blouin, et al. Concomitant traumatic spinal cord and brachial plexus injuries in adult patients. J Bone Joint Surg Am 2011；93:2271-7

Akita S, Wada E, Kawai H. Combined injuries of the brachial plexus and spinal cord. J Bone Joint Surg Br 2006；88:637-41.

Aaron W. Paul, Robert J. Spinner, Allen T. Bishop, et al. Two cases of traumatic brachial plexus injury with complete spinal cord injury. Hand 2018；13: 27–31

David C. Preston, Barbara E. Shapiro. Ch30 Brachial Plexopathy. David C. Preston, Barbara E. Shapiro. Barbara electromyography and neuromuscular disorders. 3rd Elsevier. 2013. p.468-86.

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