Parsonage Turner Syndrome

Parsonage Turner Syndrome
Also known as neuralgic amyotrophy after the description of Parsonage and Turner in 1948 emphasizing the pain and weakness of the syndrome.
Other synonyms-Immune Brachial Plexus Neuropathy (IBPN), brachial plexus neuritis, cervical radiculoplexus neuropathy.
An acquired sporadic brachial plexus neuropathy-presumed to be inflammatory-immune mediated; differentiated from hereditary or familial form with genetic localization. Also differentiated from pathology due to trauma, radiation, cancer.
Historical background.

IBPN 1st appeared in literature in late 1800s.
1896-Lesxynskiy reported case of bilateral plexus neuritis, following “acute croupous pneumonia”.
1897- Feinberg described case associated with influenza.
1941- Wyburn-Mason reported 42 cases over 8 month period without common etiology.
1948-Parsonage and Turner provided detailed description of the clinical syndrome in a large group of 136 pts seen mainly among the military personnel in the UK and India during WWII.
Clinical features.  Pain starts suddenly without disturbance across the top of shoulder blade, radiating into arm or neck.  Flaccid paralysis follows.  Pain begins abruptly, often at night. Muscles most often affected-deltoid, supra/infraspinatus, serratus anterior, biceps brachii, triceps brachii.  Selected nerve involvement of anterior interosseous, radial, musculocutaneous nerves.  Presentation may mimic mononeuritis multiplex. Occasional reports of phrenic nerve, multiple cranial nerve involvement.
Antecedent illness, associated conditions.  In some cases, onset of symptoms preceded by flu-like or UTI; similar to post infectious GBS.  Antecedent vaccination reported in 14% of pts in one series.
Antecedent illness, associated conditions

Infectious

UTI
Influenza
Coxsackievirus
Parvovirus B19
Epstein-Barr virus
HIV
Immunizations

Tetanus toxoid
Hepatitis B
Swine flu
Medications

Interferon
Interleukin-2
Lamotrigine
Botulinum toxin
Connective tissue disorders

SLE
RA
Sceleroderma
Polyarteritis Nodosa
Giant cell arteritis
Ehlers-Danlos Syndrome
Post operative
Pregnancy and Puerperium
Other

IV drug (heroin) use
Infective endocarditis
Paraproteinemia
Hodgkins’s disease
Strenuous exercise
Associated with DM
Pathogenesis and Pathology

Underlying inflammatory immune process
Acute onset-monophasic course
Both humoral and cellular immune mechanism implicated
Complement-fixing antibodies to peripheral nerve myelin (anti-PNM)
Treatment

Corticosteroids
Immunomodulation

Plasmapheresis
IViG
Prognosis

In general-monophasic illness with good prognosis for full recovery
Recurrences may occur-reported 1-5%

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Ray Jurewicz
412-731-0173
E-mail: rj@NerveStudy.com Web Site design by Larry Berman and Chris Maher

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