Neuralgic amyotrophy is an uncommon neurologic syndrome of unknown etiology involving the brachial plexus, which is manifest by shoulder and arm pain, weakness, and sensory loss. Because of the diversity and variability of the initial features and similarity to other neurologic and non-neurologic disorders, patients may initially present to internists, orthopedic surgeons, or pulmonologists, and may be initially diagnosed with an alternative disorder.Neuralgic amyotrophy occurs at an annual incidence rate of 1 to 2 cases per 100,000 population. The disorder is most common in adulthood, but patients of any age may be affected. Pain is the most common initial symptom and is followed by weakness and sensory loss in the distribution of a single nerve or diffuse regions of the brachial plexus. Although the exact etiology is unknown, many associated factors, such as immunizations, minor trauma, infectious diseases, pregnancy, and surgical procedures have been associated with the development of the disorder. Evaluation with electrodiagnostic and radiographic studies is useful in confirming the diagnosis and excluding alternative disorders. No treatment has been definitively proven to improve the course of the disorder; however, the overall prognosis is good, with approximately 90% of patients demonstrating significant improvement.Neuralgic amyotrophy is an important, potentially debilitating disorder, which may present to physicians in multiple specialties. Awareness of this disorder may preclude unnecessary testing or surgical procedures and can guide toward appropriate treatment with physical therapy. Counseling patients about the overall good prognosis can help appease patients' anxiety about a more sinister diagnosis or course.
“Dizziness” is a common presenting symptom to a neurologist in the outpatient setting. Dizziness can occur as a result of a vestibular disorder involving the peripheral or central vestibular pathways or nonvestibular centers as the result of a disorder of balance, proprioceptive input, or autonomic nervous system dysfunction. A careful clinical history and examination along with ancillary testing can usually lead to determination of the underlying disorder and implementation of the appropriate treatment. The authors review the general approach to the “dizzy” patient in an office-based neurology practice, focusing on the clinical diagnostic features that may help to determine the etiology and treatment options for the dizzy patient.
We report a case of sudden onset of deep peroneal neuropathy resulting from a ganglion cyst. Electrophysiology demonstrated a severe deep peroneal neuropathy with axonal loss and probably proximal conduction block. Magnetic resonance imaging demonstrated a mass arising from the proximal tibiofibular joint extending along the peroneal nerve. Surgical resection of the ganglion resulted in gradual improvement of strength. Peroneal nerve ganglia should be considered in the evaluation of patients with sudden painless foot drop.
