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Radiation-induced malignant and atypical peripheral nerve sheath tumors.

The reported peripheral nerve complications of therapeutic irradiation in humans include brachial and lumbar plexus fibrosis and cranial and peripheral nerve atrophy. We have encountered 9 patients with malignant (7) and atypical (2) peripheral nerve tumors occurring in an irradiated site suggesting that such tumors represent another delayed effect of radiation treatment on peripheral nerve. The neoplasms appeared 4 to 41 years following radio-therapy, at a time when the patients (6 females and 3 males) were 16 to 70 years old and cured of their original tumors. Eight patients had received irradiation to treat malignant disease; the ninth had a benign condition. The sites of peripheral nerve tumor were the brachial plexus in 5, cervical plexus in 1, lumbar plexus in 2, and retroperitoneum in 1. Eight patients presented with painful masses, and in 6 of the 8 there was a progressive neurological deficit. Seven patients died with metastases within two years of diagnosis. In all instances the radio-therapy was within an acceptable radiation dosage, yet 3 patients developed local radiation-induced skin and bony abnormalities. In 3 patients there were either clinical signs or a family history of von Recklinghausen disease, but the malignant peripheral nerve sheath tumors developed only in the radiation port. Animal studies support the clinical observation that malignant peripheral nerve sheath tumors can occur as a delayed effect of irradiation. Other etiological mechanisms, including an increased risk of second primaries in cancer patients and a genetic predisposition to peripheral nerve tumors, may also play a role.

Adolescent↗

Neurophysiological studies in malignant disease with particular reference to involvement of peripheral nerves.

Neurological and neuromuscular disorders are frequent complications in patients with neoplasms and may involve the neuromuscular system, including motor and sensory nerve cell bodies, axons, myelin, neuromuscular transmission and muscle alone or in combination. Electrophysiological studies are of value in delineating the type, degree and extent of involvement, and may be of assistance in pointing towards the underlying cause: paraneoplastic factors, treatment with chemotherapy or radiation or metastatic infiltration. Though some electrophysiological features may be characteristic of certain syndromes, they rarely can stand alone but require clinical, pathological, radiological, and laboratory studies to obtain a diagnosis. Even in cases where such studies are obtained, a final diagnosis may only be ascertained during follow up, since the neuromuscular disorders frequently occur before the neoplasm is detected.

Animals↗

Spinal root and plexus hypertrophy in chronic inflammatory demyelinating polyneuropathy.

MRI was performed on the spinal roots, brachial and lumbar plexuses of 14 patients with chronic inflammatory demyelinating polyneuropathy (CIDP). Hypertrophy of cervical roots and brachial plexus was demonstrated in eight cases, six of whom also had hypertrophy of the lumbar plexus. Of 11 patients who received gadolinium, five of six cases with hypertrophy and one of five without hypertrophy demonstrated enhancement. All patients with hypertrophy had a relapsing-remitting course and a significantly longer disease duration. Gross onion-bulb formations were seen in a biopsy of nerve from the brachial plexus in one case with clinically evident nodular hypertrophy. We conclude that spinal root and plexus hypertrophy may be seen on MRI, particularly in cases of CIDP of long duration, and gadolinium enhancement may be present in active disease.

Adult↗

[Acute plexus lesions in heroin dependence].

A wide spectrum of acute and chronic neurological syndromes are associated with heroin addiction. We report two cases with acute brachial/lumbar plexus lesions, with details of the clinical findings, diagnostic procedures and therapy. Possible causes are allergic or toxic reactions to heroin or added substances, as well as nerve compression due to local muscle swelling in connection with rhabdomyolysis. The extent of paresis which occurs is also determined by this compression.

Acute Kidney Injury↗

[Brachial plexitis and myelitis and herpes-zoster lumbar plexus disorder in patient treated with infliximab].

Infliximab, a chimeric monoclonal antibody, is a TNF-a inhibitor approved for use in refractory rheumatoid arthritis and Crohn s disease. We present the case of a patient affected by severe rheumatoid arthritis who was successfully treated with infliximab. She suffered diverse neurological complications: brachial plexitis, asymptomatic thoracic myelitis with extensive lesions in MRI study, and herpes zoster lumbar plexitis. We review the neurological adverse effects of infliximab (aseptic meningitis, opportunistic germs infections, disseminated herpes zoster) and focus in their potential adverse effect to induce central and peripheral nervous system demyelination.

Antibodies, Monoclonal↗