Neuropediatrics 2015; 46 - PS02-28
DOI: 10.1055/s-0035-1550740

Neuralgic Amyotrophy: A Rare Disease in Adolescence

A. Schwerin-Nagel 1, M. Brunner-Krainz 1, U. Gruber-Sedlmayr 1, T. Seifert-Held 2, L. Stroedter 3, S. Quasthoff 2
  • 1Univ. Klinik für Kinder- und Jugendmedizin, Graz, Austria
  • 2Universitätsklinik für Neurologie, Graz, Austria
  • 3Universitätsklinik für Kinder- und Jugendchirurgie, Graz, Austria

Introduction: Neuralgic amyotrophy (NA) is a distinct clinical syndrome characterized by sudden onset of neuropathic pain usually in the shoulder and/or arm with sensory loss and subsequent paresis. NA is considered as a benign, self-limiting disease with good recovery. The following pathogenesis of NA is still in discussion: trigger (vaccination and infection), genetic, and autoimmune mediated.

Case: A 16-year-old boy presented with pain in the right shoulder after a football match. No accident, no infection, and no vaccination recently. X-ray shoulder was normal. Overall, 7 days later, he presented with asymmetric shoulders and painful shoulder movements of the right side with no constraint. MRI shoulder was normal.

Day 11 after first symptoms: abduction, antero- and retrolateral movement with right arm were impossible, sensation in right upper arm was reduced. The patient complained severe pain in arm and shoulder with no relief after excessive analgesic medication. MRI cervical spine was normal.

On day 16, nerve conduction study showed axonal neuropathy in N. axillaris and normal results in N. radialis and N. medianus. EMG showed no abnormal spontaneous activity.

A psychogenic paresis was considered and a psychological exploration was initiated. The patient was treated with analgesics and physiotherapy.

On day 28, EMG showed abnormal spontaneous activity in Mm. deltoideus, supraspinatus, infraspinatus, and serratus inferior right sight.

On day 35, the pain was reduced and the paresis was unchanged.

On day 63, the patient was free of pain and the range of arm movement slowly began to expand. Physiotherapy was still on going.

Conclusion: NA is a rare disease in adolescence. The diagnosis is made clinically. Neurophysiology studies and MRI are helpful to confirm diagnosis. Early treatment with corticosteroids can reduce pain. Physical therapy is necessary over a long period. Complete restitution is frequent.

Keywords: neuralgic amyotrophy in adolescence.