Neoplastic Brachial Plexopathy
- Author: Mark A Wren, MD, MPH; Chief Editor: Robert H Meier III, MD more...
Background
Neoplastic brachial plexopathy (NBP) is an uncommon diagnosis in most physiatrists' offices, but the condition bears review as it can mimic symptoms of many common upper limb neuropathies. Approximately 10% of all peripheral nerve lesions involve some type of brachial plexus lesion. Neoplastic invasion of the brachial plexus is an uncommon, though not rare, cause of plexopathy. This article reviews the more common issues associated with physiatric treatment of patients with NBP.[1]
Pathophysiology
Lesions of the brachial plexus occur most often secondary to neoplasms that reach the plexus by direct extension (Pancoast syndrome) or, more commonly, by metastasis through lymphatics from the axilla. Pain in the shoulder, radiating down the limb, may be observed, as well as pain in the medial forearm and hand with lower trunk innervation (C8-T1 roots) in some series. The most common pathophysiology revealed on electrodiagnostic tests is axonal loss. Peripheral pain mechanisms may include lowering of the nociceptor threshold by prostaglandins and other noxious chemical substances and persistent nociceptor stimulation. Compression or infiltration of the nerves of the plexus by a tumor may produce neuralgia and inflammation.
Epidemiology
Frequency
United States
Approximately 14% of all upper limb neurologic lesions are due to brachial plexopathy of all types. Neoplastic plexopathies were responsible for 1.4 and 14.5% of symptoms in 2 series of patients who had undergone surgery. Insufficient data have been published to determine the frequency of NBP, but symptomatic NBP has been estimated to occur in 4% of patients with lung cancer and 2% of patients with breast cancer.
International
The international incidence of NBP is unknown.
Mortality/Morbidity
Primary neoplasms of the brachial plexus generally are benign, while secondary neoplasms are malignant. Most secondary tumors are metastatic, contributing to higher mortality.[2]
Sex
Solitary neoplastic lesions of the brachial plexus are more common in females. Neurofibromas demonstrate a male-to-female ratio of 1:1.
Age
Incidence of metastatic neoplasm of the brachial plexus increases with age; thus, the condition is more common in elderly patients.
Kim DH, Murovic JA, Tiel RL. A series of 397 peripheral neural sheath tumors: 30-year experience at Louisiana State University Health Sciences Center. J Neurosurg. Feb 2005;102(2):246-55.
Siqueira MG, Martins RS, Teixeira MJ. Management of brachial plexus region tumours and tumour-like conditions: relevant diagnostic and surgical features in a consecutive series of eighteen patients. Acta Neurochir (Wien). Sep 2009;151(9):1089-98. [Medline].
Kori SH, Foley KM, Posner JB. Brachial plexus lesions in patients with cancer: 100 cases. Neurology. Jan 1981;31(1):45-50. [Medline].
Killer HE, Hess K. Natural history of radiation-induced brachial plexopathy compared with surgically treated patients. J Neurol. Jul 1990;237(4):247-50.
Kamenova B, Braverman AS, Schwartz M, et al. Effective treatment of the brachial plexus syndrome in breast cancer patients by early detection and control of loco-regional metastases with radiation or systemic therapy. Int J Clin Oncol. Jun 2009;14(3):219-24. [Medline].
Gerevini S, Mandelli C, Cadioli M, Scotti G. Diagnostic value and surgical implications of the magnetic resonance imaging in the management of adult patients with brachial plexus pathologies. Surg Radiol Anat. Mar 2008;30(2):91-101. [Medline].
Cross NE, Glantz MJ. Neurologic complications of radiation therapy. Neurol Clin. Feb 2003;21(1):249-77. [Medline].
Dumitru D. Brachial plexopathy and proximal mononeuropathies. In: Electrodiagnostic Medicine. Philadelphia:. Hanley & Belfus Inc;1995:585-642.
Harper CM Jr, Thomas JE, Cascino TL, Litchy WJ. Distinction between neoplastic and radiation-induced brachial plexopathy, with emphasis on the role of EMG. Neurology. Apr 1989;39(4):502-6. [Medline].
Hathaway PB, Mankoff DA, Maravilla KR, et al. Value of combined FDG PET and MR imaging in the evaluation of suspected recurrent local-regional breast cancer: preliminary experience. Radiology. Mar 1999;210(3):807-14. [Medline].
Kline DG, Judice DJ. Operative management of selected brachial plexus lesions. J Neurosurg. May 1983;58(5):631-49.
Lachance DH, O''Neill BP, Harper CM Jr, et al. Paraneoplastic brachial plexopathy in a patient with Hodgkin''s disease. Mayo Clin Proc. Jan 1991;66(1):97-101.
Liang R, Kay R, Maisey MN. Brachial plexus infiltration by non-Hodgkin''s lymphoma. Br J Radiol. Nov 1985;58(695):1125-7. [Medline].
Meador KJ, Richards B, Hunter S, et al. Bibrachial palsy due to paraneoplastic encephalomyelitis. South Med J. Aug 1989;82(8):1053-5. [Medline].
Mukherji SK, Castillo M, Wagle AG. The brachial plexus. Seminars in Ultrasound, CT and MRI. Semin Ultrasound CT MR. Dec 1996;17(6):519-38. [Medline].
Pierce SM, Recht A, Lingos TI, et al. Long-term radiation complications following conservative surgery (CS) and radiation therapy (RT) in patients with early stage breast cancer. Int J Radiat Oncol Biol Phys. 1992;23(5):915-23. [Medline].
Stewart JB. The brachial plexus. In: Focal Peripheral Neuropathies. New York, NY:. Raven Press Ltd;1993:111-140.
Weber RJ. Rehabilitation issues in plexopathies. In: Physical Medicine and Rehabilitation. Philadelphia: WB Saunders Co:. 990-1001.
Wilbourn AJ. Brachial plexus disorders. In: Peripheral Neuropathy, PDPTJE. Philadelphia:. WB Saunders Co;1993:911-50.
Wilbourn AJ. Electrodiagnosis of plexopathies. Neurol Clin. Aug 1985;3(3):511-29. [Medline].
Print
