Simultaneous traumatic brachial plexopathy and cervical root avulsion

Abstract

We report a 38-year-old man who sustained combined brachial plexus injury and cervical root avulsion after a fall. Such combined injuries are not very common and the diagnosis of a combined lesion needs a high index of suspicion. The electrophysiological evaluation of a brachial monoplegia showing absent sensory nerve action potentials (SNAPs) and denervation in the appendicular muscles confirm a lesion distal to dorsal root ganglion. If the study is terminated at this point, a co-existing preganlionic lesion can be easily missed due to the exclusion of cervical paraspinal muscles during electromyography (EMG). This report emphasizes that in every instance of a traumatic brachial plexopathy, an additional preganglionic lesion like a root avulsion must be suspected and may be carefully evaluated by means of electrophysiologic techniques and myelographic computerized axial tomography (MCT) scan or magnetic resonance imaging (MRI). A brief review of neuroimaging techniques and their correlation with electrodiagnostic findings in cervical root avulsion is also presented.