Plexopathy

Plexopathy is a disorder affecting a network of nerves, blood vessels, or lymph vessels.[1] The region of nerves it affects are at the brachial or lumbosacral plexus. Symptoms include pain, loss of motor control, and sensory deficits.[2]

There are two main types of plexopathy: brachial plexopathy and lumbosacral plexopathy. They are usually caused from some sort of localized trauma such as a dislocated shoulder. The disorder can also be caused secondary to a compression, co-morbid vascular disease, infection, or may be idiopathic with an unknown cause.[2] Both plexopathies can also occur as a consequence of radiation therapy,[3] sometimes after 30 or more years have passed, in conditions known as Radiation-induced Brachial Plexopathy (RIBP)[4] and Radiation-induced Lumbosacral Plexopathy (RILP).[5]

Evaluation and management

The first steps in the evaluation and later management of plexopathy would consist of gathering a medical history and conducting a physical examination by a healthcare clinician. Motor function defect patterns detected within either the upper or lower extremities help with diagnosis of the disorder.[2]

X-rays of the cervical spine, chest, and shoulder are usually ordered if symptoms point to acute Brachial plexopathy. If the physical history reveals a history of diabetes, collagen vascular disease, or symptoms of infection, the physician may order a series of blood tests including a complete blood count (CBC) and a comprehensive metabolic panel (CMP).[2]

Treatment

Mild cases are usually treated by the administration of analgesia and muscle relaxers. Reduced and limited physical activity with repeated follow-ups with the health care provider are required for one diagnosed with plexopathy. Individuals with prolonged, chronic symptoms will require additional testing and treatment.[2] With brachial plexopathy, surgical decompression may be warranted if the pathophysiology of the disease is causing pressure on the affected nerves. In some cases of brachial plexopathy, no treatment is required and recovery happens on its own.[6] Treatment for lumbosacral plexopathy that is not caused by trauma, but instead from diabetic plexopathy, is directed at controlling the person's blood sugar level. By preventing the deterioration of the nerve fibers from hyperglycemia, patients may recover significant muscle strength.[7] For radiation-induced plexopathies, treatment options are limited to pain/symptom mananagement and provision of assistive devices.

Disposition

Plexopathy symptoms often resemble spinal cord disorders.[8] A neurosurgical consultation is usually undertaken to ensure proper diagnosis, management, and treatment. Patients with chronic symptoms will likely be advised to follow up with outpatient care from either their health care provider or specialist.[2]

See also

References

  1. ↑ Plexopathy entry in the public domain NCI Dictionary of Cancer Terms
  2. 1 2 3 4 5 6 Allan B. Wolfson, ed. (2005). Harwood-Nuss' Clinical Practice of Emergency Medicine (4th ed.). pp. 614–615. ISBN 0-7817-5125-X.
  3. ↑ "Radiation plexopathy - Introduction". www.medmerits.com. Retrieved 2016-03-03.
  4. ↑ "Radiation-Induced Brachial Plexopathy: Background, Pathophysiology, Epidemiology".
  5. ↑ "Radiation-Induced Lumbosacral Plexopathy: Background, Pathophysiology, Epidemiology".
  6. ↑ "Brachial Plexopathy". Health Guide. The New York Times. 2009-12-09. Retrieved 10 December 2009.
  7. ↑ "Lumbosacral Plexopathies: Diagnosis and rehabilitation". BNET. CBS Interactive Inc. 1999. Retrieved 10 December 2009.
  8. ↑ Dyck, PJ; Thomas, PK (1993). Peripheral Neuropathy (3rd ed.). Philadelphia: WB Sanders.

 This article incorporates public domain material from the U.S. National Cancer Institute document "Dictionary of Cancer Terms".

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