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CIDP Causing Brachial Plexopathy

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This was a 21-year-old who had an antecedent infection

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approximately six weeks prior to presenting

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with a brachial plexopathy.

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The MRI of the brain was performed as well as the

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cervical spine. The brain was unremarkable.

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When we look at the cervical spine

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on T2-weighted imaging,

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we see enlargement of the nerve roots coming out of the

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neuroforamina and extending into the brachial plexus.

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Let's do a quick reminder about the

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anatomy of the brachial plexus.

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The brachial plexus is derived from the

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C5 through T1 nerve roots.

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And where we look for the brachial plexus, is behind

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the anterior scaling muscle, so posterior to it,

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but in front of the middle scaling,

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posterior scaling muscle complex.

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So it runs in that area between the two muscle groups.

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And you can see that as bright signal intensity here on

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the T2-weigghted scan coming from the neuroforamina.

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Now, in this case,

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the neuroforamina also appears to be enlarged bilaterally.

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Again, brachial plexus coming through here,

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and then it's going to run in close approximation to

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the subclavian artery. Now, as we look at this,

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we would say that this is a process which is extradural,

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that is, outside the thecal sac.

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However, on the post contrast scans,

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we see that in point of fact,

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these nerve roots are showing abnormal contrast

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enhancement with the anterior and posterior

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rootlets coming out of the spinal cord.

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In the neuroforamina,

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the nerve roots are also showing contrast enhancement

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as they extend from there into the brachial plexus.

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So this is indeed an intradural extra medullary, as well

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as an extradural process associated with enlargement of

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the nerve roots. In this case, an example of CIDP.

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CIDP may or may not show contrast enhancement of the nerve roots,

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but it does show enlargement,

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as you can see in the neuroforamina.

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If we were to look on a parasagittal

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image in the cervical spine,

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you would be able to see this as well manifesting as

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enlarged neuroforamina with nerve roots coming out

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and the enhancement intradural extramedullary.

Report

Description

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Tags

Spine

Non-infectious Inflammatory

Neuroradiology

Musculoskeletal (MSK)

MRI

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