vitamin-b-12 and Brachial-Plexus-Neuropathies

This article reports a case of a 59-year-old male who suffered from left brachial plexopathy occurring at night in bed. He had experienced multiple surgical courses of thyroid tumor resection including neck dissection and had presented left secondary jugular phlebectasia Jugular phlebectasia is mainly congenital and sometimes secondarily induced by compression, mechanical ventilation, trauma, thrombosis, etc. Brachial plexopathy is usually caused by neck and arm trauma, additionally caused by iatrogenic nerve and vessel injury. To our knowledge, this is the first report of brachial plexopathy accompanied by ipsilateral jugular phlebectasia. We hypothesized the etiology of this case through multimodal examinations and reviewed the literature about jugular phlebectasia and brachial plexopathy.

Topics: Brachial Plexus Neuropathies; Diagnostic Imaging; Dilatation, Pathologic; Humans; Jugular Veins; Male; Middle Aged; Physical Therapy Modalities; Postoperative Complications; Thyroid Neoplasms; Vitamin B 12

A 64-year-old woman underwent open-heart surgery for repair of atrial septal defect (ASD) and tricuspid valve regurgitation. Preoperative complications included rheumatoid arthritis with pain in both wrists treated with methotrexate. Following smooth endotrachial intubation, a pulmonary arterial (PA) catheter was inserted into the right jugular vein after several attempts. She was placed in a supine position with abduction of the shoulders to approximately 90 degrees and of the elbows to 60 degrees. Operation was performed through sternum splitting to second intercostal space, and the 4-h intraoperative course was uneventful. On the first postoperative day, she complained of inability to raise her right arm. Neurological examination revealed marked weakness of the deltoid and biceps brachialis muscles, and decreased sensitivity around the right shoulder. Iatrogenic brachial plexus injury was diagnosed. Administration of vitamin B12 and physical therapy were instituted. Symptoms improved gradually and had disappeared by 3 months postoperatively. Neuropathy might be attributed to stretch and compression of the brachial plexus caused by traction of the pectoralis minor muscle enhanced by sternotomy and/or malposition of the upper extremity, or direct injury due to cannulation of the PA catheter into the internal jugular vein.

Topics: Anesthesia, General; Brachial Plexus; Brachial Plexus Neuropathies; Cardiac Surgical Procedures; Catheterization, Swan-Ganz; Female; Humans; Iatrogenic Disease; Middle Aged; Physical Therapy Modalities; Postoperative Complications; Vitamin B 12