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Abstract Details

Idiopathic Brachial Plexopathy Presenting with Unilateral Vocal Cord Paresis
Neuromuscular and Clinical Neurophysiology (EMG)
P9 - Poster Session 9 (5:30 PM-6:30 PM)
Idiopathic brachial plexopathy (IBP) is an inflammatory disorder of the brachial plexus.  The exact mechanism is yet to be elucidated, but an autoimmune process has been hypothesized.  It typically involves the suprascapular, long thoracic, musculocutaneous, radial, anterior interosseous, and axillary nerves.  Rarely, the phrenic and recurrent laryngeal nerves may be affected. We report a case of IBP with an atypical presentation of unilateral vocal cord paresis.


Case Report:  A 31-year-old gentleman presented with an 8-week history of hoarseness with associated left shoulder girdle weakness.  He had no antecedent vaccination, flu-like illness, trauma, or shoulder injury.  He had no neck pain, radicular pain, shoulder pain, facial weakness, dysphagia, or paresthesias.  Clinical examination was essentially normal save for the dysphonia, left medial scapular winging, and left rhomboid and serratus anterior weakness.  Cervical spine MRI showed mild posterior disc bulges at C2-C6 levels.  No significant foraminal narrowing or abnormal spinal cord signals were noted.  Left shoulder MRI showed findings suggestive of rotator cuff tendinosis versus partial rotator cuff tear.  Chest and neck CT scan showed thickening and medialization of the left true vocal fold with associated superomedial displacement of the left false vocal cord.  Laryngeal electromyography (EMG) showed evidence of a left focal recurrent laryngeal mononeuropathy.  Routine nerve conduction studies (NCS) in the arms and legs were normal.  EMG showed chronic denervation in the left rhomboid and serratus anterior.  The rest of the ancillary tests were unrevealing.  The patient was given prednisone (1mg/kg) tapered within 14 days and underwent physiotherapy.  He noticed significant improvement at around 10-12 weeks from symptom onset.  He had complete recovery within one year.
Hoarseness with accompanying shoulder girdle muscle weakness may be a manifestation of idiopathic brachial plexopathy even in the absence of the typical preceding symptom of rapid or subacute shoulder or scapular pain.
Marjorie Anne Dela Cruz Bagnas, MD (Kingston Health Sciences Centre - Kingston General Hospital Site)
Dr. Bagnas has nothing to disclose.