Late-onset radiation-induced brachial plexopathy

Abstract

The late-onset variant of radiation-induced brachial plexopathy is most often seen after treatment for breast or lung cancers. It has an insidious onset, with symptoms noted years after receiving radiotherapy, and the condition gradually continues to deteriorate with time. We present the case of an elderly man who we saw in view of worsening paraesthesias and weakness of his left arm with associated prominent muscle wasting along the left shoulder girdle. Fifteen years prior to this, he had received radiotherapy for the treatment of nasopharyngeal carcinoma.

Keywords: neurological injury; neurology; peripheral nerve disease; radiology; radiotherapy.

Figure 1

Marked muscle wasting of the left shoulder girdle.

Figure 2

Radiation-induced dermatitis—a sharply delineated, hypopigmented rash can be seen over the left posterior and lateral aspects of the neck.

Figure 3

Radiation maculopathy, worse on the left. Images taken in 2007.

Figure 4

Coronal T2-weighted Short-tau Inversion Recovery MRI of the brachial plexus, showing a relatively thickened and fluid hyperintense brachial plexus on the left, with mild loss of volume and intramuscular fatty streaking throughout most of the visualised shoulder girdle musculature when compared with the right side.

Figure 5

This diagram describes the pathophysiology of RIBP and the development of symptoms. It also shows the classical nerve conduction study and electromyography findings. This diagram was created by Dr. Kelly Anne Attard. RIBP, radiation-induced brachial plexopathy.

Figure 6

This diagram, created by Dr. Kelly Anne Attard, is a representation of the anatomical relations of the brachial plexus (A). It also shows the relations of the brachial plexus to the lymph node levels of the neck (B).