There was no medial scapular winging that suggested that the long thoracic nerve was spared. Her left shoulder was drooping, with deltoid and supraspinatus muscles noticeably atrophied. She was breathless at rest and found it difficult to speak in complete sentences. On presentation at the authors’ hospital 10 months after the onset of symptoms, she appeared weak, anxious, and spoke in a low volume. Her symptoms remained undiagnosed for months and were treated unsuccessfully as laryngitis, tonsillitis, and pneumonia with non-steroidal anti-inflammatory drugs (NSAIDs) and antibiotics, which included 5-day courses of oral amoxicillin-clavulanic acid and oral azithromycin sequentially. She also reported regurgitation of liquids through her nose right after swallowing and difficulty swallowing liquids “unless she pushed through the left side of her throat.” The symptoms were accompanied by a change in her voice, described as high-pitched and low volume, as well as a paroxysmal cough and breathlessness. On Day 7 of symptom onset, she noticed gradual resolution in pain as well as onset of progressive weakness of the shoulder evidenced by drooping of the shoulder and weakness in lifting the arm above shoulder level, but no noticeable weakness of the forearm or hand. She had undergone a dental surgery for dental caries 2 weeks before the symptoms started. Her symptoms started about 10 months earlier as severe acute pain in the left shoulder, jaw, and chest. 3 CASE DESCRIPTIONĪ 35-year-old female presented with pain and severe progressive weakness of the left shoulder. The authors’ case is only the second report in the medical literature that shows this unique combination of brachial plexus, phrenic nerve, and recurrent laryngeal nerve palsies. While the typical presentation of PTS involves brachial plexus, other nerves like the lumbosacral plexus, phrenic nerves, and recurrent laryngeal nerves are rarely affected. 1,2 This condition, also known as brachial plexopathy, is centred around inflammatory damage to specific peripheral nerve bundles as evidenced by histopathologic and neurophysiologic studies (see Diagnostic Tests). It is thought to occur in 1–3 people in 100,000 however, this incidence might be an underestimation because of underdiagnosis. Parsonage–Turner Syndrome (PTS) is a rare autoimmune disease of the peripheral nervous system. This bears evidence that steroids and adjuvant therapy is useful even months after onset of the disease. This case was also remarkable for the significant improvement in her symptoms with treatment, despite the delay in diagnosis. The patient has recovered significantly since then and continues to improve.Ĭonclusion: The authors presented a case of PTS with a rare combination of brachial plexus, recurrent laryngeal nerve, and phrenic nerve injuries. A clinical diagnosis of exclusion of PTS was finally made, and treatment with steroids, neurotropic drugs, and physiotherapy was started. The symptoms remained undiagnosed for about 10 months.
The 35-year-old female presented with acute onset of severe left shoulder pain followed by severe progressive weakness of the left shoulder muscles, progressive weakness of her voice, nasal regurgitation of fluids, paroxysmal bouts of coughing, and exertional dyspnoea at rest.
They also highlight successful treatment with pharmacological intervention despite several months’ delay in diagnosis. The authors present a case of PTS with a rare combination of unilateral brachial plexus, phrenic nerve, and recurrent laryngeal nerve injuries. The limited data available typically describes involvement of branches of brachial nerves. Introduction: Parsonage–Turner Syndrome (PTS) is a rare disease of the brachial plexus of unclear aetiology.