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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Parsonage&#8211;Turner syndrome &#40;PTS&#41; is a neuritis of the idiopathic brachial plexus&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> We report the case of a patient affected by this disorder&#44; which had no triggering factor&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The patient was 67-year-old man with type 2 diabetes mellitus&#44; with good metabolic control and obstructive sleep apnea hypopnea syndrome&#46; He had been diagnosed with a lung squamous cell carcinoma&#44; stage pT<span class="elsevierStyleInf">1</span>apN<span class="elsevierStyleInf">0</span>&#44; in March 2015&#46; He was treated with left upper lobectomy and lymphadenectomy&#46; He was admitted to our hospital in November after several days of severe pain in the right scapular region&#44; followed by paresis involving extension of his 4th finger&#44; with no history of traumatic injury or infection&#46; Physical examination revealed weakness in dorsal interossei and in all the extensor carpi&#44; with slight amyotrophy&#46; He underwent cervicothoracic computed tomography&#44; which ruled out lung apex disease&#44; as well as cervical magnetic resonance imaging &#40;MRI&#41;&#44; which revealed spondyloarthrosis without myelopathy&#44; and MRI of the brachial plexus&#44; which showed no changes&#46; An electromyogram performed 2 weeks after symptom onset indicated right brachial plexopathy with inferior predominance &#40;C8-T1&#41;&#46; Cerebrospinal fluid was normal&#46; Suspecting PTS&#44; we began treatment with analgesics&#44; glucocorticoids and rehabilitation&#44; which achieved resolution of the pain and nearly complete recovery of the movement of the 4th finger 2 months later&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Parsonage&#8211;Turner syndrome &#40;amyotrophic neuralgia&#41; is an acute neuritis of the brachial plexus characterized by shoulder pain&#44; followed by a motor deficit and muscle atrophy&#44; generally in the shoulder and the area of the elbow&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> There are idiopathic and hereditary forms&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> In the idiopathic form&#44; 50&#37; of the patients are exposed to a previous event &#40;infection&#44; surgery&#44; systemic disease or vaccination&#41;&#44; which would activate lymphocytes sensitized to the brachial plexus in individuals with a genetic predisposition&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;3&#44;4</span></a> A number of cases of PTS have been reported after different types of surgery&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;5&#44;6</span></a> Some authors suggest that surgical stress could activate an unidentified virus that remains latent in the peripheral nervous system&#44; as occurs in some cases of postoperative reactivation of herpes zoster&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> Others propose a mechanical lesion affecting the plexus during general anesthesia&#46; Our patient was subjected to pulmonary surgery &#40;contralateral to the clinical findings&#41; during the previous months&#46; However&#44; we do not consider that to be a triggering factor&#44; since the clinical signs develop soon after surgery &#40;1&#8211;13<span class="elsevierStyleHsp" style=""></span>days&#41; in all the reported cases&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">It especially affects men&#44; ranging from 20 to 60 years old&#44; with an incidence of 1&#46;6&#8211;3<span class="elsevierStyleHsp" style=""></span>cases&#47;100<span class="elsevierStyleHsp" style=""></span>000<span class="elsevierStyleHsp" style=""></span>population&#47;year&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> The typical clinical signs and symptoms consist of severe pain in the shoulder&#44; that develops suddenly and is not traumatic&#44; and frequently radiates toward the cervical region and the outside of the arm&#46; After a variable period of time&#44; muscle atrophy appears&#44; followed by paresis&#59; the latter is flaccid&#44; patchy and progressive&#44; and its distribution does not always coincide with the painful area&#46; It can affect several peripheral nerves and nerve roots &#40;especially C5 and C6&#41; or a combination of both&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> A third of the patients develop bilateral and symmetrical symptoms&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> The diagnosis is based on the medical records&#44; physical examination and the electromyogram&#44; which typically shows acute denervation in a specific nerve or a patchy nerve loss throughout the entire plexus&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> Magnetic resonance imaging of the cervical spine and brachial plexus can&#44; in the initial phases&#44; look normal or have hyperintense signals in T2 due to muscle edema&#44; and&#44; once atrophy is established&#44; there can be an increased intramuscular linear signal intensity in T1 due to fatty infiltration&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> The attempt is made to treat the symptoms with analgesics&#44; immobility of the limb and rehabilitation&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> The use of moderate doses of glucocorticoids at the initiation seems to relieve the pain and accelerate recovery&#44; which is generally slow &#40;from months to years&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> After 3<span class="elsevierStyleHsp" style=""></span>years&#44; a third of the patients have chronic pain and 2 thirds have a functional deficit&#44; and the recurrence rate is 26&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare they have no conflicts of interest&#46;</p></span></span>"
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Letter to the Editor
Parsonage–Turner Syndrome: A Case Report
Síndrome de Parsonage-Turner: a propósito de un caso
Itxasne Cabezón
Corresponding author
itxascabezon@yahoo.es

Corresponding author.
, Guillermo Barreiro, María Victoria Egurbide
Servicio de Medicina Interna, Hospital Universitario de Cruces, Baracaldo, Vizcaya, Spain
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with no history of traumatic injury or infection&#46; Physical examination revealed weakness in dorsal interossei and in all the extensor carpi&#44; with slight amyotrophy&#46; He underwent cervicothoracic computed tomography&#44; which ruled out lung apex disease&#44; as well as cervical magnetic resonance imaging &#40;MRI&#41;&#44; which revealed spondyloarthrosis without myelopathy&#44; and MRI of the brachial plexus&#44; which showed no changes&#46; An electromyogram performed 2 weeks after symptom onset indicated right brachial plexopathy with inferior predominance &#40;C8-T1&#41;&#46; Cerebrospinal fluid was normal&#46; Suspecting PTS&#44; we began treatment with analgesics&#44; glucocorticoids and rehabilitation&#44; which achieved resolution of the pain and nearly complete recovery of the movement of the 4th finger 2 months later&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Parsonage&#8211;Turner syndrome &#40;amyotrophic neuralgia&#41; is an acute neuritis of the brachial plexus characterized by shoulder pain&#44; followed by a motor deficit and muscle atrophy&#44; generally in the shoulder and the area of the elbow&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> There are idiopathic and hereditary forms&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> In the idiopathic form&#44; 50&#37; of the patients are exposed to a previous event &#40;infection&#44; surgery&#44; systemic disease or vaccination&#41;&#44; which would activate lymphocytes sensitized to the brachial plexus in individuals with a genetic predisposition&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;3&#44;4</span></a> A number of cases of PTS have been reported after different types of surgery&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;5&#44;6</span></a> Some authors suggest that surgical stress could activate an unidentified virus that remains latent in the peripheral nervous system&#44; as occurs in some cases of postoperative reactivation of herpes zoster&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> Others propose a mechanical lesion affecting the plexus during general anesthesia&#46; Our patient was subjected to pulmonary surgery &#40;contralateral to the clinical findings&#41; during the previous months&#46; However&#44; we do not consider that to be a triggering factor&#44; since the clinical signs develop soon after surgery &#40;1&#8211;13<span class="elsevierStyleHsp" style=""></span>days&#41; in all the reported cases&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">It especially affects men&#44; ranging from 20 to 60 years old&#44; with an incidence of 1&#46;6&#8211;3<span class="elsevierStyleHsp" style=""></span>cases&#47;100<span class="elsevierStyleHsp" style=""></span>000<span class="elsevierStyleHsp" style=""></span>population&#47;year&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> The typical clinical signs and symptoms consist of severe pain in the shoulder&#44; that develops suddenly and is not traumatic&#44; and frequently radiates toward the cervical region and the outside of the arm&#46; After a variable period of time&#44; muscle atrophy appears&#44; followed by paresis&#59; the latter is flaccid&#44; patchy and progressive&#44; and its distribution does not always coincide with the painful area&#46; It can affect several peripheral nerves and nerve roots &#40;especially C5 and C6&#41; or a combination of both&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> A third of the patients develop bilateral and symmetrical symptoms&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> The diagnosis is based on the medical records&#44; physical examination and the electromyogram&#44; which typically shows acute denervation in a specific nerve or a patchy nerve loss throughout the entire plexus&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> Magnetic resonance imaging of the cervical spine and brachial plexus can&#44; in the initial phases&#44; look normal or have hyperintense signals in T2 due to muscle edema&#44; and&#44; once atrophy is established&#44; there can be an increased intramuscular linear signal intensity in T1 due to fatty infiltration&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> The attempt is made to treat the symptoms with analgesics&#44; immobility of the limb and rehabilitation&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> The use of moderate doses of glucocorticoids at the initiation seems to relieve the pain and accelerate recovery&#44; which is generally slow &#40;from months to years&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> After 3<span class="elsevierStyleHsp" style=""></span>years&#44; a third of the patients have chronic pain and 2 thirds have a functional deficit&#44; and the recurrence rate is 26&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare they have no conflicts of interest&#46;</p></span></span>"
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