Brachial Plexus

Clinical case and images provided by Avneesh Chhabra, M.D., Johns Hopkins University School of Medicine, Baltimore, USA

Clinical question

27-year-old women with irritable bowel syndrome.

  • Multiple masses found in abdominal CT
  • Interpreted as Neurofibromatosis
  • Referred to Johns Hopkins Neurofirbomatosis clinic for further evaluation
  • Clinically found to have hand weakness bilaterally
  • EMG showed diffuse abnormality suggesting hereditary neuropathy or CIDP
  • Referred for Brachial Plexus MR Neurography for further evaluation

 

Clinical images

Interpretation

  • Diffusely enlarged and hyperintense bilateral brachial plexus segments
  • Symmetrical involvement
  • No abnormal enhancement
  • DTI - Symmetrically low FA values (0.2) and high ADC values - 1.9 and 2.0. Tractography shows mildly disrupted tracts
  • Diagnosis - Charcot Mary Tooth Disease (CMT)

 

Consequences for treatment

  • MR Neurography provided initial diagnosis for abnormality
  • MR Neurography served as pre-intervention road map for biopsy 
  • Final diagnosis - CMT type 1A
  • The diagnosis was proven from subsequent genetic testing and surgical biopsy of a intercostal lesion