Intercostal nerve mononeuropathy: study of 14 cases

Abstract

-This re t rospective study describes 14 cases of intercostal nerve mononeuropathy (INM) found in 5,560 electromyography (EMG) exams perf o rmed between January 1991 and June 2004 in our University Hospital. Medical charts of all patients with history of thoracic pain and EMG diagnosis of intercostal monon e u ropathy were reviewed. INM was detected in 14 patients; etiology was thoracic surg e ry in 6 (43%), post-herpetic neuropathy in 4 (28%), probable intercostal neuritis in 2 (14%), lung neoplasia in 1 (7%), and radiculopathy in 1 (7%). From this study, trauma and infection were the main etiologies in intercostal neuropathic pain development. Tricyclic antidepressants and anticonvulsants were the most common therapeutic drugs used.KEY WORDS: intercostal mononeuropathy, EMG, etiology. Mononeuropatia de nervo intercostal: estudo de 14 casosRESUMO -Este trabalho apresenta estudo re t rospectivo de 14 pacientes com mononeuropatia de nerv o i n t e rcostal (MNI), obtidos dentre 5.560 exames eletromiográficos, realizados de janeiro de 1991 até junho de 2004, em nosso Hospital Universitário. MNI foi encontrada em 14 pacientes, tendo como causas prováveis intervenções cirúrgicas torácicas em 6 (43%), neuropatia por herpes-zoster em 4 (28%), pro v á v e l neurite de nervo intercostal em 2 (14%), neoplasia pulmonar em 1 (7%) e radiculopatia em 1 (7%). As principais causas de MNI de nosso Serviço são similares às da literatura. Os antidepressivos tricíclicos e anticonvulsivantes foram os fármacos mais utilizados no controle da dor. PALAVRAS-CHAVE: mononeuropatia intercostal, EMG, etiologia.The first descriptions of intercostal nerve monon e u ropathy (INM) were re p o rted by USA army surgeons treating patients with chronic pain after t h oracotomy as a result of thoracic trauma during the Second World Wa r 1 . There is an estimated 11 to 8 0 % incidence of chronic pain after thoracotomy 2 , but c h ronic pain tends to reduce over time 3 . High doses of analgesics consumed during the first week a f t e r s u rg e rymay be a risk factor for pain after thoracotomy 3 . However, low-dose treatment of post-surgical pain induces the liberation of stress re l a t e d chemical mediators, which may cause pulmonary, c a rd i o v a s c u l a r, metabolic and neuro e n d o c h r i n e d i s t u r b a n c e s 4 . Despite these clinical problems, int e rcostal nerves have been transferred to the brachial plexus to treat traumatic brachial plexopathy with minimal effects on pulmonary function 5 . The first clinical descriptions related to Va r i c e l l a zoster were in the XIX century 6 . Infection by Va r icella zoster is also a common cause of INM 7 , usually presented as unilateral vesicular eruption in a b e l tlike distribution mainly on the thoracic sensory d e rmatomes, most cases preceded by pain and pare sthesias. The prognosis is usually good, most cases p resents complete re c o v e ryor significant impro v em e n t 7 . Atypical clinical presentations are described in imunosupressed patients 7 . The objective of o...

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