Non‐Sedated Rapid Volumetric Proton Density MRI Predicts Neonatal Brachial Plexus Birth Palsy Functional Outcome

Shen, Peter Y.; Nidecker, Anna E.; Neufeld, Ethan A.; Lee, Paul S.; James, Michelle A.; Bauer, Andrea S.

doi:10.1111/jon.12389

Cited by 8 publications

(4 citation statements)

References 26 publications

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“…New protocols are implemented instead of MRI protocols that require sedation and long-term imaging. Rapid non-sedated volumetric Cube Proton Density MRI protocol detected the location and severity of the injury quickly and accurately without sedation [16,17].…”

Section: Discussionmentioning

confidence: 99%

Long term outcome in obstetric brachial plexus injury at a tertiary care center

Tekin¹,

Olukman²

2022

Journal of Surgery and Medicine

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Background/Aim: Obstetric brachial plexus injury (OBPI) is caused by traction to the brachial plexus during labor. Traction injury may vary from neurapraxia or axonotmesis to neurotmesis and can cause edema, avulsion, or rupture of the nerve. Improvement in the first two weeks after birth is a good indicator of outcome. The disability varies according to the location and severity of the effect in the plexus. However, most injuries are transient, with a total return of function in many cases. This study aimed to obtain clues for the prevention and follow-up of obstetric brachial plexus injuries by revealing the outcome and clinical features. Methods: In this retrospective cohort study, hospital records of patients with brachial plexus injury due to delivery were reviewed between January 2017 and September 2021. Injury levels, birth weights, other injuries at birth, maternal age, gravidity, gestation time, and treatment response were recorded. Brachial plexus injuries of the patients were classified per the NARAKAS classification. The Spearman correlation and Pearson correlation tests were used for correlation analyses. The variables were evaluated with the Chi-Square and Student's t-tests. The normality of the distribution was assessed with the Kolmogorov-Smirnov test. A value of P<0.05 was considered statistically significant. Results: Thirty-nine cases were included in the study (21 males, 18 females). The mean and median birth weights were 3857 (392) grams, and 3880 (3100-4600) grams, respectively. The median gestational week of birth was 39 weeks. Most mothers were primigravida. All patients were born by vaginal delivery. Per the NARAKAS classification, 29 patients (74.4%) were in group 1, 5 patients (12.8%) were in group 2, 4 patients (10.3%), in group 3, and 1 patient (2.5%) was in group 4. The mean follow-up period was 23.2 (14.1) months. Twenty-four patients recovered spontaneously; six had sequelae without functional impairment, five had sequelae with functional impairment, and two had contractures. The relationship between the NARAKAS groups and birth weight was insignificant (P=0.09). There was a significant correlation between the NARAKAS group and recovery (P<0.001). A correlation was found between sequelae and functional loss (P=0.01) and the NARAKAS group. Functional loss was not related to maternal age, week of birth, birth weight, baby gender (P=0.15, P=0.30, P=0.20, P=0.15 respectively). Conclusion: Permanent functional loss in brachial plexus injury is associated with the NARAKAS classification, and patients in groups 3 and 4 should undergo imaging as soon as possible. Electromyography (EMG), a complex invasive procedure for the newborn, should be preferred if there is no satisfactory recovery. We recommend performing brachial plexus magnetic resonance imaging before EMG to give the patient a chance for early surgery.

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Section: Discussionmentioning

confidence: 99%

Long term outcome in obstetric brachial plexus injury at a tertiary care center

Tekin¹,

Olukman²

2022

Journal of Surgery and Medicine

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“…The dorsal root ganglion, located just proximal to this landmark, is a key structure for the classification of preganglionic and postganglionic lesions (►Fig. 2). Each spinal nerve diverges distally into dorsal and ventral rami.…”

Section: Brachial Plexus Anatomymentioning

confidence: 99%

“…The role of imaging is evolving with advancements of magnetic resonance imaging (MRI) that allow direct visualization of nerve injury that could benefit from early intervention. 2 For patients with persistent neurologic deficits, clinical and radiologic evaluation is crucial. Untreated BPBP can progress to significant sequelae, such as muscle contractures and glenohumeral dysplasia (GHD).…”

mentioning

confidence: 99%

Brachial Plexus Birth Palsy: Practical Concepts for Radiologists

Gonzalez-Mantilla

Abril

Bedoya

2022

Semin Musculoskelet Radiol

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Brachial plexus birth palsy (BPBP) is classified as a preganglionic or postganglionic injury based on the site of injury. Most patients recover spontaneously and are followed up with clinical evaluation; however, permanent sequelae are not uncommon. For patients with persistent neurologic deficits, clinical and radiologic evaluation is crucial. Untreated BPBP can progress to significant sequelae, such as muscle contractures and glenohumeral dysplasia (GHD). Timely characterization of these entities based on different imaging modalities is a high priority for optimal patient outcomes. We describe the anatomy and pathogenesis, as well as the different imaging modalities involved in the evaluation and classification of BPBP and GHD.

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“…3). 22 Using this system, each injured level was first assigned 1 point. Additional points were then assigned based on the location (pre-vs postganglionic) and severity of the injury.…”

Section: Mri Protocolmentioning

confidence: 99%