Severe Compression Neuropathy Following Sudden Onset of Parkinsonian Immobility

Kurlan, Roger; Baker, P. D.; Miller, Charlyne; Shoulson, Ira

doi:10.1001/archneur.1985.04060070114029

Cited by 14 publications

(8 citation statements)

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“…The onset timing of the disease could be logically inferred. Unlike the case of stereotyped posture-caused neural compression reported previously, [5,10] we inferred that repeated involuntary motion might have been 1 of the causes of the patient's nerve compression. Similarly to our case, by Luigi Vimercati et al [7] the profession of pizza chef exposing workers to several biomechanical risk factors (including repetitive and forceful movements of the hands and the elbows) for CTS and UN at the elbow was reported.…”

Section: Discussioncontrasting

confidence: 86%

“…Nerve compression caused by prolonged flexion posture is considered to be the primary cause of simultaneous bilateral UN. Kurlan et al [10] published a case series focused on three patients with Parkinson's disease and on-off motor fluctuations that developed severe compression neuropathy following a sudden onset off period. These 2 literatures concluded that antipsychotic-associated rigidity is the main cause of UN.…”

Section: Discussionmentioning

confidence: 99%

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Simultaneous bilateral ulnar neuropathy: an unusual complication caused by neuroleptic treatment-induced tardive dyskinesia

Wei

Yang²

2019

Medicine

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Rationale:In the past decade, only a few studies have focused on simultaneous bilateral ulnar neuropathy.Patient concerns:A 54-year-old Asian male who has suffered from paranoid schizophrenia for 2 years. He reported that flexion contracture occurring over his fourth and fifth fingers on both hands appeared since six months after he started taking the antipsychotic drug. The electromyogram revealed bilateral ulnar neuropathy with chronic axonal degeneration at the elbow level. McGowan classification was performed to evaluate the severity of the ulnar nerve injury, and the patient was diagnosed with a grade 3 injury on his left hand and a grade 2 injury on his right hand.Diagnosis:Simultaneous bilateral ulnar neuropathy at the elbow, a complication caused by tardive dyskinesia in a patient under the high-dose, first-generation, antipsychotic drug.Interventions:We consulted a psychiatrist to assist in adjusting the patient's kind of the antipsychotic drug and performed the anterior transposition of ulnar nerve to avoid nerve entrapment caused by tardive dyskinesia.Outcomes:Numbness of the palms continued to regress over the following 6 months after the anterior transposition of the ulnar nerve. Regression of the involuntary movements, including repeated bending of the elbows, and shaking of both feet, was noted from the patient but was incomplete.Lessons:Two literatures concluded that parkinsonian rigidity is the main cause of simultaneous bilateral ulnar neuropathy by Sampath et al and Kurlan et al. Unlike the cases of stereotyped posture-caused neural compression reported previously, we inferred that repeated involuntary motion caused by first-generation antipsychotic drug might have been one of the causes of the patient's nerve compression.

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Section: Discussioncontrasting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Simultaneous bilateral ulnar neuropathy: an unusual complication caused by neuroleptic treatment-induced tardive dyskinesia

Wei

Yang²

2019

Medicine

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“…Although autonomic involvement was extensively described in Parkinson’s disease (PD) and other forms of parkinsonism (e.g. multiple system atrophy, Lewy body disease), the presence of sensorimotor peripheral neuropathy (PN) was only detailed in case reports and small case series until recently [ 1 , 2 ]. In the early 2000s, peripheral neuropathy was thought to be present in genetic forms of Parkinson’s disease [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Small (autonomic) and large fiber neuropathy in Parkinson disease and parkinsonism

et al. 2016

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BackgroundRecent studies have reported that peripheral neuropathy (PN) is common in patients with Parkinson’s disease (PD) and raised the possibility that levodopa neurotoxicity is the main culprit.MethodsWe evaluated the presence of large & small (autonomic) fiber PN in 54 consecutive patients with PD or parkinsonism in a tertiary outpatient clinic from Brazil. Initial PN screening consisted of history/neurological exam and skin wrinkling test (SWT). In addition, we also performed Nerve conduction studies/Electromyography (NCS/EMG) in all patients with PN signs/symptoms and/or abnormal SWT.ResultsThirty eight patients with PD (10 women, mean age: 63 ± 2.1 years, P < 0.05 versus parkinsonism, mean disease duration: 8 ± 0.8 years) and 16 patients with other forms of parkinsonism [7 women, mean age: 50.1 ± 3.9 years, mean disease duration: 6.9 ± 1.1 years] completed clinical neuromuscular evaluation. SWT was performed in 48 patients (33 PD, 15 parkinsonism). In the PD group, SWT was abnormal in 57.6 % of the tested patients (comprising 50 % of all PD patients). In the parkinsonism group, SWT was abnormal in 37.5 % (comprising 35.3 % of all parkinsonism patients). NCS/EMG was performed in 39 patients (26 PD and 13 parkinsonism). Twelve out of the 26 PD (34.2 % of all PD) and 4 out of the 13 parkinsonism (23.5 % of all parkinsonism) had abnormal NCS/EMG results. Neuropathy prevalence was similar in PD and parkinsonism groups as detected either by NCS/EMG or SWT.ConclusionsLarge fiber and small (autonomic) fiber PN are common in patients with PD and parkinsonism. The etiology for the neuropathy was likely to be multifactorial and may be secondary to PD itself.Electronic supplementary materialThe online version of this article (doi:10.1186/s12883-016-0667-3) contains supplementary material, which is available to authorized users.

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“…Radial nerve palsy was the most common and its prognosis did not differ from other cause . There has been only one report of brachial plexopathy associated with PD . The reason for this rarity of traumatic nerve injuries in PD might be that these nerve injuries commonly occur in the advanced stage.…”

Section: Discussionmentioning

confidence: 99%

“…The occurrence of compression neuropathy was not uncommon in disabled patients. 2 Immobility in PD also can cause compression nerve injury. Radial nerve palsy was the most common and its prognosis did not differ from other cause.…”

Section: Discussionmentioning

confidence: 99%

Traumatic brachial plexopathy in a patient with off‐state Parkinson disease

Hoshiyama

Kokubun

Hirata

2018

Neurology & Clinical Neurosc

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The patient was a 67-year-old woman who had an advanced Parkinson disease. She developed flaccid monoplegia with areflexia in the right upper limb after a fall during off-state. Neurophysiological examinations revealed a neurapraxia in the proximal segment of the peripheral nerves. MRI showed high signal intensity in the right supraclavicular area including the brachial plexus and peripheral tissue on short TI inversion recovery images, which supported the diagnosis of the crush injury. The diagnosis of the traumatic brachial plexopathy was made. By the combination of neurophysiological examination and MRI, more elaborate diagnosis of the traumatic nerve injuries can be made.

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Severe Compression Neuropathy Following Sudden Onset of Parkinsonian Immobility

Cited by 14 publications

References 1 publication

Simultaneous bilateral ulnar neuropathy: an unusual complication caused by neuroleptic treatment-induced tardive dyskinesia

Simultaneous bilateral ulnar neuropathy: an unusual complication caused by neuroleptic treatment-induced tardive dyskinesia

Small (autonomic) and large fiber neuropathy in Parkinson disease and parkinsonism

Traumatic brachial plexopathy in a patient with off‐state Parkinson disease

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