The Diagnostic Value of CT Myelography, MR Myelography, and Both in Neonatal Brachial Plexus Palsy

Tse, Raymond; Nixon, Jason N.; Iyer, Ramesh S.; Kuhlman-Wood, Kate; Ishak, Gisele E.

doi:10.3174/ajnr.a3878

Cited by 35 publications

(39 citation statements)

References 49 publications

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“…Computed tomography (CT) myelography and magnetic resonance imaging (MRI) can help characterize injury patterns and can distinguish between pre-ganglionic and post-ganglionic injury. Both modalities are highly correlated (no advantage to using both), although MRI eliminates the radiation exposure [39]. Currently, BPBP remains a clinical diagnosis based on exam.…”

Section: Discussionmentioning

confidence: 99%

The natural history and management of brachial plexus birth palsy

Buterbaugh

Shah

2016

Curr Rev Musculoskelet Med

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Brachial plexus birth palsy (BPBP) is an upper extremity paralysis that occurs due to traction injury of the brachial plexus during childbirth. Approximately 20 % of children with brachial plexus birth palsy will have residual neurologic deficits. These permanent and significant impacts on upper limb function continue to spur interest in optimizing the management of a problem with a highly variable natural history. BPBP is generally diagnosed on clinical examination and does not typically require cross-sectional imaging. Physical examination is also the best modality to determine candidates for microsurgical reconstruction of the brachial plexus. The key finding on physical examination that determines need for microsurgery is recovery of antigravity elbow flexion by 3-6 months of age. When indicated, both microsurgery and secondary shoulder and elbow procedures are effective and can substantially improve functional outcomes. These procedures include nerve transfers and nerve grafting in infants and secondary procedures in children, such as botulinum toxin injection, shoulder tendon transfers, and humeral derotational osteotomy.

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Section: Discussionmentioning

confidence: 99%

The natural history and management of brachial plexus birth palsy

Buterbaugh

Shah

2016

Curr Rev Musculoskelet Med

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“…29 Given that neurotmetic lesions or root avulsions will not spontaneously recover, work has focused on the earlier identification of such lesions by imaging as a means of improving clinical decision making. 32,35 Other work has focused on additional examination findings that suggest the poor likelihood of spontaneous recovery as a means of improving surgical stratification. For example, concurrent phrenic nerve palsy in patients with NBPP has been shown to portend a poor likelihood of spontaneous recovery.…”

Section: Discussionmentioning

confidence: 99%

Peripartum and neonatal factors associated with the persistence of neonatal brachial plexus palsy at 1 year: a review of 382 cases

Wilson

Chang

Chauhan

et al. 2016

PED

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OBJECTIVE Neonatal brachial plexus palsy (NBPP) occurs due to the stretching of the nerves of the brachial plexus before, during, or after delivery. NBPP can resolve spontaneously or become persistent. To determine if nerve surgery is indicated, predicting recovery is necessary but difficult. Historical attempts explored the association of recovery with only clinical and electrodiagnostic examinations. However, no data exist regarding the neonatal and peripartum factors associated with NBPP persistence. METHODS This retrospective cohort study involved all NBPP patients at the University of Michigan between 2005 and 2015. Peripartum and neonatal factors were assessed for their association with persistent NBPP at 1 year, as defined as the presence of musculoskeletal contractures or an active range of motion that deviated from normal by > 10° (shoulder, elbow, hand, and finger ranges of motion were recorded). Standard statistical methods were used. RESULTS Of 382 children with NBPP, 85% had persistent NBPP at 1 year. A wide range of neonatal and peripartum factors was explored. We found that cephalic presentation, induction or augmentation of labor, birth weight > 9 lbs, and the presence of Horner syndrome all significantly increased the odds of persistence at 1 year, while cesarean delivery and Narakas Grade I to II injury significantly reduced the odds of persistence. CONCLUSIONS Peripartum/neonatal factors were identified that significantly altered the odds of having persistent NBPP at 1 year. Combining these peripartum/neonatal factors with previously published clinical examination findings associated with persistence should allow the development of a prediction algorithm. The implementation of this algorithm may allow the earlier recognition of those cases likely to persist and thus enable earlier intervention, which may improve surgical outcomes.

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“…Prior studies have evaluated the utility of MRI imaging via a retrospective approach where patients who went to surgery had their intra‐operative findings compared to imaging findings . Imaging was only performed on patients who did not demonstrate good clinical recovery . As such, the ability of MRI to predict the functional arm mobility outcome of patients has yet to be tested.…”

Section: Discussionmentioning

confidence: 99%

“…Distinguishing these 2 groups at initial presentation is often not possible, delaying prognosis and surgical intervention for months . While imaging has played only a minor role in assessment of these infants in the past, advances in MRI have made visualization of these damaged nerves possible and may be a method to direct earlier intervention …”

Section: Introductionmentioning

confidence: 99%

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

Shen

Nidecker

Neufeld

et al. 2016

Journal of Neuroimaging

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BACKGROUND AND PURPOSE:The current prognostic biomarker of functional outcome in brachial plexus birth palsy is serial clinical examination throughout the first 6 months of age. This can delay surgical treatment and prolong parental anxiety in neonates who will recover spontaneously. A potentially superior biomarker is a volumetric proton density MRI performed at clinical presentation and within the first 12 weeks of life, providing a high spatial and contrast resolution examination in 4 minutes. METHODS: Nine neonates ranging in age from 4 to 9 weeks who presented with brachial plexus birth palsy were enrolled. All subjects underwent non-sedated 3 Tesla MRI with Cube Proton Density MRI sequence at the same time as their initial clinical visit. Serial clinical examinations were conducted at routine 4 week intervals and the functional performance scores were recorded. MRI findings were divided into pre-ganglionic and post-ganglionic injuries and a radiological scoring system (Shriners Radiological Score) was developed for this study. RESULTS:Proton Density MRI was able to differentiate between pre-ganglionic and post-ganglionic injuries. Radiological scores (Shriners Radiological Score) correlated better with functional performance at 6 months of age (P = .022) than the initial clinical examinations (Active Movement Scale P = .213 and Toronto P = .320). CONCLUSIONS: Rapid non-sedated volumetric Cube Proton Density MRI protocol performed at initial clinical presentation can accurately grade severity of brachial plexus birth palsy injury and predict functional performance at 6 months of age.

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The Diagnostic Value of CT Myelography, MR Myelography, and Both in Neonatal Brachial Plexus Palsy

Cited by 35 publications

References 49 publications

The natural history and management of brachial plexus birth palsy

The natural history and management of brachial plexus birth palsy

Peripartum and neonatal factors associated with the persistence of neonatal brachial plexus palsy at 1 year: a review of 382 cases

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

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