Radiation Induced Plexopathies (Radiation Plexopathy)

Diagnosis:

The diagnosis is made based on findings of plexopathy clinically and on imaging supported by exclusion of other causes.

Clinical features:

Exposure to radiation, exclusion of other causes
Weakness, usually painless
Clinical fasciculations and myokymia may occur

Findings on investigations:

NCS/EMG:

  • Fasciculations and myokymia may occur
  • SNAP and CMAP: slowed conduction velocity is common

MRI and other imaging: to rule out recurrence of tumor

Forms:

Transient brachial plexopathy: acute onset within weeks to months, numbness and weakness
Late-delayed brachial plexopathy: onset months to years, numbness and weakness, usually painless,
Lumbosacral plexopathy: slowly progressive unilateral <bilateral leg weakness and sensory symptoms with no or very little pain,

Pathology:

Fibrous encasement of brachial plexus
Axonal loss

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