Brakiyal Pleksopatiler
Özet
Brakiyal pleksopatiler, brakiyal pleksusun travmatik veya non-travmatik nedenlerle hasarlanması sonucu ortaya çıkan, üst ekstremitede kas güçsüzlüğü ve duyu anormallikleri ile seyreden hastalıklardır. Anatomiye bakıldığında pleksus; C5-T1 köklerinin ventral dallarından oluşur; trunkus, divizyon, kord ve periferik sinirler şeklinde ilerler. Etiyolojide Erb-Duchenne/Klumpke paralizileri gibi obstetrik travmalar, künt/penetran yaralanmalar, omuz çıkıkları, tümör invazyonları (Pancoast tümörü), radyasyon hasarı ve nöraljik amyotrofi gibi inflamatuar süreçler yer alır. Tanıda öykü ve nörolojik muayenenin yanı sıra lokalizasyon ile prognozu belirleyen sinir iletim çalışmaları ve iğne EMG en önemli elektrodiagnostik testlerdir. Radikülopatilerden farklı olarak paraspinal kasların normal, duyu sinir aksiyon potansiyellerinin (BSAP) ise anormal olması beklenir. Görüntülemede MRG ve MR nörografi; infiltratif lezyonları, ödemi ve kontrastlanmayı göstermede BT'ye göre daha duyarlıdır. Tedavi yaklaşımları ise altta yatan etiyolojiye göre cerrahi dekompresyon, tümör tedavisi, analjezikler ve fizik tedavi uygulamalarını kapsamaktadır.
Brachial plexopathies are disorders resulting from traumatic or non-traumatic injury to the brachial plexus, presenting with muscle weakness and sensory abnormalities in the upper extremity. Anatomically, the plexus is formed by the ventral rami of the C5-T1 roots and progresses as trunks, divisions, cords, and peripheral nerves. The etiology includes obstetric traumas such as Erb-Duchenne/Klumpke palsies, blunt/penetrating injuries, shoulder dislocations, tumor invasions (Pancoast tumor), radiation damage, and inflammatory processes like neuralgic amyotrophy. In diagnosis, along with history and neurological examination, nerve conduction studies and needle EMG are the most crucial electrodiagnostic tests for determining localization and prognosis. Unlike radiculopathies, paraspinal muscles are expected to be normal, while sensory nerve action potentials (SNAP) are abnormal. In imaging, MRI and MR neurography are more sensitive than CT in demonstrating infiltrative lesions, edema, and contrast enhancement. Treatment approaches encompass surgical decompression, tumor management, analgesics, and physical therapy, depending on the underlying etiology.
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