Abstract

Emilia Burada*, Adrian Tudor Balseanu, Smaranda Mitran, Veronica Sfredel, Florin Burada and Bogdan Catalin

ABSTRACT

Introduction: Delayed radiation-induced brachial plexopathy (RIBP) is a rare condition that occurs as a late side effect of radiation therapy for cancer treatment. Only few data are available about RIBP in patients that received radiotherapy for nasopharyngeal cancer. Case Presentation: We present a 72 years old woman patient with a slowly progressive bilateral brachial plexopathy and carotid arterial disease after radiotherapy for nasopharyngeal carcinoma. RIBP diagnosis was based on history of radiotherapy after cancer, clinical features, neurological and electrophysiological exams. The patient was diagnosed thirty two years ago with nasopharyngeal cancer and treated with radiation therapy. She developed paraesthesia on the left and right lateral side of the arm, forearm, hand and thumb. Also, skin pigmentation and endured area on the anterior part of the neck were noted from the moment of radiotherapy. Motor examination revealed right and left loss of shoulder flexion, internal rotation and abduction worse on the left part, tendon jerks depressed on biceps and brachioradialis tendon, atrophy of bilateral deltoid, biceps, supraspinatus and infraspinatus accentuated on left with fasciculation at this level. Nerve conduction study showed a reduced nerve conduction velocity, prolonged latency, and decreased amplitude in motor axilar nerves, antebrachial cutaneus nerves, sensory radial nerves, and right sensory and motor median nerve. Needle electromyographic examination revealed myokymic discharges, fibrillation and positive sharp waves on bilateral medial deltoid and biceps brachii muscles, motor unit potential varying in morphology and decreased recruitment. Conclusion: RIBP is a rare complication of radiotherapy in nasopharyngeal carcinoma patients. Electromiography plays an essential role in the differential and positive diagnosis of delayed radiation-induced brachial plexopathy, showing typical changes - myokymic discharges.