Disclosures: Grenville R.J. Fernandes, MD: Nothing to disclose

Case Description: The patient was endotracheally intubated and later suffered cardiopulmonary arrest in the ICU and was ultimately discharged to a Skilled Nursing Facility where she developed inexplicable RUE monoparesis with the abrupt onset of shoulder pain/paresthesia. She was deemed an appropriate candidate for Acute Inpatient Rehabilitation with the intent to reverse her deconditioned state. Physiatric examination revealed a right-sided Hoffman’s Sign, 3/5 RUE strength, and no less than 4/5 strength in the remaining extremities. Non-contrast cranial CT was unrevealing of any acute intracranial pathology, while right glenohumeral radiography revealed mild inferior subluxation without overt dislocation. Laboratory studies were widely unremarkable.

Setting: Inpatient Rehabilitation

Patient: A 42-year-old female presenting to the ED in respiratory distress due to pneumonia.

Assessment/Results: The patient attained resolution of her symptoms within a few weeks of conservative pharmacotherapy and physical therapy. Despite scheduling electromyography and nerve conduction studies to aid in confirming the proposed clinical diagnosis, the patient was ultimately lost to follow-up.

Discussion: Nearly half of patients with NA present with antecedent infections, much like the patient described within this vignette. The proposed mechanism of NA is surmised to be of inflammatory nature, displaying a predilection for peripherally affecting motor rather than sensory nerves. Two elements within the history confounded the diagnostic approach, however. First, protracted hypoxemia during cardiopulmonary arrest likely imposed cerebral insult, and the Hoffman’s Sign on exam (suggesting central etiology) appeared to corroborate this notion. Furthermore, simply residing in an IRF destined the patient to receive physical therapy (a mainstay of NA management) while her neuropathic complaints warranted a gabapentin trial (one of the pillars of pharmacologic NA treatment).

Conclusion: Neuralgic amyotrophy is an often-overlooked plexopathic condition of unclear pathophysiology. Fortunately, general rehabilitation principles and non-specific conservative management will likely accelerate the recovery process, should a patient with NA find themselves under an unsuspecting provider’s care.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/neuralgic-amyotrophy-na-a-case-report/