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Transverse Myelitis and Neuralgic Amyotrophy

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The Pediatric Upper Extremity

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Abstract

Neuralgic amyotrophy (NA), a lower motor neuron (LMN) lesion, presents a flaccid monoplegia of the upper extremity in children. Transverse myelitis (TM) may present with either an LMN or an upper motor neuron (UMN) injury, depending on areas affected on the cord. Both entities are inflammatory and autoimmune in nature. Diagnosis is with MRI and serological studies as well as nerve conduction studies (NCS) and electromyography (EMG). Treatment varies slightly, but includes immunosuppression with steroids, replacement of antibodies with plasmapheresis in addition to intravenous immunoglobulin (IVIG), immunosuppressant, and antineoplastic agents. Further management includes rehabilitation measures with stretching, strengthening, range of motion, neuromuscular electrical stimulation, patient and family education, and equipment evaluation. Children with persistent LMN deficits and limited recovery (6–8 months after onset of disease) may warrant surgical considerations for peripheral nerve surgery. This may include the use of nerve transfers. Secondary surgery, including muscle and tendon transfers, can be considered 1–2 years after disease onset, if persistent residual deficits are present. Most children with NA have good outcomes with resolution of symptoms and improvement in function. Children with TM have a less favorable outcome with one third resolution rate.

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Authors and Affiliations

  1. Department of Neurosurgery, The Johns Hopkins Hospital, Meyer Building, Room 5-181, 600 North Wolfe Street, 21287, Baltimore, MD, USA

    Allan Belzberg

  2. Children’s Memorial Hermann Hospital, The University of Texas Health Science Center at Houston (UTHealth) Medical School, 6411 Fannin St, 77030, Houston, TX, USA

    Glendaliz Bosques

  3. Johns Hopkins University, Baltimore, MD, USA

    Kelly Pham

Authors
  1. Allan Belzberg
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  2. Glendaliz Bosques
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  3. Kelly Pham
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Corresponding author

Correspondence to Allan Belzberg .

Editor information

Editors and Affiliations

  1. Dept. of Orthopedics, University of Maryland School of Medicine, Baltimore, Maryland, USA

    Joshua M. Abzug

  2. Shriners Hospitals for Children, Philadelphia, Pennsylvania, USA

    Scott H. Kozin

  3. Shriners Hospitals for Children, Philadelphia, Pennsylvania, USA

    Dan A. Zlotolow

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Belzberg, A., Bosques, G., Pham, K. (2015). Transverse Myelitis and Neuralgic Amyotrophy . In: Abzug, J., Kozin, S., Zlotolow, D. (eds) The Pediatric Upper Extremity. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8515-5_32

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  • DOI: https://doi.org/10.1007/978-1-4614-8515-5_32

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-8513-1

  • Online ISBN: 978-1-4614-8515-5

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