(1)
Department of Neurosurgery, University of Wisconsin, Madison, WI, USA
Fig. 25.1
Right Horner’s syndrome: ptosis (drooping of the upper lid) and miosis (smaller pupil). In the setting of trauma, the patient had a right lower brachial plexus avulsion. This could also be observed in cases of right Pancoast tumor or carotid dissection. Central causes include brain stem stroke, tumor, or syrinx
Fig. 25.2
Sagittal oblique (A) and axial (B) T2-weighted MRI showing right pseudomeningoceles. These are highly suggestive of nerve root avulsion
Fig. 25.3
Right scapular winging. Differential diagnosis includes long thoracic neuropathy (serratus anterior), more pronounced with elbows extended [remember long thoracic = long arms]; spinal accessory neuropathy (trapezius), more pronounced with elbows flexed; and dorsal scapular neuropathy (rhomboids). Other causes of scapular winging: facioscapulohumeral dystrophy (FSHD). The latter is usually bilateral and familial
Fig. 25.4
Left suprascapular neuropathy. Note the prominence of the spine of the scapula from atrophy of supraspinatus and infraspinatus. If combined with deltoid and biceps brachii weakness, the lesion localizes to the upper trunk of the brachial plexus
Fig. 25.5
Left deltoid weakness. (A) Limited left shoulder abduction. Differential diagnosis includes weakness of the supraspinatus, deltoid or trapezius. (B) Left deltoid atrophy. Note the decreased deltoid contour on the left compared to the right, while the trapezius contour is symmetric. Causes include C5 radiculopathy or axillary neuropathy. In both cases, sensation can be decreased over the deltoid area
Fig. 25.6
Thenar atrophy from severe carpal tunnel syndrome. The patient had weakness of the abductor pollicis brevis and opponens pollicis, as well as decreased sensation on the palmar aspect of the lateral 3.5 fingers sparing the palm of the hand (the palmar cutaneous branch of the median nerve is usually superficial to the transverse carpal ligament)
Fig. 25.7
Right AIN (anterior interosseous nerve) palsy. Note the inability to flex the interphalangeal joint of the thumb (flexor pollicis longus) and the distal interphalangeal joint of the index (flexor digitorum profundus). Typically, there is no sensory loss
