Presentation
54yo male post trauma. Fracture inferior angle right scapula and right upper limb weakness.
Patient Data
The roots of the brachial plexus are abnormal. The C5, C6 and C7 nerve roots are thickened, wavey and hyperintense, and the dorsal ganglia appears displaced externally, with suggestion of pseudomeningocoele formation at the C6-7 foramen. The cervical spinal cord is normal, and the rootlets appear preserved. Denervation edema with moderate atrophy of the rotator cuff muscles present. Fracture through the inferior angle of the right scapula. Prominence of the left C7 dorsal root ganglia may be related to injury. Anterior C6-C7 fusion noted.
Conclusion
Likely ganglion/post ganglionic avulsion of the C5 to C7 nerve roots.
Case Discussion
Postganglionic lesions of the brachial plexus occur distal to the dorsal root ganglion and can be managed with nerve grafting to provide a better prognosis. MRI features of post-ganglionic lesions include 1,2:
- Hypo to isointense appearance of the affected nerve on T1-weighted imaging, hyperintense on T2-weighted imaging
- Nerve fibers appear in discontinuity and distal nerve contraction ball visible if avulsion injury
- Can have direct compression of involvement of nerves by hematoma, fracture fragment, exuberant callus secondary to fracture
Case courtesy of A/Prof Pramit Phal.
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