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The clinical spectrum of neuralgic amyotrophy in 246 cases.
[neuralgic amyotrophy]
We
investigated
the
symptoms
,
course
and
prognosis
of
neuralgic
amyotrophy
(
NA
)
in
a
large
group
of
patients
with
idiopathic
neuralgic
amyotrophy
(
INA
,
n
=
199
)
and
hereditary
neuralgic
amyotrophy
(
HNA
,
n
=
47
)
to
gain
more
insight
into
the
broad
clinical
spectrum
of
the
disorder
.
Several
findings
from
earlier
smaller-scale
studies
were
tested
,
and
for
the
first
time
the
potential
differences
between
the
hereditary
and
idiopathic
phenotypes
and
between
males
and
females
were
explored
.
Generally
,
the
course
of
the
pain
manifests
itself
in
three
consecutive
phases
with
an
initial
severe
,
continuous
pain
lasting
for
approximately
4
weeks
on
average
.
Sensory
involvement
was
quite
common
and
found
in
78
.
4
%
of
patients
but
was
clinically
less
impairing
than
the
initial
pain
and
subsequent
paresis
.
As
a
typically
patchy
disorder
NA
can
affect
almost
any
nerve
in
the
brachial
plexus
,
although
damage
in
the
upper
and
middle
trunk
distribution
with
involvement
of
the
long
thoracic
and
/
or
suprascapular
nerve
occurred
most
frequently
(
71
.
1
%
)
.
We
found
no
correlation
between
the
distribution
of
motor
and
sensory
symptoms
.
In
INA
recurrent
attacks
were
found
in
26
.
1
%
of
the
patients
during
an
average
6
year
follow-up
.
HNA
patients
had
an
earlier
onset
(
28
.
4
versus
41
.
3
years
)
,
more
attacks
(
mean
3
.
5
versus
1
.
5
)
and
more
frequent
involvement
of
nerves
outside
the
brachial
plexus
(
55
.
8
versus
17
.
3
%
)
than
INA
patients
,
and
a
more
severe
maximum
paresis
,
with
a
subsequent
poorer
functional
outcome
.
In
males
the
initial
pain
tended
to
last
longer
than
it
did
in
females
(
45
versus
23
days
)
.
In
females
the
middle
or
lower
parts
of
the
brachial
plexus
were
involved
more
frequently
(
23
.
1
versus
10
.
5
%
in
males
)
,
and
their
functional
outcome
was
worse
.
Overall
recovery
was
less
favourable
than
usually
assumed
,
with
persisting
pain
and
paresis
in
approximately
two
-thirds
of
the
patients
who
were
followed
for
3
years
or
more
.
Diseases
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Diseases presenting
"severe maximum paresis"
symptom
neuralgic amyotrophy
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