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Parsonage–Turner Syndrome

A Case of Idiopathic Upper Extremity Paresis Following Middle Cranial Fossa Resection of a Vestibular Schwannoma

Prueter, James; Stevens, Shawn M.; Andaluz, Norberto; Samy, Ravi N.

doi: 10.1097/MAO.0000000000001153
MEDICAL NEUROTOLOGY
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Objective: In this patient report, Parsonage–Turner syndrome (acute brachial neuropathy) developed in our patient 1 day after resection of a vestibular schwannoma by a middle cranial fossa approach. Aiming to increase awareness of this rare disorder among neurotologists, we describe differential diagnoses, work-up, and management strategies.

Patient: A 67-year-old man treated for vestibular schwannoma at a single tertiary referral center.

Intervention: Surgery for vestibular schwannoma, electromyography for confirmation of diagnosis, and physical therapy.

Main Outcome and Results: After ruling out postoperative complications by intracranial imaging and physical examination, electromyography was confirmatory of the suspected diagnosis, Parsonage–Turner syndrome; steroids were not indicated. With physical therapy as treatment, our patient is experiencing gradual recovery of all neurologic deficits, including gross motor function.

Conclusion: As a rare condition reported only sporadically in the orthopedic and neurology literature, our patient with Parsonage–Turner syndrome represents (to our knowledge) the first within neurotology literature. This rare, idiopathic disease process is usually self-limiting, and may mimic cerebral-vascular accident or injury from surgical positioning. Its presentation is one of limited motor and sensory neuropathies of the brachial plexus distribution.

*Department of Otolaryngology—Head and Neck Surgery, Ohio University Heritage College of Osteopathic Medicine, Dayton

Department of Otolaryngology—Head and Neck Surgery, University of Cincinnati (UC) College of Medicine, and Neurosensory Disorder Center at UC Neuroscience Institute

Department of Neurosurgery, University of Cincinnati (UC) College of Medicine, and Brain Tumor Center at UC Neuroscience Institute, and Mayfield Clinic, Cincinnati, Ohio

Address correspondence and reprint requests to Ravi N. Samy, M.D., F.A.C.S., Department of Otolaryngology—Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0528; E-mail: Ravi.Samy@UC.edu

Dr. R.N.S. has received honoraria and/or research support within the past 3 years from the Stryker Corporation, Cochlear Corporation, Grace Medical, Otonomy, Inc. None impact this submission.

The other authors disclose no conflicts of interest.

Copyright © 2016 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company