Meningomyeloradiculitis mimicking recurrent bilateral neuralgic amyotrophy.

Neuralgic amyotrophy (NA), also known as idiopathic brachial plexopathy or “Parsonage-Turner syndrome”, is a clinical idiopathic unilateral disorder that involves the brachial plexus with monophasic and self-limiting course. Bilateral and/or hereditary forms of NA have been also reported. We discuss the case of a 35-year-old woman with ten-year-history of bilateral recurrent NA. Initially she presented shoulder pain followed by prominent weakness and wasting of shoulder girdle musculature, with asymmetric and asynchronous pattern. Some years later she developed left Aran-Duchenne muscular atrophy. When she came to our attention she complained pain and weakness at lower limbs. Neurophysiologic studies excluded brachial and lumbosacral plexopathy. The cerebrospinal fluid (CSF) examination showed pleocytosis (15 elements/mm3) and hyperproteinorrhachia (7.0 g/l). Neurotropic virus were negative in both serum and CSF. Spinal cord MRI showed abnormal intramedullary hyperintensity of anterior horn on T2-weighted at dorsal tract and contrast-enhancement of the cauda equine roots. Pain and weakness were partially relieved by steroid pulse endovenous therapy. In our patient menigomyeloradiculitis of unknown origin mimicked recurrent bilateral neuralgic amyotrophy involving both upper and lower limbs. Finally, we suggest to perform CSF examination and spinal cord MRI in all cases of NA with atypical course.