BRAIN and NERVE Shinkei Kenkyu no Shinpo Volume 68, Issue 5 (May 2016)

Cervical Spondylotic Amyotrophy Masahiro Sonoo 1 1Department of Neurology, Teikyo University School of Medicine Keyword: 頸椎症性筋萎縮症 , Keegan型 , 解離性運動麻痺 , 下垂指 , 神経痛性筋萎縮症 , cervical spondylotic amyotrophy , Keegan type , dissociated motor loss , drop finger , neuralgic amyotrophy pp.509-519
Published Date 2016/5/1
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Keegan (1965) reported a patient who presented with “dissociated motor loss,” an acute paralysis of the upper extremity with minimal sensory signs and no long tract signs, and documented an anterior root lesion following autopsy. Sobue et al. (1975) reported similar cases using the term “cervical spondylotic amyotrophy (CSA),” but postulated pathology of the anterior horn. Although Keegan's “dissociated motor loss” surely referred to isolated motor paresis with no or minimal sensory signs, contrary to existing criticism, a more general term, CSA, should be preferred. CSA is divided into proximal and distal types. Distal CSA often presents with a drop finger, and thus may be misdiagnosed as posterior interosseous nerve palsy. Documentation of the involvement of ulnar muscles by clinical signs and EMG would lead to the diagnosis of distal CSA. Proximal CSA may be confused with neuralgic amyotrophy (NA), although the sparing of the serratus anterior and the stereotypic involvement of deltoid, infraspinatus, biceps brachii, and brachioradialis suggest CSA. Cervical MRI is not diagnostic in around half of CSA cases, and denervation in paraspinal EMG is a more sensitive test that can exclude NA. Amyotrophic lateral sclerosis is another important differential diagnosis for CSA.

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BRAIN and NERVE-神経研究の進歩
68巻5号 (2016年5月)
電子版ISSN 1344-8129 印刷版ISSN 1881-6096 医学書院