True Neurogenic Thoracic Outlet Syndrome with Elongated C7 Transverse Processes in a Hemiplegic Patient: A Case Report

Yeon-Gyu Jeong, Jin-Hee Jung, Joo Sup Kim, Hyo Jeong Lee
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Abstract

Thoracic outlet syndrome (TOS) is caused by the compression of neurovascular structures in the thoracic cage. TOS can be classified into neurogenic TOS (NTOS) and vascular TOS. Congenital anomalies, such as cervical ribs and elongated C7 transverse processes, may be the cause of NTOS. NTOS can be subcategorized as either disputed NTOS or true NTOS. True NTOS, a very rare disease with a prevalence of about one in a million, is diagnosed by the weakness and atrophy of T1-innervated intrinsic muscles of the hand and corresponding electrodiagnostic abnormalities. We report a case of a 42-year-old patient, who presented with a 5-year history of clumsiness and 1 1-year history of weakness and atrophy in her right hand. The patient was diagnosed with true NTOS during comprehensive rehabilitation, which she received for left hemiplegia due to intracranial hemorrhage. Elongated bilateral C7 transverse processes were found on a radiological evaluation. True NTOS is often overlooked or mistaken for carpal tunnel syndrome, thus delaying the diagnosis and inevitably worsening outcomes. Therefore, an electrodiagnostic study is crucial for detecting true NTOS, rather than typical physical examinations such as the Roos stress test and Adson’s test.
偏瘫患者真神经源性胸廓出口综合征伴C7横突延长1例报告
胸廓出口综合征(TOS)是由胸廓内神经血管结构受压引起的。TOS可分为神经源性TOS和血管性TOS。先天性异常,如颈肋和C7横突拉长,可能是NTOS的原因。NTOS可以细分为争议NTOS和真实NTOS。真正的NTOS是一种非常罕见的疾病,患病率约为百万分之一,通过手部t1神经支配的固有肌肉的无力和萎缩以及相应的电诊断异常来诊断。我们报告一例42岁的患者,她表现出5年的笨拙史和11年的右手无力和萎缩史。患者因颅内出血左偏瘫接受综合康复治疗,诊断为真正的NTOS。影像学检查发现双侧C7横突拉长。真正的NTOS常常被忽视或误认为是腕管综合征,从而延误了诊断并不可避免地恶化了预后。因此,电诊断研究对于检测真正的NTOS至关重要,而不是典型的物理检查,如Roos压力测试和Adson测试。
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