Delayed bilateral anterior interosseous neuritis: an atypical presentation

Brachial neuritis, or Parsonage–Turner syndrome, is manifested by a constellation of symptoms resulting from inflammation of the brachial plexus. Heralded by an episode of acute pain, onset of symptoms can be immediate or delayed. Motor deficits are ubiquitous, and sensory impairment is also found in up to 80% of patients. Pain transitions over weeks to progressive weakness and sensory abnormalities that typically involve the shoulder and proximal upper limb. The variability in location and severity of symptoms is dependent upon which peripheral nerves are affected and to what extent. The condition is not well understood, but has been noted to occur following surgical procedures, and is associated with immunologic disease, neoplasm, vaccinations, immunosuppressive medications, and infections. Bilateral neuritis is believed to occur more commonly in a proximal location; however, the symptoms may be subclinical. Bilateral presentation and recurrent attacks have been described, although in only one-quarter of patients (van Alfen and van Engelen, 2006). When the condition occurs distally, the presentation is more likely unilateral and localized (van Alfen and van Engelen, 2006). Unilateral, isolated involvement of the anterior interosseus nerve (AIN) is rare and bilateral AIN neuropathy is only anecdotally reported (Squintani et al., 2009, van Alfen and van Engelen, 2006). We present the unique case of delayed AIN palsy, 13 years following an identical event in the opposite extremity. © The Author(s) 2012 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav doi: 10.1177/1753193412446405 available online at http://jhs.sagepub.com