Parsonage-Turner syndrome following coronavirus disease 2019 immunization with ChAdOx1-S vaccine: a case report and review of the literature.

Parsonage-Turner syndrome is an acute peripheral neuropathy that affects the upper brachial plexus region. Previously published reports demonstrate that the condition can be triggered by surgery, infection, autoimmune diseases, strenuous exercise, trauma, radiation, and vaccination. Parsonage-Turner syndrome has already been reported in three other patients who were vaccinated against coronavirus disease 2019. We report the case of a 51-year-old Caucasian man without comorbidities who received the first dose of the ChAdOx1-S recombinant vaccine (Vaxzevria, AstraZeneca, Oxford, UK) against coronavirus disease 2019 and was diagnosed with Parsonage-Turner syndrome. A few days after getting vaccinated, the patient reported a progressive increase in pain in the region of vaccine administration. One month later, the shoulder pain was followed by symptoms of hypoesthesia and muscle weakness on abduction and elevation of the left upper limb. Neurological examination revealed an atrophy of the proximal muscles of the left upper limb, accompanied by paresis of the left deltoid, biceps brachii, triceps brachii, and infraspinatus muscles. Electroneuromyography carried out 3 months after the onset of symptoms showed signs consistent with brachial plexus neuritis. The adverse reaction has been properly reported to the Italian Pharmacovigilance System (Italian Medicines Agency-Agenzia Italiana del Farmaco. The increased awareness of such association is essential for early identification and diagnosis and, thus, better clinical outcomes.

Vitturi BK ，Grandis M ，Beltramini S ，Orsi A ，Schenone A ，Icardi G ，Durando P ... -  《-》

Parsonage-Turner Syndrome Post-COVID-19 Oxford/AstraZeneca Vaccine Inoculation: A Case Report and Brief Literature Review.

Parsonage-Turner syndrome (PTS) is a rare brachial plexus neuropathy that typically presents as a severe, sudden-onset pain followed by atrophic weakness with slow recovery, which may occur after an identifiable triggering event. Vaccination is one of several known triggers of PTS, and this syndrome has already been reported in other patients who were vaccinated against coronavirus disease. We report the case of a 75-year-old Caucasian man who received the third dose of the coronavirus disease 2019 (COVID-19) Oxford/AstraZeneca vaccine and was diagnosed with PTS. A week after inoculation, the patient, with no history of trauma, developed a sudden-onset left shoulder mechanical pain and later reported an abduction deficit. Neurological examination showed an atrophy of the proximal muscles of the left upper limb. No bulbar weakness or pathological upper motor neuron signs were seen. The MRI excluded rotator cuff pathology, including ruptures and tendinopathy. Electroneuromyography findings carried out 10 months after the onset of symptoms indicated left brachial panplexopathy, suggestive of PTS. The raised consciousness of PTS and vaccine association is crucial for prompt identification and diagnosis and, therefore, better clinical outcomes.

Meixedo S ，Correia M ，Machado Lima A ，Carneiro I ... -  《-》

[Bilateral Parsonage-Turner syndrome after COVID-19 vaccination. A case report and review of the literature].

Lukács K ，Csőregh É ，Fekete B 《-》

Shoulder palsy following SARS-CoV-2 infection: two cases of typical Parsonage-Turner syndrome.

Coronavirus disease 2019 (COVID-19) is now known to cause neurological complications in both the central and the peripheral nervous system. Two new cases of typical neuralgic amyotrophy or Parsonage-Turner (PT) syndrome following coronavirus 2 infection (SARS-CoV-2) are reported here with explicit electrophysiological and imaging pathological features, underlining the possible association between COVID-19 and PT syndrome. Case 1 was a 45-year-old schoolteacher presenting with acute pain in the right shoulder a few days after SARS-CoV-2 infection, with shoulder abduction and elbow flexion weakness. Needle electromyography showed a decrease in motor unit recruitment in the biceps brachii, and plexus magnetic resonance imaging (MRI) revealed a hyperintense signal involving the right C6 root and the superior truncus of the brachial plexus. Case 2 was a 21-year-old man hospitalized for dyspnea secondary to SARS-CoV-2 infection. Ten days after symptom onset, he presented right shoulder pain with difficulty in raising his right arm, revealing an isolated deficit of the serratus major muscle with a right scapula winging. Electrophysiological evaluation exhibited an isolated involvement of the long thoracic nerve with a neurogenic recruitment pattern in the serratus major muscle. Plexus MRI displayed a thickening and hyperintense signal involving the right long thoracic nerve. Parsonage-Turner syndrome triggered by SARS-CoV-2 seems to present clinical, electrophysiological and MRI characteristics similar to classic para-infectious PT syndrome, including the time frame between viral infection and neurological symptom onset. Conclusion SARS-CoV-2 might be a new infectious trigger of PT syndrome.

Fortanier E ，Le Corroller T ，Hocquart M ，Delmont E ，Attarian S ... -  《-》

COVID-19 Vaccine-Induced Parsonage-Turner Syndrome: A Case Report and Literature Review.

All modern vaccines share the risk of neurological adverse effects. Only a few cases of Parsonage-Turner syndrome (PTS), an uncommon peripheral nerve condition associated with coronavirus disease 2019 (COVID-19) immunization, have been reported to date. We describe a case of COVID-19 vaccine-induced PTS and provide a brief literature review. A 78-year-old male non-smoker with a medical history of coronary artery disease presented with non-exertional, constant chest pain for one hour and new onset of bilateral hand weakness for three days. He had no neurological disease or allergies and denied any recent trauma or infection. Three weeks before the onset of the symptoms, the patient received a second dose of the BNT162b2 COVID-19 vaccine, which was administered 21 days after the first dose. Physical examination was significant for weakness in right-hand grip and wrist flexion. There were no other motor deficits, upper motor neuron signs, bulbar weakness, or sensory deficits. Diagnostic workup for the underlying diabetes mellitus, infections, or other autoimmune diseases was negative. Imaging workup revealed no demyelination, fracture deformity, traumatic subluxation, or compressive myelopathy. Nerve conduction studies, including needle electromyography, showed decreased motor unit recruitment in the bilateral first dorsal interosseous and right deltoid, biceps, and triceps muscles confirming PTS. The patient was treated with 40 mg/day of oral prednisone and occupational therapy to maintain range of motion and activities of daily living. PTS is also known as neuralgic amyotrophy, brachial plexus neuritis, brachial plexopathy, and shoulder-girdle syndrome. It is characterized by asymmetrical, chronic, resistant upper extremity neuropathic pain and neurological defects such as paralysis and paresthesia. There are two different types of PTS: non-hereditary and inherited. The etiology and pathophysiology of PTS are not fully understood. Various aspects such as genetic, environmental, and immunological predisposition may play a role in developing the syndrome. Infections, vaccines, and injuries are typical causes of non-hereditary forms. After the COVID-19 epidemic and the commencement of a global immunization effort, similar instances happened. Presently there is no available test that unequivocally confirms or excludes PTS itself. Electrodiagnostic study and imaging modalities help to rule out other differential diagnoses. Also, there is no specific treatment available; however, it may resolve independently of treatment with supportive care.

Amjad MA ，Hamid Z ，Patel Y ，Husain M ，Saddique A ，Liaqat A ，Ochieng P ... -  《Cureus》