Congenital lower brachial plexus palsy due to cervical ribs.
Congenital brachial plexus palsy (CBPP) usually occurs secondarily to intrapartum trauma, but this is not always the case. Cervical ribs have previously been reported to increase the risk of CBPP in association with birth trauma. We report the cases of two children (one female, one male) with congenital lower brachial plexus palsy in whom the presence of non-ossified cervical ribs was the only identified risk factor. In the female child magnetic resonance imaging (MRI) of the brain, spinal cord, and brachial plexus revealed no abnormality except for the presence of bilateral cervical ribs at the level of the seventh cervical (C7) vertebra. Chest radiography was normal, which suggested that the cervical ribs identified on the MRI were fibrous bands or cartilaginous ribs rather than ossified ribs. In the male child, MRI of the spine and brachial plexus was normal but he was noted to have bilateral cervical ribs at C7. These were not identifiable on chest radiography and, therefore, are likely to reflect fibrous bands or cartilaginous ribs.
Department of Paediatric Neurology, Evelina Children's and St Thomas' Hospitals, London, UK.
Archana
A
Desurkar
Kerry
K
Mills
Matthew
M
Pitt
Wajanat
W
Jan
Marco
M
Sinisi
Marco
M
Sinsi
Ian
I
Male
Elizabeth
E
Wraige
D020516:Brachial Plexus Neuropathies / Q000151:congenital* / Q000175:diagnosis / Q000503:physiopathology; D057070:Cervical Rib / Q000002:abnormalities* / Q000503:physiopathology; D002573:Cervical Rib Syndrome / Q000151:congenital* / Q000175:diagnosis / Q000503:physiopathology; D002675:Child, Preschool; D004576:Electromyography; D005260:Female; D005500:Follow-Up Studies; D005542:Forearm / Q000294:innervation; D006225:Hand / Q000294:innervation; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D008475:Median Nerve / Q000503:physiopathology; D018908:Muscle Weakness / Q000151:congenital / Q000175:diagnosis / Q000503:physiopathology; D009133:Muscular Atrophy / Q000151:congenital / Q000175:diagnosis / Q000503:physiopathology; D009431:Neural Conduction / Q000502:physiology; D009460:Neurologic Examination; D014459:Ulnar Nerve / Q000503:physiopathology