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We report 11 women with at least one episode of neuralgic amyotrophy occurring postpartum.One woman had three episodes,two postpartum and a third occurring after minor foot surgery.Two others had a second episode, one following a first trimester spontaneous abortion and one after a viral syndrome.Pain followed delivery from as little as 1 to 2 hours to up to 2 weeks and usually lasted from a few weeks to several months.WEakness,if delayed,followed onset of pain by 2 or 3 days up to 5 weeks.Four of the episodes were bilateral.Clinical weakness and electrodiagnostic findings varied widely,from involvement of a single peripheral nerve(e.g.,long thoracic,anterior interosseous)to multiple bilateral proximal and distal nerves.Functional recovery was excellent(90 to 100%)in 8 of the 10 with adequate followup requiring as little as 2 weeks or up to 3 years.Two women have moderate persisting weakness(both bilateral)at 3 years and 2 years.Five patients went on to subsequent deliveries without recurrence of neuralgic amyotrophy.Only one of the 11 women had a history suggesting familial neuralgic amyotrophy,a disorder generally thought to be associated particularly with postpartum episodes.Although the etiology of postpartum neuralgic amyotrophy remains unknown,an immunologic mechanism is suspected.Focal demyelination may play a role in some but clearly axonal degeneration is predominant in the majority. |
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