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Título

Left brachial plexopathy as a consequence of the neurological sequelae of COVID-19

RESUMO

Case presentation: Male patient, 46 years old, diagnosed with COVID-19, remained hospitalized in the ICU for 38 days, and after being discharged, he presented with flaccid paresis in MSE, loss of strength and sensitivity and pain. The patient underwent an electroneuromyography (ENMG) which indicated a plexopathy in the lower left trunk and a cranial Magnetic Resonance (RNM), which showed abnormalities in right semi-oval center. Subsequently, a plexus MRI was performed, which demonstrated a regular diffuse thickening of the left brachial plexus. Dorene TABS 75mg, Benerva and FST were prescribed. After 5 months, there was improvement in paresis, sensitivity, maintaining difficulty in moving the MSE.

Discussion: The brachial plexus is a complex nervous structure, and is formed by the roots C5, C6, C7, C8 and T1, and which can also receive contributions from C4 and T2, and is a critical region of the peripheral nervous system, due to the fragility of its anatomical region and its relationship with neighboring mobile structures.
Commonly, brachial plexus injuries are divided into: open, closed, perinatal paralysis and after radiation. Closed injuries can be further classified into supra, infra and subclavicular.
The symptomatology presented by the patient is wide, as it is closely related to the type of nerve that was injured, whether it is sensory, motor or mixed. If it is a lesion of an exclusively motor nerve, the symptomatology will be a paralysis of the musculature innervated by it. If it is a lesion of an exclusively sensory nerve, the symptomatology will be a loss of sensation. And if it is a lesion of a mixed nerve, the symptoms presented by the patient will be characteristic of sensory and motor losses.
To make the diagnosis, the patient's history and neurological examination must be taken into account. Electroneuromyography is an essential test to confirm the diagnosis, and imaging tests may also be requested.
In general, in less severe injuries, the nerve can heal on its own, and physical therapy or occupational therapy is usually indicated. In more severe injuries, surgical intervention is usually required.

Conclusions: Brachial plexus injury is a common pathology that compromises the individual in numerous spheres, such as social and economic. Therefore, it must be recognized early in order to reduce the risk of sequelae that this injury can cause.

Palavras Chave

Brachial plexus; COVID-19; neurological sequel;