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December 15, 2022Resident & Fellow Section

Clinical Reasoning: A 26-Year-Old Female With Recurrent Pain, Weakness, and Atrophy in Bilateral Upper Limbs During Pregnancy and Puerperium

Tian-fang Zeng, Xin Ding, Dan Yang, Chang-Chuan Wu, Dan-Dan Xie, Wen-Min Zhang
First published December 15, 2022, DOI: https://doi.org/10.1212/WNL.0000000000201705
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Abstract

We present a case of a 26-year-old female with recurrent episodes of severe pain, weakness, and atrophy in her bilateral upper extremities during pregnancy and puerperium. She reported two similar episodes at ages five and ten, after which she fully recovered. On examination, we observed significant atrophy in her bilateral upper extremity muscles with decreased strength. Needle electromyography (EMG) revealed neurogenic damage in her bilateral upper limbs. The patient's clinical manifestations and auxiliary examination suggested a brachial plexopathy. Metabolic and immune factors that may occur during pregnancy and puerperium were evaluated. We also screened for paraneoplastic, neoplastic, and genetic factors. Finally, a hereditary form of disease was considered. This case emphasizes the importance of early diagnosis and avoidance of triggers.

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