Metastasis to the brachial plexus is a fairly common complication of breast carcinoma, lung carcinoma, and lymphoma. Metastatic tumor involving the lumbosacral plexus is an increasingly recognized complication of a number of neoplasms. It is important for neurologists to diagnose metastatic brachial plexopathies early and to differentiate them from radiation-induced plexus injury or other etiologies. In this clinical article, Dr. Edward Dropcho of the Indiana University Medical Center discusses the clinical presentations, diagnostic issues, and management of patients with metastatic plexopathies.
Carcinomas of the lung or breast are the most common sources of brachial plexus metastases, whereas lumbosacral plexus metastases most often arise from primary pelvic tumors or from lymphoma.
Local and/or radicular pain is the most common presenting symptom of nerve plexus metastasis and is eventually followed by motor and sensory deficits.
MRI is fairly sensitive and specific in diagnosing nerve plexus metastases, and FDG-PET scanning may also be useful in some patients.
Treatment of nerve plexus metastases usually brings about significant pain relief, although motor and sensory deficits are less likely to improve.