Radiation-induced brachial plexopathy
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A 37-year-old male treated with chemoradiation therapy for nasopharyngeal carcinoma (NPC) 11 years prior, presented with progressive upper extremity numbness and weakness. Physical exam revealed decreased upper extremity tone, strength, and reflexes bilaterally. Needle electromyography demonstrated myokymic discharges from bilateral deltoid, biceps, and triceps.Coronal STIR sequence from a brachial plexus MRI showed marked symmetric thickening and hyperintensity of the brachial plexus roots, trunks, and divisions, in a pattern that matched the radiation treatment port. The cords and branches appeared normal. Axial post-contrast T1WI with fat suppression showed thickened right the left brachial plexus with no abnormal contrast enhancement. A contrast-enhanced neck CT performed 7 months prior to the MRI also demonstrated symmetric thickening of right the left brachial plexus and symmetric bilateral fibrosis of the lung apices.

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