The Spectrum of Clinical, Etiological, Electrophysiological and Radiological Findings of Non Traumatic Brachial Plexopathies from a Tertiary Care Centre

Abstract

Background: Non-traumatic brachial plexitis (NTBP) is an under-recognised inflammatory and immune-mediated disorder characterised by acute or subacute upper-limb pain, weakness, and sensory disturbance in the absence of mechanical injury. Its aetiological spectrum includes diabetic radiculoplexus neuropathy, malignancy-associated plexopathy, radiation-induced injury, and connective tissue disease-related vasculitis. Published case series from Indian tertiary neurology centres remain limited. Methods: Eight patients diagnosed with NTBP between March 2024 and June 2025 were retrospectively analysed. Clinical features, aetiologies, nerve conduction study and electromyography findings, brachial plexus MRI, treatment, and functional outcomes were systematically recorded. Results: The cohort comprised four males and four females with a mean age of 50.1 years (range 16-81). Right-sided involvement predominated (87.5%). Aetiologies included diabetes mellitus (n=3, 37.5%), malignancy or its treatment (n=3, 37.5%), rheumatoid arthritis (n=1, 12.5%), and deep-vein thrombosis on anticoagulation (n=1, 12.5%)-all patients presented with upper-limb pain. NCS and EMG demonstrated post-ganglionic motor axonal lesions spanning C5-T1 in all patients, with concomitant sensory axonal involvement of C6-C7 in seven. Brachial plexus MRI was abnormal in seven of eight cases (87.5%), revealing T2/STIR hyperintensity and denervation oedema; one patient additionally showed post-gadolinium enhancement. All patients received corticosteroids and structured neurorehabilitation. Marked functional improvement was achieved in five of eight patients (62.5%), all with non-malignant aetiologies; malignancy-associated cases showed only mild improvement. Conclusions: NTBP presents with a consistent post-ganglionic axonal electrophysiological signature across diverse aetiologies. Early aetiological identification, immunomodulatory therapy, and neurorehabilitation are associated with favourable outcomes. Malignancy-related plexopathy carries a guarded prognosis. Dedicated brachial plexus MRI is a valuable complement to electrodiagnosis.

Keywords: brachial plexitis; non-traumatic brachial plexopathy; diabetic radiculoplexus neuropathy; neuralgic amyotrophy; radiation-induced brachial plexopathy.