Brachial plexopathy
A 42-year-old male presented with complaints of progressive numbness of the right hand since 2 years, with similar complaints of the left hand since 6 months. He noticed progressive weakness of the right upper limb since 3 months. During the course of the illness, he noted significant wasting of the intrinsic muscles of the right hand. On examination, predominant proximal weakness (grade 1/5) was observed. Pin prick and temperature sensation were reduced in the right hand, whereas joint position sense and vibration were normal. Deep tendon reflexes were absent in both upper limb. A burn mark was observed over the right arm. He did not have thickened nerves. With the presence of flail arm right more than left and sensorimotor affection, brachial plexus or spinal cord was thought to be the probable site of the lesion. The CSF report showed nil cells, mildly raised proteins, and normal sugar. Electrodiagnostic studies showed asymmetric right more than left, multifocal motor more than sensory and demyelinating more than axonal, with evidence of minimal demyelination in the lower limbs. MRI right brachial plexus showed hypertrophied plexus while MRI cervical spine was normal. Therefore, a final diagnosis of multifocal acquired demyelinating sensory and motor neuropathy (MADSAM) was made [].\nIdiopathic hypertrophic brachial neuropathy as a presentation of MADSAM has been reported in the literature.[]