Letters to the Editor

731

Brachial plexitis following bee sting Dear Sir, We appreciated thoughtful commentaries on our case.[1] Nerve conduction studies (NCS) were carried out on 10th day of illness. There was no edema during the NCS. Needle electromyography  (EMG) was not performed because the patient was not willing for the same. In our patient, the roots of the brachial plexus (anterior primary rami) were affected; not preganglionic root as indicated by the absence of the sensory nerve action potential  (The lateral ante brachial cutaneous nerve, medial ante brachial cutaneous nerve; median recording from the thumb and index fingers; superficial radial; and ulnar, recording from the little finger). The brachial plexus is the most complex structure in the peripheral nervous system and its anatomy and electrophysiology have been described elsewhere. It is difficult to characterize the exact site of lesion in extensive brachial plexitis without EMG. We used contrast magnetic resonance imaging  (MRI) to delineate plexus. The brachial plexus MRI can be normal even if the contrast is used. Reported MRI findings range from normal[2] to diffusely enlarged and hyper intense nerves of the plexus on T2‑weighted images, hypothesized to represent intra‑neural inflammation and edema.[3]

Department of Neurology, Calicut Medical College, Calicut, Kerala, India For correspondence: Dr. K. Saifudheen, Department of Neurology, Calicut Medical

College, Calicut ‑ 673 008, Kerala, India. E‑mail: [email protected]

References 1. Jithendranath P, Byju N, Saifudheen K, Jose J. Brachial plexitis following bee sting. Ann Indian Acad Neurol 2012;15:234. 2. Bilbey JH, Lamond RG, Mattrey RF. MR imaging of disorders of the brachial plexus. J Magn Reson Imaging 1994;4:13‑8. 3. Posniak HV, Olson MC, Dudiak CM, Wisniewski R, O’Malley C. MR imaging of the brachial plexus. AJR Am J Roentgenol 1993;161:373‑9. Access this article online Quick Response Code:

Website: www.annalsofian.org

DOI: 10.4103/0972-2327.120435

P. Jithendranath, N. Byju, K. Saifudheen, James Jose

Electrocardiographic abnormalities in acute cerebrovascular events Dear Sir, The recent report on “electrocardiographic abnormalities in acute cerebrovascular events” is very interesting.[1] Togha et al., concluded that “Ischemia‑like ECG changes and arrhythmias are frequently seen in stroke patients, even in those with no history or signs of primary heart disease, which support a central nervous system origin of these ECG abnormalities.[1]” The interesting question is why there is a high rate of concomitant abnormalities. Indeed, the pathophysiology of cardiovascular and cerebrovascular abnormalities usually starts from the thromboembolic disorders and this might be the possible clue for the possible high concurrence. Based on this work, it might imply that there is a need to investigate for possible cardiac disorder among any patients with cerebrovascular problem and there is also a need to perform complete neurological assessment for any patients with cardiovascular diseases. Last but not least, investigation for the underlying metabolic disorders (diabetes mellitus, dyslipidemic, etc.) which can be the starting points for unwanted vascular events should be done.

Wiwanitkit House, Bangkhae, Bangkok, Thailand, 1Joseph Ayobabalola University, Ikeji‑Arakeji, Osun state, Nigeria For correspondence: Mrs. Somsri Wiwanitkit, Wiwanitkit House, Bangkhae,

Bangkok, Thailand. E‑mail: [email protected]

Reference 1. Togha M, Sharifpour A, Ashraf H, Moghadam M, Sahraian MA. Electrocardiographic abnormalities in acute cerebrovascular events in patients with/without cardiovascular disease. Ann Indian Acad Neurol 2013;16:66‑71. Access this article online Quick Response Code:

Website: www.annalsofian.org

DOI: 10.4103/0972-2327.120436

Somsri Wiwanitkit, Viroj Wiwanitkit1

Annals of Indian Academy of Neurology, October-December 2013, Vol 16, Issue 4

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