Is plexopathy considered a type of peripheral neuropathy?

Plexopathy as a Type of Peripheral Neuropathy

Yes, plexopathy is considered a type of peripheral neuropathy, but with distinct anatomical localization to nerve plexuses rather than diffuse or isolated peripheral nerves. 1

Classification and Anatomical Context

• Plexopathies affect networks of nerves (plexuses) formed by the ventral rami of spinal nerves, with the two main types being brachial plexopathy (C5-T1) and lumbosacral plexopathy (L1-S4) 1, 2
• Unlike length-dependent peripheral neuropathies that typically affect distal nerves first, plexopathies have a regional distribution corresponding to the affected plexus 3
• Plexopathies are considered a rare subtype of peripheral neuropathy with distinct localization patterns requiring specific diagnostic approaches 3

Clinical Distinction from Other Neuropathies

• Plexopathies present with pain, weakness, and sensory loss across multiple peripheral nerve distributions within a specific anatomical region (arm/shoulder or leg/hip) 2
• Key distinguishing feature: symptoms and signs cross multiple dermatomes and peripheral nerve territories but remain confined to the region supplied by the affected plexus 1, 2
• Unlike radiculopathies (which follow single dermatome distributions), plexopathies affect multiple nerve distributions simultaneously 4, 3

Diagnostic Considerations

• Electrodiagnostic studies are essential to confirm plexopathy by demonstrating abnormalities across multiple nerve distributions supplied by the affected plexus 3
• MRI is the preferred imaging modality for plexopathies due to superior soft-tissue contrast and ability to visualize intraneural anatomy 5, 4
• Clinical diagnosis can be challenging due to overlap between plexopathy and radiculopathy presentations, often requiring both clinical and electrodiagnostic confirmation 5

Etiological Classification

• Traumatic plexopathy: results from blunt force or penetrating injuries 1
• Neoplastic plexopathy: can be primary (nerve sheath tumors) or secondary (invasion/metastasis) 5, 1
• Inflammatory/immune-mediated plexopathy: includes brachial neuritis, CIDP affecting plexuses, and vasculitic neuropathies 1, 6, 7
• Radiation-induced plexopathy: delayed complication of radiation therapy 1
• Diabetic plexopathy: also called diabetic amyotrophy or Bruns-Garland syndrome when affecting the lumbosacral plexus 6, 8
• Idiopathic plexopathy: similar to neuralgic amyotrophy but affecting lumbosacral plexus 8
• Hereditary conditions: can present with plexopathy, as seen in Ehlers-Danlos syndrome 9

Treatment Approaches

• Management depends on the underlying etiology of the plexopathy 6
• Inflammatory/immune-mediated plexopathies may respond to immunotherapy including corticosteroids and other immunosuppressants 6, 7
• Traumatic plexopathies may require surgical intervention, especially for complete nerve rupture 4
• Neoplastic plexopathies require treatment of the underlying malignancy 5

Common Pitfalls to Avoid

• Failing to distinguish between plexopathies and radiculopathies, which require different diagnostic and treatment approaches 4, 3
• Not recognizing that lateral disc herniations may cause plexopathy that is not detected on standard spine MRI 4
• Delaying appropriate imaging in traumatic cases; imaging should be performed approximately 1 month after injury to allow for resolution of blood and soft-tissue edema 4
• Missing the diagnosis of inflammatory/microvasculitic processes that may respond to timely immunotherapy 6, 7