POSTPARTUM NEURALGIC AMYOTROPHY

We report 11 women with at least one episode of neuralgic amyotrophy o ccurring postpartum. One woman had three episodes-two postpartum and a third occurring after minor foot surgery. Two others had a second epi sode, one following a first trimester spontaneous abortion and one aft er a viral syndrome. Pain followed delivery from as little as 1 to 2 h ours to up to 2 weeks and usually lasted from a few weeks to several m onths. Weakness, if delayed, followed onset of pain by 2 or 3 days up to 5 weeks. Four of the episodes were bilateral. Clinical weakness and electrodiagnostic findings varied widely, from involvement of a singl e peripheral nerve (e,g., long thoracic, anterior interosseous) to mul tiple bilateral proximal and distal nerves. Functional recovery was ex cellent (90 to 100%) in 8 of the 10 with adequate follow-up, requiring as Little as 2 weeks or up to 3 years. Two women have moderate persis ting weakness (both bilateral) at 3 years and 2 years. Five patients w ent on to subsequent deliveries without recurrence of neuralgic amyotr ophy. Only one of the 11 women had a history suggesting familial neura lgic amyotrophy, a disorder generally thought to be associated particu larly with postpartum episodes. Although the etiology of postpartum ne uralgic amyotrophy remains unknown, an immunologic mechanism is suspec ted. Focal demyelination may play a role in some, but clearly axonal d egeneration is predominant in the majority.