Bilateral Neuritis of the Brachial 
Plexus following Acute 
Croupous Pneumonia. 
BY 
WILLIAM M. LESZYNSKY, M. D., 
Instructor in Mental and Nervous Diseases at the New York 
Post-Graduate Medical School, etc. 
BBPBIMTED FROM THE 
Neto York ^eUical ^Journal 
for April 11, 1896. Reprinted from the New York Medical Journal, 
for April 11. 1896. 
BILATERAL NEURITIS OF THE 
BRACHIAL PLEXUS 
FOLLOWING ACUTE CROUPOUS PNEUMONIA. 
By WILLIAM M. LESZYNSKY, M. D., 
INSTRUCTOR IN MENTAL AND NERVOUS DISEASES 
AT THE NEW YORK POST-GRADUATE MEDICAL SCHOOL, ETC. 
All practitioners are more or less familiar with the 
nervous manifestations that frequently arise in the course 
of acute lobar pneumonia. Tn former times it was thought 
that symptoms such as delirium, headache, etc., were due 
to the continued fever or hyperpyrexia. To day, however, 
most of these symptoms are attributed to functional dis- 
order resulting from the condition of toxaemia. 
Among the more prominent complications affecting the 
nervous system is purulent cerebral meningitis, which in 
my experience, and so far as I can ascertain, has invariably 
proved fatal. 
It is well known that acute lobar pneumonia or croupous 
pneumonia is classified by all recent writers as an acute 
infectious disease, and is assumed to be caused by the 
Micrococcus lanceolatus, which excites a local inflammation 
in the lungs, and by its toxines constitutional disturbance 
of varying intensity (Osler). 
Many recent investigations have confirmed this view, 
Copyright, 1896, by D. Appleton and Company. 2 
BILATERAL NEURITIS OF THE BRACHIAL PLEXUS. 
and this conception of the disease is held by the majority 
of pathologists of the present day. The medical literature 
of the last few years abounds in reports of peripheral 
paralyses following measles, scarlet fever, diphtheria, ty- 
phoid fever, small-pox, influenza, articular rheumatism, etc. 
Anatomical examination has demonstrated in many of 
these cases either haemorrhages or exudation into the nerve 
sheaths, interstitial neuritis, or parenchymatous degenera- 
tion involving the axis cylinders. With the foregoing 
facts in view, the following case is placed on record : 
W. E., born in the United States, thirty-six years of age, 
and a bookkeeper. During the third week of an attack of 
acute pneumonia affecting the right side, he began to have 
pain in both shoulders, which rapidly extended to both arms BILATERAL NEURITIS OF THE BRACHIAL PLEXUS. 
3 
and hands. The pain was of a sharp, darting, and shooting 
character, being so severe that it frequently kept him awake 
at night. It gradually subsided, and two weeks later he first 
noticed that the left shoulder was weak and there was some 
difficulty in moving it. The right arm also felt weak. 
Examination: Left Upper Extremity.-There is typical 
paralysis of the serratus magnus muscle and paresis of the 
superior portion of the trapezius, and consequent inability to 
raise the arm above the horizontal position. There is also 
some atrophy of these muscles and the supraspinatus and 
infraspinatus. No disturbance of sensation. 
Right Upper Extremity.-Supraspinatus and infraspinatus 
are somewhat atrophied; deltoid markedly atrophied and 
paretic, with loss of faradaic irritability, but normal galvanic 
reaction. Absolute anaesthesia in the sensory distribution of 
the circumflex nerve. Supinator longus slightly paretic. 
The triceps reflex is active on both sides. All of the other 
nerves and muscles react normally to the faradiac current. 
Both knee-jerks are well marked. No clonus. No in- 
volvement of the lower extremities. The pupils are normal 
in size and reaction. No evidence of lesion in ocular fundi. 4 
BILATERAL NEURITIS OF THE BRACHIAL PLEXUS. 
The heart's action is somewhat feeble. The lungs are nor- 
mal. Examination of urine negative. 
There is no history of exposure to cold, traumatism, alco- 
holism, syphilis, or rheumatism, or other similar toxic condi- 
tion that could be considered as a constitutional or local 
cause of his present condition. 
This patient was first seen by me on June 27, 1895. The 
triweekly application of the galvanic current to the paralyzed 
and atrophied muscles resulted in a moderate degree of im- 
provement in motility after four months' treatment. Gen- 
eral tonic measures were also instituted. 
The accompanying reproductions of photographs clearly BILATERAL NEURITIS OF THE BRACHIAL PLEXUS. 
5 
show the typical deformity of the back resulting from 
paralysis of the left serratus magnus. 
Among three hundred or more cases of peripheral- 
neuritis observed by the writer, this is the only one into 
which pneumonia en- 
tered as an aetiological 
factor. 
Osler, in the last 
edition of his work on 
the Practice of Medi- 
cine (page 557), states 
that " among rare com- 
plications (of pncu 
monia) may be men- 
tioned peripheral neu- 
ritis, of which seveial 
instances have been de- 
scribed." 
One of the promi- 
nent features in the 
case under considera- 
tion was the paralysis 
of the serratus mag- 
nus. It may therefore 
be interesting to note 
that the usual causes of such paralysis are traumatism, pres- 
sure from carrying heavy weights on the shoulder, excessive 
muscular effort, exposure to cold, and the involvement of 
the muscle in the course of progressive muscular atrophy. 
The unusual features in this case are: 1. The primary 
cause of the'acute degenerative neuritis affecting the upper 
branches of the brachial plexus on both sides. 2. The 
early limitation of the permanent lesion to the right cir- 
cumflex nerve and the left posterior thoracic nerve. 
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