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]