Brachial Plexopathy and Nonaccidental Injury: Role of the Neurologist

Child neurologists must remain vigilant to the possibility of nonaccidental injury. Just as clinicians have become accustomed to considering potential abuse or neglect in children presenting with a head injury or skeletal trauma, physical abuse must also be considered when children present with lesions at other sites of the neuraxis, as illustrated by this child’s brachial plexopathy. Key elements from the history can assist clinicians in differentiating accidental events from nonaccidental injuries secondary to abuse or neglect. We report a toddler who presented with a recurrent brachial plexopathy due to nonaccidental injury. Her parents initially denied the occurrence of any significant trauma. Furthermore, her diagnosis was complicated by the identification of concomitant, but unrelated lead toxicity. In this case, the vague and inconsistent parental history, plexopathy recurrence, and identification of a fracture all heightened suspicion of child abuse.