1,721,096 research outputs found
A novel approach to the measurement of motor conduction velocity using a single fibre EMG electrode
No full textOBJECTIVE: To evaluate whether, for patients with suspected myelin impairment, the sensitivity of motor nerve conduction studies can be increased by using an SFEMG electrode which makes it possible to study conduction velocity in a small number of axons (SF-CV). METHODS: We studied 22 consecutive patients with suspected neuropathy through conventional motor conduction study and through SF-CV. For each patient we selected a nerve that was normal at conventional neurography and studied it through SF-CV. Also, we performed SF-CV in 15 healthy subjects. We considered 36 m/s as the low limit of normal SF-CV (the normal value commonly accepted in the literature for the slowest alpha motor axons). RESULTS: In the healthy subjects we never observed abnormal SF-CV values. Of the 22 patients, in 18 the conventional tests showed abnormal findings suggestive of neuropathy. The remaining 4 patients were completely normal at the conventional tests. Through SF-CV we studied 22 nerves that were normal at the conventional tests. Fourteen of 22 (64%) nerves presented pathological SF-CV test. Half of the patients with normal findings at the conventional tests showed pathological SF-CV test. CONCLUSIONS: SF-CV evaluation may be useful in detecting early, mild, or partial myelin damage, because it makes it possible to detect nerve conduction slowing when conventional tests are normal. SIGNIFICANCE: Increasing sensitivity of motor conduction evaluation
In response to "Correlations of nerve conduction measures in axonal and demyelinating polyneuropathies"
No full textComment on
Correlations of nerve conduction measures in axonal and demyelinating polyneuropathies. [Clin Neurophysiol. 2007
The tiles make a puzzle but the single tile is not the puzzle: The need for a global assessment of the patient
No full textThe Lambert-Eaton myasthenic syndrome (LEMS) is an autoimmune disease of the neuromuscular transmission associated, in most patients, with antibodies against the voltage-gated calcium channel (VGCC) on the presynaptic nerve terminal (Lennon et al., 1995). The antibody attack results in a reduced influx of calcium into the presynaptic bottom, leading to a defect of acetylcholine release (Fukunaga et al., 1983 and Lang et al., 1987). As a consequence, the availability of acetylcholine at the neuromuscular junction is reduced and depolarization of the postsynaptic muscle membrane is impaired, causing weakness and fatigability
Work increases the incidence of carpal tunnel syndrome in the general population.
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Work increases the incidence of carpal tunnel syndrome in the general population. [Muscle Nerve. 2008
The challenge of basilar artery occlusion wake-up stroke: too late for intravenous thrombolysis?
No full textWe describe the case of a patient carried to our emergency department, with the
wake-up finding of dysarthria, right hemiplegia and worsening consciousness
impairment (NIHSS 12). After performing a CT angiography, which showed complete
basilar occlusion, we determined the MR DWI-FLAIR mismatch to estimate the stroke
onset time. Because of the favorable mismatch (DWI hyperintensity in the left
pons, no FLAIR hyperintensity in the same region), the patient underwent
thrombolysis with sudden neurological improvement. In addition, the DWI
hyperintensity first observed in the left pons totally regressed after
thrombolysis. Wake-up stroke constitutes about 14 % of all strokes, while the
percentage of basilar artery occlusion wake-up strokes is still unknown. Although
thrombolysis in patients with unknown-onset time is still an off-label therapy,
basilar artery occlusion is a potentially fatal event. In our case we used RM
DWI-FLAIR mismatch to rapidly estimate the stroke onset time and to treat the
patient with an off-label but potentially effective and safe therapy
About neurophysiological evaluation in suprascapular nerve entrapment and methods of review
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Thoracic outlet syndrome: wide literature for few cases. Status of the art
No full textDespite its low prevalence and incidence, considerable debate exists in the literature on thoracic outlet syndrome (TOS). From literature analysis on nerve entrapments, we realized that TOS is the second most commonly published entrapment syndrome in the literature (after carpal tunnel syndrome) and that it is even more reported than ulnar neuropathy at elbow, which, instead, is very frequent. Despite the large amount of articles, there is still controversy regarding its classification, clinical picture, diagnostic objective findings, diagnostic modalities, therapeutical strategies and outcomes. While some experts believe that TOS is underrated, overlooked and very frequent, others even doubt its existence as a nosological entity. In the attempt to shed more light on this condition, we performed a systematic review of the literature and report evidence and opinions around this controversial subject. Only articles focused on neurogenic TOS were considered. Understanding the status of the art and the underlying reasons of doubts and weaknesses could help clinical practice and set the stage for future research
Reliability and validity of the CMT neuropathy score as a measure of disability
No full textComment on
Reliability and validity of the CMT neuropathy score as a measure of disability. [Neurology. 2005
Differential involvement of A-delta and A-beta fibres in neuropathic pain related to carpal tunnel syndrome
No full textCarpal tunnel syndrome (CTS), a common entrapment neuropathy involving the median nerve at the wrist, frequently manifests with neuropathic pain. We sought information on pain mechanisms in CTS. We studied 70 patients with a diagnosis of CTS (117 CTS hands). We used the DN4 questionnaire to select patients with neuropathic pain, and the Neuropathic Pain Symptom Inventory (NPSI) to assess the intensity of the various qualities of neuropathic pain. All patients underwent a standard nerve conduction study (NCS) to assess the function of non-nociceptive Abeta-fibres, and the cutaneous silent period (CSP) after stimulation of the IIIrd and Vth digits, to assess the function of nociceptive Adelta-fibres. In 40 patients (75 CTS hands) we also recorded laser-evoked potentials (LEPs) in response to stimuli delivered to the median nerve territory and mediated by nociceptive Adelta-fibres. We sought possible correlations between neurophysiological data and the various qualities of neuropathic pain as assessed by the NPSI. We found that the median nerve sensory conduction velocity correlated with paroxysmal pain and abnormal sensations, whereas LEP amplitude correlated with spontaneous constant pain. Our findings suggest that whereas paroxysmal pain and abnormal sensations reflect demyelination of non-nociceptive Abeta-fibres, spontaneous constant pain arises from damage to nociceptive Adelta-fibres
Relationships between ultrasonographic, clinical, and neurophysiological findings in ulnar neuropathy at elbow
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