Nerve conduction studies through landmark based recording and effects of hand length.

As per existing guidelines, the distance between stimulator and recording electrodes in nerve conduction studies (NCS) should be the same (fixed) in all the subjects, i.e., it should not be based on anatomical landmarks. However, there are no studies comparing fixed distance recordings with landmark based NCS. We postulated that hand length can influence the NCS parameters in fixed distance recordings and this can be nullified using landmark based recordings. To test this theory, we performed NCS in 48 normal subjects as per standard guidelines (standard protocol) and then compared it to NCS with ulnar styloid as the landmark (modified protocol). NCS were performed on median and ulnar nerves of the right upper limb. Three motor NCS parameters including distal latency, compound muscle action potential (CMAP) amplitudes and nerve conduction velocities were measured. Sensory nerve action potential (SNAP) amplitudes and conduction velocities were the two sensory parameters measured. On analysis, ulnar motor conduction velocity was the only parameter affected by hand length in both standard and modified protocols. Modified protocol did not have any additional advantage to the standard protocol advised by NDTF. We conclude that the NDTF guidelines are therefore reasonable when considering the effects of hand length. Possible reasons for this result including anatomical and anthropometric explanations are discussed.

Reversal of uniocular blindness with corticosteroids in a solid organ transplant recipient with cryptococcal meningitis and immune reconstitution syndrome (IRIS): A case report.

Cryptococcal meningitis is a life-threatening infection commonly seen in patients with advanced HIV infection and solid organ transplant recipients. We report a case of cryptococcal meningitis with immune reconstitution syndrome (IRIS) who presented to us with a headache and complete loss of vision in the left eye. He was managed with antifungals and a short course of steroids, and he regained vision completely. In the hospital, he developed complications including tacrolimus toxicity, fluconazole-induced QT prolongation, and flucytosine-induced thrombocytopenia. Our case demonstrates the importance of a multidisciplinary approach in the management of complex cases like cryptococcal meningitis in solid organ transplant recipients.

Spectrum of Acute Neuropathy Associated With Covid-19: A Clinical and Electrophysiological Study of 13 Patients From a Single Center.

OBJECTIVES: To analyze clinical and nerve conduction patterns in patients with acute neuropathy, preceded by or concomitantly having Covid-19 disease (Acute neuropathy associated with Covid-19 or ANAC 19). METHODS: A retrospective analysis of clinical details, laboratory evaluation and electrophysiological parameters in patients with ANAC 19 was performed. These data were compared with non-Covid Guillain-Barre syndrome (GBS) described in literature and also with patients with acute neuropathy without Covid-19 who had presented to the center during the study period. RESULTS: Records of 13 patients with ANAC 19 were reviewed. Most patients clinically had paraparesis, and electrophysiologically showed demyelinating neuropathy. Peroneal and sural nerves were the most frequently abnormal motor and sensory nerves, respectively. A proportion of patients showed a peroneal velocity-sparing pattern. Higher incidence of paraparesis and encephalopathy differentiated ANAC 19 from non-Covid GBS. CONCLUSIONS: ANAC 19 had a comparable electrophysiological profile to non-Covid GBS; however, it had a distinct clinical presentation.