RESUMO
OBJECTIVE: To describe a patient with multifocal motor neuropathy with conduction block who had annual clinical and physiological examinations for 18 years but declined treatment for personal reasons. DESIGN: Case report. SETTING: Collaboration between 2 academic tertiary care hospitals. Patient One patient with multifocal motor neuropathy with conduction block. RESULTS: At age 44 years, there was weakness and wasting of the left biceps with conduction block in the left musculocutaneous and right ulnar nerves. The left median nerve was inexcitable. The right median, ulnar, and left peroneal nerves developed axonal change (loss of distal compound muscle action potential amplitude) at years 5, 12, and 13. By 2005, new weakness had appeared in 20 muscles (16 in the arms); he could not use a keyboard, button buttons, or write his name. Nerves that initially showed conduction block became inexcitable over the course of the illness. CONCLUSIONS: Multifocal motor neuropathy with conduction block is a disease that may be "only" slowly progressive but is not always benign. Nerves showing conduction block may develop axonal change. Better markers for this disease are needed.
Assuntos
Doença dos Neurônios Motores/patologia , Condução Nervosa/fisiologia , Potenciais de Ação/fisiologia , Adulto , Braço/inervação , Braço/fisiologia , Eletromiografia , Humanos , Imunização Passiva , Masculino , Doença dos Neurônios Motores/fisiopatologia , Músculo Esquelético/fisiopatologia , Exame Neurológico , Nervos Periféricos/fisiopatologia , Recusa do Paciente ao TratamentoRESUMO
Development of clinical neurophysiology, especially in neuromuscular disease investigation in the 20th century underscores the careers of two academic physician-investigators. Experimental models of neuromuscular disorders (toxic and diabetic neuropathies, myasthenia gravis, nerve transplant and repair) with emphasis on regeneration are described. Subsequent clinical application has validated the animal studies. The value of disease related support societies (Muscular Dystrophy, Charcot Marie Tooth and Myasthenia Gravis) is discussed, not only for patient information and support but also for support of research projects and clinical research fellowship training. The clinician-teacher-investigator as a role model is mentioned, particularly in relation to Dr. Jack Petajan's career, a truly renaissance man. Credit is given to the great teachers of clinical neurophysiology and neuromuscular diseases of the past 50 years.
Assuntos
Modelos Animais de Doenças , Cabras , Doenças Neuromusculares/fisiopatologia , Pesquisadores , Animais , História do Século XX , História do Século XXI , Humanos , Masculino , Doenças Neuromusculares/história , MédicosRESUMO
Carpal tunnel syndrome (CTS) is a frequent and underdiagnosed complication of pregnancy. Conservative therapies are common initial measures, but data on the course of improvement are limited. We report a case of pregnancy-associated CTS with unusually detailed serial electrophysiologic studies before and after wrist splinting. Physiologic measures reached a nadir and then rapidly improved following conservative therapy, paralleling clinical improvement. Responses took between 6 and 20 months postpartum to approach baseline values.
