Sural-sparing pattern: A study against electrodiagnostic subtypes of Guillain-Barre syndrome.

Objective: To study sural-sparing pattern in Guillain-Barre syndrome (GBS) and compare it among GBS's electrodiagnostic subtypes, classified by two recent criteria. Methods: This study retrospectively reviewed clinical data and electrodiagnostic studies (EDXs) of 88 GBS patients diagnosed in a tertiary care hospital (2010-2019). Results: Overall, 79/88 (89.8%) and 36/45 (80%) patients had bilateral sensory nerve conduction studies (NCS) in the first EDX and follow-up EDX, respectively. Sural-sparing occurred in all subtypes (50% overall occurrence rate), most commonly in demyelination. There was no statistically significant difference in sural-sparing occurrence rates between demyelinating and axonal GBS; however, sural-sparing in axonal GBS tended to show a lower number of abnormal upper-limb sensory nerve action potentials (SNAPs) than demyelinating GBS. Shifting between sural-sparing and no sural-sparing occurred in approximately-one-fourth of patients receiving serial studies. Follow-up EDX additionally discovered 20% of all sural-sparing. Unilateral EDX could have omitted up to 30% of sural-sparing. Conclusions: Sural-sparing is less obviously manifested in axonal than demyelinating GBS, with respect to the number of affected upper-limb SNAPs. Extended sensory NCS is worth in detecting sural-sparing as a supportive electrodiagnostic GBS feature. Significance: This report showed one different character of sural-sparing (number of affected upper-limb SNAPs) between demyelinating and axonal GBS.

Mid-palm recording technique, a new electrodiagnostic approach in Martin-Gruber anastomosis.

INTRODUCTION: Median and ulnar motor nerve conduction study recording from median-innervated 2nd lumbrical and ulnar-innervated 1st palmar and 2nd dorsal interossei is designated in electrodiagnostic evaluation of carpal tunnel syndrome. In this technique, both responses are recorded by the same surface recording electrode placing over their shared motor point in mid-palm. To the best of our knowledge, this technique has never been utilized in demonstration of Martin-Gruber anastomosis. CASE REPORTS: By applying this technique to the conventional CMAP comparison method, the authors accordingly demonstrated Martin-Gruber anastomosis in four cases. Three presented with focal mononeuropathies of the upper limbs, including a severe carpal tunnel syndrome, a mild to moderate carpal tunnel syndrome, and an ulnar neuropathy. One was a normal individual. SIGNIFICANCE: This report described a new electrophysiological pattern of MGA. Adding the mid-palm recording to conventional CMAP comparison method provides a broader view in terms of innervation of MGA. This technique is not complicated and can be added to the electrophysiological investigation for complete studying of the innervated muscles in MGA.

Needle EMG, a Jigsaw to Disclose Lipid Storage Myopathy Due to Multiple Acyl-CoA Dehydrogenase Deficiency.

Multiple acyl-CoA dehydrogenase deficiency is a rare autosomal recessive inborn error of metabolism. The late-onset multiple acyl-CoA dehydrogenase deficiency is frequently caused by mutations in ETFDH gene. Because of its clinical heterogeneity, diagnosis and treatment of late-onset multiple acyl-CoA dehydrogenase deficiency are often delayed. The authors described a previously healthy 40-yr-old Thai woman presenting with subacute severe weakness of bulbar-limb muscles and elevated serum creatine kinase. The authors emphasized the importance of needle EMG and prompt muscle histopathological evaluation, which rapidly led to the diagnosis and riboflavin therapy, resulting in a dramatic and rapid improvement before genetic study disclosed mutation in ETFDH gene.

Isolated intermittent neurogenic priapism: an unusual presentation in degenerative lumbar spinal stenosis.

Priapism is a relatively uncommon clinical presentation. The well-recognised causes are sickle cell anaemia and the use of medications, such as vasoactive erectile agents. Infrequently, it could be the result of lumbar spinal stenosis. The authors reported an elderly man with 1-year history of isolated intermittent priapism aggravated by walking. MRI showed lumbosacral spondylosis with severe stenosis at the level of L4-L5. Total laminectomy of L4 and L5 was done, resulting in a rapid and complete resolution of symptom without recurrence during the follow-up time of 10 years.