predictive value of electrodiagnostic study in carpal tunnel syndrome surgery

Electrodiagnostic study has false positive and false negative results, moreover it is invasive and costly. This research aimed to evaluate if this study is obligatory before carpal tunnel release surgery in patients with clinically evident diagnosis, and if this study can predict surgical outcome. A prospective comparative study included 207 cases [mean age+/-standard deviation 42.35+/-11.19 years] diagnosed with carpal tunnel syndrome. One hundred cases had undergone confirmatory electrodiagnostic study [Group 1] while 107 had not [Group 2]. Patients in both groups were comparable for age, symptoms, duration of complaint, and physical findings. Both groups underwent open carpal tunnel release surgery and were evaluated two weeks and six months later by a physician not aware to which group the patient belonged. Response to surgery was comparable between the two groups [excellent in 91%, acceptable in 5.8%, and bad in 4.8% in the first vs. 87.9%, 5.6%, and 6.5% respectively in the second, p=0.493]. Electrodiagnostic study could be omitted in clinically evident carpal tunnel syndrome, even when patient is referred to surgery

Spontaneous spinal epidural hematoma: a case report and review of the literature

Spontaneous spinal epidural hematoma [SSEH] is a rare emergency with potentially serious sequel. We report a case of SSEH to emphasize the importance of early recognition and urgent surgery for this challenging emergency. A 10-year-old boy presented with gradual onset of neck and back pain, vomiting, and nuchal rigidity followed by rapidly progressive paraparesis, abdomen and lower extremities hyperesthesia and sphincter dysfunction. MR imaging demonstrated epidural hematoma of cervico-thoracic spinal segments [C7-T3]. Emergent decompressive laminectomy with hematoma evacuation was performed the third day after paraplegia onset. Neurological improvement was obvious but slow, and the patient was discharged walking with aid 10 days after surgery. Two months later he got full functional recovery. We conclude that SSEH is a rare but disabling or even fatal clinical challenge. Early diagnosis and prompt surgery improve the neurological and functional outcome. Initial nonspecific symptoms can lead to a delay in diagnosis, especially in younger children. Relevant physicians should pay attention to the symptoms of this rare entity and SSEH should be one of differential diagnoses of rapidly evolving spinal cord syndrome