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1.
Muscle Nerve ; 55(5): 664-668, 2017 05.
Article in English | MEDLINE | ID: mdl-27571443

ABSTRACT

INTRODUCTION: The inter-rater variability in determination of ulnar nerve conduction across the elbow compromises test accuracy. The extent of this variability is unknown. The objective of this study was to determine and compare inter-rater reliability of variables derived from 2 different ulnar nerve conduction studies (NCSs) across the elbow. METHODS: Two investigators performed a standard ulnar NCS and a 6-cm conduction time (Six-Centimeter Conduction Time test, SCCT) on 60 extremities of asymptomatic subjects. In the standard test, below-elbow (BE) and above-elbow (AE) stimulation points were ≥ 10 cm apart, measured along a curved path, to calculate across-elbow NCV. In SCCT, BE and AE were precisely 6 cm apart measured linearly to calculate CTE (conduction time elbow). Inter-rater reliability was assessed by means of intraclass correlation coefficients (ICC). RESULTS: ICC for across-elbow NCV and CTE were 0.726 and 0.801, respectively. CONCLUSIONS: Reliability of CTE and across-elbow NCV are similar. Shorter distances, if measured linearly, can be used to determine across-elbow ulnar nerve conduction. Muscle Nerve 55: 664-668, 2017.


Subject(s)
Elbow/physiology , Neural Conduction/physiology , Ulnar Nerve/physiology , Adolescent , Adult , Electric Stimulation , Electrodiagnosis , Female , Humans , Male , Middle Aged , Reproducibility of Results , Young Adult
2.
Muscle Nerve ; 54(6): 1139-1144, 2016 12.
Article in English | MEDLINE | ID: mdl-27299856

ABSTRACT

INTRODUCTION: Peripheral nerve injuries (PNI) sustained in combat are typically severe and are frequently associated with marked soft tissue damage, anatomic distortion, and retained metallic fragments. These features complicate clinical and electrodiagnostic assessment and may preclude MRI. METHODS: We describe 4 cases of military personnel who sustained high-velocity gunshot wounds or blasts with metal fragment injuries in which high resolution peripheral nerve ultrasound (US) proved beneficial. RESULTS: In these cases, the clinical and electrodiagnostic exams provided inadequate localization and severity data of the nerve injuries, and MRI was either precluded or provided no additional information. In each case, US disclosed focal nerve segment abnormalities, including regions of focal enlargement and nerve discontinuity with end-bulb neuroma, which guided surgical planning for nerve repair. The findings on US were subsequently confirmed intra-operatively. CONCLUSIONS: High resolution peripheral nerve US is a useful modality in assessment of combat-related PNI. Muscle Nerve, 2016 Muscle Nerve 54: 1139-1144, 2016.


Subject(s)
Peripheral Nerve Injuries/diagnostic imaging , Peripheral Nerve Injuries/etiology , Ultrasonography , Wounds, Gunshot/complications , Adult , Electromyography , Female , Humans , Magnetic Resonance Imaging , Male , Military Personnel , Muscle, Skeletal/diagnostic imaging , Muscle, Skeletal/physiopathology , Young Adult
3.
A A Case Rep ; 3(2): 23-6, 2014 Jul 15.
Article in English | MEDLINE | ID: mdl-25611019

ABSTRACT

A 30-year-old man developed unexplained rhabdomyolysis, persistently increased creatine kinase and severe debilitating muscle cramps. After a nondiagnostic neurologic evaluation, he was referred for a muscle biopsy, to include histology/histochemistry, a myoglobinuria panel, and a caffeine halothane contracture test. Only the caffeine halothane contracture test was positive, and a subsequent ryanodine receptor type 1 gene evaluation revealed a mutation functionally causative for malignant hyperthermia. His identical twin brother, who was suffering from similar complaints, was found to share the same mutation. They each require oral dantrolene therapy to control symptoms, despite difficulty in identifying health care providers familiar with treating this disorder.

4.
J Card Surg ; 25(6): 662-4, 2010 Nov.
Article in English | MEDLINE | ID: mdl-20796093

ABSTRACT

We report a case of postpericardiotomy myasthenia gravis. A 68-year-old male patient without prior history of neuromuscular or autoimmune disorders presented with respiratory failure and severe left ventricular dysfunction four weeks after mitral valve replacement. Markedly elevated acetylcholine receptor antibodies were noted, and the patient responded promptly to immunologic therapy. Awareness of this rare but potentially fatal consequence of cardiac surgery may allow the early institution of specific treatment.


Subject(s)
Heart Valve Prosthesis Implantation , Mitral Valve Insufficiency/surgery , Mitral Valve/surgery , Myasthenia Gravis/complications , Postoperative Complications , Respiratory Insufficiency/etiology , Ventricular Dysfunction, Left/etiology , Acute Disease , Aged , Humans , Immunoglobulins, Intravenous/administration & dosage , Male , Myasthenia Gravis/therapy , Respiratory Insufficiency/therapy , Treatment Outcome , Ventricular Dysfunction, Left/therapy
5.
Semin Neurol ; 29(1): 53-65, 2009 Feb.
Article in English | MEDLINE | ID: mdl-19214933

ABSTRACT

Patients presenting with multiple cranial neuropathies are not uncommon in neurologic clinical practice. The evaluation of these patients can often be overwhelming due to the vast and complicated etiologies as well as the potential for devastating neurologic outcomes. Dysfunction of the cranial nerves can occur anywhere in their course from intrinsic brainstem dysfunction to their peripheral courses. The focus of this review will be on the extramedullary causes of multiple cranial neuropathies as discussion of the brainstem syndromes is more relevant when considering intrinsic disorders of the brainstem. The goals are to provide the reader with an overview of those extramedullary conditions that have a predilection for causing multiple cranial nerve palsies. In turn, this will serve to provide a practical and systematic approach to allow for a more targeted diagnostic evaluation of this, often cumbersome, presentation.


Subject(s)
Brain Stem/pathology , Cranial Nerve Diseases/diagnosis , Cranial Nerve Diseases/etiology , Cranial Nerves/pathology , Cranial Nerves/physiopathology , Meningitis/complications , Bone Diseases/complications , Brain Ischemia/complications , Chronic Disease , Cranial Nerve Diseases/therapy , Diagnosis, Differential , Humans , Meningitis/etiology , Meningitis/pathology , Wounds and Injuries/complications
6.
Mil Med ; 171(6): 494-6, 2006 Jun.
Article in English | MEDLINE | ID: mdl-16808127

ABSTRACT

Acquired focal dystonia is often precipitated by minor local traumatic injury, resulting in severe pain and disability. An active duty soldier with shoulder dystonia, after a fall, that responded partially to botulinum toxin A is described. Post-traumatic dystonia as a neurological illness is discussed, with emphasis on mechanisms, precipitating causes, differential diagnosis, and treatment implications for battlefield clinicians.


Subject(s)
Dystonic Disorders/etiology , Military Medicine , Military Personnel , Shoulder Injuries , Wounds and Injuries/complications , Adult , Botulinum Toxins, Type A/therapeutic use , Diagnosis, Differential , Dystonic Disorders/physiopathology , Humans , Male , Time Factors
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