Postpartum Guillain-Barré syndrome: a case report.

Guillain-Barré syndrome (GBS) is an immune-mediated disorder of the central nervous system presenting as symmetrical, progressive weakness and areflexia. The incidence of GBS is very low during pregnancy, but the risk increases in the postpartum period. The management is done by intravenous immunoglobulin or conservatively. Case Presentation: Case of 27 years female with parity 1, living 1, on postpartum day 20 presented to the emergency department (ED) with weakness over legs and hands since 20 days following emergency lower segment cesarean section for her delivery. The weakness prevailed over the lower extremities and progressed to the upper extremities in 4-5 days, affecting her grip strength and ability to stand alone. No history of prior diarrheal or respiratory illness. Cerebrospinal fluid analysis revealed albuminocytologic dissociation. A nerve conduction study showed in-excitable bilateral radial, median, ulnar, and sural nerves. Intravenous immunoglobulin was administered at the rate of 0.4 g/kg once daily for 5 days. Patient was discharged after 2 weeks with regular physiotherapy follow-up. Conclusion: GBS in the postpartum period is very rare. There must be a high degree of suspicion among physicians for GBS if a pregnant female or a woman during her postpartum period presents with ascending muscle paralysis, even if there is no recent antecedent history of diarrheal episodes or respiratory illness. An early diagnosis with multidisciplinary supportive measures helps improve the prognosis for both the mother and the fetus.

Electrodiagnostic Study of the Patients with Suspected Carpal Tunnel Syndrome.

BACKGROUND: Various electrodiagnostic tests are employed for diagnosis of carpal tunnel syndrome reporting wide range of sensitivity and specificity for each test in clinical practice. Therefore, the aim of our study is to assess the sensitivity of electrodiagnostic tests used in our set up for the diagnosis of carpal tunnel syndrome. METHODS: This cross-sectional study consisted of 21 patients suspected with carpal tunnel syndrome who were referred to neurophysiology lab for electrodiagnostic evaluation and 21 age-group gender matched healthy controls. Digit 4, lumbrical versus ulnar interossei latencies and conventional nerve conduction variables were recorded. A p value of less than 0.05 was considered significant. RESULTS: The sensitivity of median versus ulnar digit 4 sensory latency difference was the highest (72.72 %) whereas the conduction velocity of median nerve was the lowest (45.45%). The lumbrical versus ulnar interossei latency difference was significant between groups; however the sensitivity was only 51.52%. The conduction velocity of median nerve was relatively slower in the suspected cases than controls (49.67±13.75 vs. 60.90 ±6.70; p=0.007). The distal sensory latency of median nerve was significant between groups (3.47 ±0.58 vs. 2.16±0.25; p=0.03). The distal and proximal latencies of motor median nerve were significant between suspected cases and controls (4.70±1.82 vs. 2.75±0.38; p=<0.001). CONCLUSIONS: The sensitivity of median versus ulnar digit 4 sensory latency difference was the highest in our set up therefore, addition of this test with conventional method can be helpful in achieving a higher diagnosis rate.

Mean Motor Nerve Conduction Velocity of Right Ulnar Nerve among Physically Trained Adult Males in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Neural adaptation to physical training allows a person to better coordinate the activation of all relevant muscles producing maximum force. Nerve conduction velocity measures the speed of impulse along the motor neuron and is strongly associated with muscle contraction time. This study aimed to find out the mean motor nerve conduction velocity of the right ulnar nerve among physically trained adult males in a tertiary care centre. Methods: This descriptive cross-sectional study was conducted in the Neurophysiology Laboratory of a tertiary care centre from 3rd November, 2019 to 2nd November, 2020. Thirty young adult males who were engaged in the physical training at a training centre for more than 3 months were studied after receiving ethical approval from the Institutional Review Committee (Reference number: 1578/019). Motor nerve conduction parameters of the right ulnar nerve were measured and data were entered in Microsoft Excel. Statistical analysis was done using the Statistical Packages for the Social Sciences version 25.0. Point estimate at 95% Confidence Interval was calculated along with frequency and percentages for binary data, and mean and standard deviation for continuous data. Results: Among 30 males studied, the mean motor nerve conduction velocity of the ulnar nerve was found to be 61.02±5.86 m/sec (58.92-63.11 at 95% Confidence Interval). The mean distal latency and amplitude of the muscle action potential were 2.33±0.53 ms and 8.08±1.17 mv respectively. Conclusions: Our study found that the mean nerve conduction velocity of the ulnar nerve was similar when compared to studies conducted in similar settings. Keywords: Nepal; nerve conduction; ulnar nerve.