Methodology of nerve conduction studies Motor nerves Sensory nerves Myoanatomic Atlas for Clinical EMG For a patient with weakness due to neuromuscular disease , the EMG and nerve conduction studies are probably reasonably diagnostic in about 75% of cases. Role of EMG evaluation in muscle hyperactivity syndromes . This article reviews the electromyographic features and pathophysiology of fasciculations, high frequency discharges, myokymia, and neuromyotonia. Nerve conduction studies Electrodiagnostic criteria for the diagnosis of acute and chronic inflammatory demyelinating polyneuropathies

Cases for Discussion Case #1: Highest level gait disorder? This 84-year-old man was referred for deteriorating gait and memory, beginning 3-5 years ago. These problems began insidiously and progressed gradually. Throughout this time, he had been sleeping in a Lazy Boy chair because of chronic low back pain. He now walks with a walker. Carbidopa-levodopa 25/100 two tablets tid did not help. Exam revealed orientation to place but not time. Recall was 0 of 3 words. He could not spell WORLD backward and could not draw intersecting pentagons. He was mildly bradykinetic and had mild paratonia in all

Pearls, Perils, and Pitfalls In the Use of the Electroencephalogram Omkar N. Markand, M.D., F.R.C.P.C. Semin Neurol 23(1):7-46, 2003. © 2003 Thieme Medical Publishers Posted 07/22/2003 Abstract and Introduction Abstract Despite advances in neuroimaging techniques over the past three decades that have helped in identifying structural lesions of the central nervous system, electroencephalography (EEG) continues to provide valuable insight into brain function by demonstrating focal or diffuse background abnormalities and epileptiform abnormalities. It is an extremely valuable test in patients

KEY TERMS nystagmus: An involuntary rhythmic oscillation of the eyes. internuclear ophthalmoplegia (INO): With attempted gaze to one side, failure of the adducting eye to move beyond the midline, with nystagmus developing in the abducting eye. INO is due to a lesion affecting the medial longitudinal fasciculus on the same side as the adducting eye. optic disk: The area of the retina entered by the optic nerve. Marcus Gunn pupil: A pupil that may react to light but does not hold the reaction, or, paradoxically, may dilate slowly; the consensual reflex may be more prompt than the direct reflex

A 20-year old woman has fluctuating weakness A 20-year old woman with past medical history of hypertension presented with a two-year history of fluctuating muscle weakness. She has increasing difficulty raising her arms to comb her hair and standing up from a chair. Six months ago she started to have intermittent double vision and difficulty chewing at night. She has no numbness or pain. On neurological exam, mild left ptosis and mild bilateral facial weakness. Limb muscle strength is 4/5 in the proximal and 5/5 in the distal muscles. No muscle atrophy. Deep tendon reflexes, sensation, and

A 65 yr old male develops the acute onset of weakness of the right face, arm and leg. There is associated numbness of face, arm, and leg. He has an expressive aphasia. Eyes are deviated to the left and he has a right homonymous hemianopia. a) What vascular territory is involved? b) Name the vessel this artery branches off from. c) Which artery or arteries supply the body and head of the caudate, upper part of the anterior limb, genu, and anterior part of the posterior limb of the internal capsule, putamen, and pallidum? d) What are the possible etiologies of stroke in this patient? A 75 yr old

Case 1 72 year old with vision problem HPI 72 y/o man 4 months ago found to have squamous cell CA of lung. 3 days ago he had lung surgery. Yesterday he developed a "vision problem". Exam by internal medicine resident and MSIII. Fundus exam shows bilateral cataracts, retinas appear normal. CN normal except "temporal deficit" in L eye, normal R eye visual field, and bilateral hearing deficit. Rest of exam normal. Labs none relevant Questions 1. What is the location of a lesion that could cause this deficit? Case 2 67 y/o with CC falling HPI 72 y/o woman with history of intermittent atrial

Clinical Vignette Meghan is a 15-year-old girl referred for an evaluation of a first seizure. She had been up at a slumber party the night prior to the event. On the following morning, she had a sudden event consisting of falling to the ground and becoming rigid in all extremities, which was followed by jerking of all extremities. The entire event lasted approximately two minutes, and afterwards she was somnolent and groggy, with gradual regaining of consciousness. And after regaining consciousness, she remained confused and disoriented for approximately 15 minutes. In hindsight, she has a

Delirium: A Neurologist's View by Lou Caplan Case 1 You are asked by the patient's wife to see Mr. A, a 60 year old, right-handed man who has recently been asked by his employer to take early retirement. Apparently he has been making mistakes on the job in recent months and his boss is concerned. For examples, he "forgot" to make a business insurance premium payment, and he was unable to complete an important report about recent new business projects. His employer believes that the patient is no longer "interested" in his job. Mrs. A has also noted subtle changes. She finds him irritable and

What is Alzheimer’s? Alzheimer’s disease is a brain disorder that slowly destroys memory and thinking skills, and, eventually, the ability to carry out the simplest tasks. In most people with Alzheimer’s symptoms first appear later in life. Estimates vary, but experts suggest that more than 6 million Americans, most of them age 65 or older, may have dementia caused by Alzheimer’s. Alzheimer’s disease is currently ranked as the sixth leading cause of death in the United States, but recent estimates indicate the disorder may rank third, just behind heart disease and cancer, as a cause of death