Arquivo da categoria: Neuromuscular

NERVE CONDUCTION STUDIES: ESSENTIALS AND PITFALLS IN PRACTICE

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A neurologist has sent a patient for nerve conduction studies (NCS) and has received the report, but what does it mean? We hope to remove some of the mysteries that may surround NCS. The techniques and how they are affected by disease are described in general terms. These principles can be applied to specific conditions discussed elsewhere. We also discuss the numerous pitfalls that may be encountered with NCS. Understanding these basic concepts will allow you to get the most from your clinical neurophysiology department. NCS are only part of a complete peripheral neurophysiological examination (PNE) and are frequently accompanied by a needle electromyogram (EMG). The combination of both techniques and those detailed in other articles in this issue are often required for a complete diagnostic study. The process of choosing the appropriate tests is the responsibility of the clinical neurophysiologist (CN) and not the referring doctor and is planned as a dynamic series of steps designed to answer specific questions about nervous system function raised by the clinical picture. (J Neurol Neurosurg Psychiatry 2005;76(Suppl II):ii23–ii31) <<< leia mais >>>

ENTRAPMENT NEUROPATHIES

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This is a case-based format to highlight the clinical presentation, diagnosis, and treatment of some of the most common entrapment neuropathies of the upper and lower limbs. The primary focus are entrapment neuropathies related to chronic compression with less attention given to focal neuropathies related to acute compression, such as radial neuropathy at the spiral groove (Saturday Night’s palsy). <<< leia mais >>>

Abordagem diagnóstica das neuropatias em serviço de referência em doenças neuromusculares

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As neuropatias, frequentemente, desafiam os neurologistas devido aos variados diagnósticos etiológicos. Na maioria dos casos exigem dispendiosos recursos financeiros e de tempo aplicados ao diagnóstico, bem como na escolha de uma abordagem terapêutica eficaz, podendo ocasionar grandes prejuízos à qualidade de vida dos pacientes. Neste artigo, fornecemos uma visão da abordagem diagnóstica aplicada no Setor de Investigação e Tratamento de Doenças Neuromusculares da Universidade Federal de São Paulo (UNIFESP), com o intuito de direcionarmos o raciocínio clínico, com base nos aspectos clínicos e anatômicos individuais de cada paciente. (Rev Neurocienc 2010;18(1):74-80). <<< leia mais >>>

NERVE CONDUCTION STUDIES: PRACTICAL PHYSIOLOGY AND PATTERNS OF ABNORMALITIES

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Nerve conduction studies (NCS), together with the needle electrode examination (NEE), constitute the electrodiagnostic examination. For most neuromuscular diagnostic problems, the NCS are the initial probe into the peripheral nervous system. The findings from the NCS will dictate what muscles must be studied during the subsequent NEE. Usually a complete electrodiagnostic impression depends upon the findings of both the NCS and the NEE, but only the NCS can confirm the presence of entrapment mononeuropathies, demyelinating neuropathies, and defects of neuromuscular junction (NMJ) transmission. Responses can be recorded along peripheral motor and sensory axons. Characteristics of the responses include the amplitude, duration, latency, and velocity of responses. From these parameters, patterns of nerve pathology can be identified, including axon loss, demyelination, and conduction block. Although there are no specific NCS features of myopathy, muscle fiber loss and muscle fiber inexcitability affect the amplitude of motor responses. With NMJ transmission defects, specific abnormalities on NCS are identified. <<< leia mais >>>

Assessment of Current Diagnostic Criteria for Guillain-Barré Syndrome

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Diagnostic criteria for Guillain-Barré syndrome (GBS) were devised in 1978 at the request of the National Institute of Neurological and Communicative Disorders and Stroke (NINCDS, now NINDS). The basis for issuing diagnostic criteria related to the swine flu vaccine incident of 1976-1977, which is reviewed in more detail elsewhere in the proceedings of this symposium. At the previous conference on Guillain-Barré syndrome in 1981, clarification of these diagnostic criteria was offered. In the intervening eight years it has become apparent that further comments and elaboration on the diagnostic criteria first stated in 1978 are in order. The reader should recognize that the suggestions made are solely the opinions of the authors and are not officially sanctioned by the NINDS or any neurological societies. The definition of GBS and criteria for diagnosis are reproduced below as they were first published in the Annals of Neurology in 1978. These are followed by a series of comments and suggested modifications.  >>> leia o artigo >>>