Case
Reviews
Please submit cases for consideration to:

Gary R. Smith, DC, DIBE
Left Median Nerve F-wave
Rec Site: APB        Latency
Stim Site: Wrist        ms
F wave                     40.33        
Left Peroneal Nerve F-wave
Rec Site: EDB        Latency
Stim Site: Ankle        ms
F wave                      54.50        
Right Peroneal Nerve F-wave
Rec Site: EDB        Latency
Stim Site: Ankle        ms
F wave        54.33        
Not shown, but performed:  Upper Extremity sensory responses absent over the Median,
Ulnar, and Radial nerves bilaterally.  H-reflexes absent bilaterally.  Needle examination of
the left arm and left leg showed no spontaneous activity and a neurogenic firing pattern
restricted to the hand intrinsics and the extensor hallicus longus.  
ELECTRODIAGNOSTIC DATA INTERPRETATION:

  1. Is there evidence of a peripheral neuropathy?
  2. Is the primary pathology demyelinating or axonal?  Why?
  3. Would you categorize this as sensory, motor, or mixed?
  4. Do the relatively normal to only slightly reduced motor NCV’s obtained, in view of
    the rest of the study, eliminate a diagnosis of a demyelinating neuropathy?
  5. Are the reduced Median motor amplitudes, with distal stimulation,
    incongruent/incompatible with the needle exam of these muscles showing no
    spontaneous activity/denervation?
  6. What information does the distal CMAP durations, obtained in this study, provide?
  7. Does the lack of significant temporal dispersion provide useful information?
  8. Is there any diagnostic significance to having normal low extremity sensory
    responses and abnormal/absent upper extremity sensory responses?
  9. Based upon the information given, could you classify this disorder as distal
    predominant, proximal predominant, or generalized?  Does the ability to classify in
    such a manner have any clinical relevance?
  10. How would you write up the data?
  11. What conclusions would you draw?
  12. Are there any additional tests that warrant consideration?

Thank you for your attention up to this point.  Part II of this case will be posted shortly,
going in to greater depth regarding the electrodiagnostic findings, differentials, and
ultimate diagnosis.  Prior to that, take some time and jot down you own impressions.  For,
it is cases like these that provide fertile ground for future clinical discussions when we are
together in person.  

                                                                Ronald Fudala, DC, DABCN, DIBE
                                                                 E-mail questions/Comments

PROCEED TO PART II