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Electrodiagnosis
Published in Mark V. Boswell, B. Eliot Cole, Weiner's Pain Management, 2005
Ross E. Lipton, David M. Glick
Laboratory safety issues include screening the patient for a history of electronic device implantation, such as a cardiac pacemaker. The American Association of Electrodiagnostic Medicine guidelines for performing studies in patients with implantable electronic devices confirm that NCV, needle EMG, and EP studies are relatively safe, as long as attention to grounding detail is meticulous. Proximal limb studies (e.g., brachial plexus stimulation) may increase the risk of an untoward cardiac event with cardiac pacemaker present. Performance of NCV studies in patients with external cardiac pacemaker is not recommended. Repetitive stimulation can be problematic in the case of sensed-rate triggered implantable defibrillators. Intra-arterial catheters present a significant current-related risk, increasing with current leaks. The patient should be screened for anticoagulant use and for history of coagulopathy, platelet disorder, visceral disease, or proclivity to bruise easily. Universal precautions and protocols are in play at all times. Needle EMG of the chest and abdominal wall musculature carries puncture risks, which should be discussed with the patient and consented to before examination. Electrical safety in the laboratory depends on the proper grounding of the machinery. A low-resistance pathway from the machine to the ground is usually provided through the electrical line in the wall plug. One must never directly ground the patient or permit the patient to make contact with grounded objects while connected to any biomedical equipment. This includes avoiding a scenario in which the patient is hooked up to two different machines simultaneously, as in the case of electrocardiography (EKG) with EEG. Extra care must be taken with electrically sensitive patients who are critically ill (Daube, 1996).
Postscript
Published in James W. Albers, Stanley Berent, Neurobehavioral Toxicology: Neurological and Neuropsychological Perspectives, 2005
James W. Albers, Stanley Berent
The differential diagnosis represents a list of possible explanations for the patient’s neurological problem. The initial differential diagnosis is based on interpretation of the patient’s symptoms and signs. However, in the context of peripheral nervous sytem disorders, regardless of cause, the electrodiagnostic examination in the form of nerve conduction studies and needle electromyography plays a unique role. Many ancillary tests, such as examination of blood, urine or cerebrospinal fluid, imaging studies, or neuropathological examination of muscle or nerve tissue, are important to the investigation of neuromuscular disorders in terms of refining the differential diagnosis or establishing causation. At times, laboratory results may establish a specific peripheral nervous system diagnosis or document the amount of exposure. Nevertheless, the electrodiagnostic examination is the one clinical test most germane to the peripheral nervous system evaluation, and most neuromuscular specialists consider the electrodiagnostic examination an extension of the clinical nervous system examination. This reflects the ability of the electromyographer to assess almost any peripheral nerve or muscle, as well as many reflex pathways. Given the sensitivity and specificity of the electrodiagnostic information, the electromyographer also can assess and document symmetry, distribution, and magnitude of peripheral nervous system abnormalities to an extent not clinically possible. As such, the specialty of electromyography is designated electrodiagnostic medicine, to emphasize the special diagnostic component of the evaluation and to distinguish the dynamic process of performing an electrodiagnostic examination from most other laboratory tests. In the context of clinical neurotoxicology, the electrodiagnostic evaluation is the evaluation most relevant to the initial clinical investigation of problems potentially associated with peripheral neurotoxicants. Once a diagnosis is established, its validity and authenticity can be determined objectively in terms of evaluating the adequacy, primacy, coherence, parsimony, robustness, and predictive potential of the diagnosis.
A case of Guillain–Barre syndrome following Pfizer COVID-19 vaccine
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Shiavax J. Rao, Sahiba Khurana, Gayathri Murthy, Elliot T. Dawson, Noushin Jazebi, Christopher J. Haas
Our patient, in contrast, was noted to have GBS symptoms one week following completion of the two-dose Pfizer COVID-19 vaccine series. Serological investigations were noted to be negative for other causes of GBS including autoimmune conditions, viral infections as well as antiganglioside antibodies which have a known association with Campylobacter jejuni associated GBS[14]. Diagnostic workup demonstrated cytoalbuminologic dissociation with mild evidence of early demyelination noted on NCS. The results of both NCS (performed 8 days and 28 days from symptom onset) showed mild demyelinating features in the lower extremities. The definite electrodiagnostic criteria for acute intermittent demyelinating polyneuropathy [15] were not met; however, the studies were consistent with probable electrodiagnostic criteria [16] proposed by the American Association of Neuromuscular & Electrodiagnostic Medicine. Additionally, the overall picture, including cytoalbuminologic dissociation, clinical presentation, and early electrodiagnostic findings were consistent with the diagnosis.
Facing symptoms and limitations: A qualitative study of women with carpal tunnel syndrome
Published in Scandinavian Journal of Occupational Therapy, 2023
Paloma Moro-López-Menchero, Margarita Inés Cigarán-Méndez, Lidiane L. Florencio, Javier Güeita-Rodríguez, César Fernández-de-las-Peñas, Domingo Palacios-Ceña
The study subjects consisted of females aged 18–65 years old and with a clinical and electromyographic diagnosis of CTS. Clinical criteria included paresthesia and/or pain in the territory innervated by the median nerve with a positive Tinel's/Phalen's test [1]. Electro-diagnostic criteria considered motor and sensory conduction deficits of the median nerve according to criteria established by the American Association of Electrodiagnostic Medicine [22]. The exclusion criteria were: (a) previous treatment with surgery and/or steroids; b) trauma to the upper extremity; or c) diagnosis of medical disease (e.g. diabetes, rheumatoid arthritis, sympathetic-reflex dystrophy, fibromyalgia) explaining the symptoms.
Bilateral Martin-Gruber and Marinacci Anastomosis Associated with Carpal Tunnel and Guyon’s Canal Syndrome: Case Report
Published in The Neurodiagnostic Journal, 2022
María Alejandra Maya-González, David Ernesto Geney-Castro, Fabio Salinas-Durán
The present case describes the presence of a bilateral MGA that innervates both the abductor digiti minimi and the FDI muscles; concomitantly associated with a bilateral MA, CTS, and a type III Guyon’s canal syndrome, which seems to be a very unusual finding not previously described in the literature. The presence of apparent conduction blocks in the median and ulnar nerves could be confused with a pathological process, hence it is important that during electrodiagnostic medicine consultation, the practitioners are familiarized with the techniques that allow differentiating pathological processes from anatomical variants and so avoiding diagnostic errors.