Nerve conduction velocities in Median, Ulnar and Peroneal nerves.
Acute denervation was determined in the supinator muscles, first dorsal
interosseous of the hand and left anterior tibialis. Polyphasic
potentials were obtained in the left trapezius.
Increased insertional activity in all the muscles explored.
The recruitment patterns of the trapezius, supinator, first dorsal
interosseous of the hand, gastrocnemius, tibialis, and left peroneal
muscles are obtained with a reduced recruitment pattern in the right
medial rump.
Neuro conduction: the median and ulnar right and left nerves, latency,
amplitude and velocity values are obtained in normal values. Its F
waves were obtained in a low percentage, but with latency within normal
values.
Peroneal nerve: very low amplitude (0.89 mV in the left and 0.79 mV in
the right). Latency and speeds in normal values. Its F waves were not
possible to obtain.
Sural nerve: the left limb showed no potential.
Superficial peroneal nerve: right limb unresponsive
As for this patient, she showed progressive weakness and numbness, both
of which indicate alterations in the peripheral nervous system (PNS),
then the EMG confirmed the damage of the PNS.
Subsequent studies revealed further deterioration of nerve conduction
velocities especially in the legs, with acute denervation in muscles
innervated by right C3-C4 roots, bilateral C5-C6 and right L4-L5-S1,
with severe degree of involvement and neuro conduction study showing
multiple motor mononeuropathy with axonal involvement of the bilateral
suprascapular, bilateral radial, right ulnar and fibula or bilateral
nerves, with a moderate degree of involvement.
Because of the sensory motor deficits, and cytological protein
dissociation in cerebrospinal fluid, the patient was diagnosed with
chronic inflammatory demyelinating polyneuropathy. It is to note that
this patient had evidence of involvement of the CNS (central nervous
system), given the MRI hyperintense areas, nystagmus and cerebellar
signs.
A 3-day course of 1000 mg
intravenous methylprednisolone was administered followed by oral
corticosteroid treatment, prednisone 60 mg daily, diminishing 20 mg
every two weeks to reach 20 mg, and then continuation to 10 mg,
associating at this point with azathioprine 100 mg daily.
The patient also started a program of physiotherapy to improve muscle
strength, function and mobility, and minimize the shrinkage of muscles
and tendons and distortions of the joints.
The numbness and weakness improved, and the patient could walk with the
help of others; In a 6 months follow-up, the results showed there was
still slight numbness of all limbs, and she could walk slowly, most of
the time without help.