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P419: Benign tumour as a rare cause of tarsal tunnel syndrome – case report
S162
Abstracts of Poster Presentations / Clinical Neurophysiology 125, Supplement 1 (2014) S1–S339
P419 Benign tumour as a rare cause of tarsal tunnel syndrome – case report
and EMG yielded diagnostic importance for demyelinating neuropathy and myopathy in patients older than 6 years of age.
K. Macek 1 , K. Tomczykiewicz 2 1 Private Neurological Practice, Warsaw, Poland; 2 Medical Military Institute, Neurology, Warsaw, Poland
P421 Age influences recovery after carpal tunnel syndrome surgery
Question: Tarsal tunnel syndrome is the most frequent entrapment neuropathy of the posterior tibial nerve [1]. It may involve also its plantar and/or calcaneal branches [3]. It is a rare and frequently underdiagnosed condition leading to motor, sensory and autonomic complications affecting the sole. Early decompression in the symptomatic cases promotes good recovery [2]. Methods: We present the case of a 59-year-old female who was admitted to our Clinic with a 2-month-history of progressive weakness and burning of the right foot. The diagnosis of the symptomatic tarsal tunnel syndrome was made based on electrodiagnostic testing and magnetic resonance imaging of the right foot. Results: Electroneurography revealed a severe right tibial nerve injury in the tarsal tunnel. MRI showed a polycyclic cystic mass medially to the lower ankle joint distorting the swollen tibial nerve. The postoperative outcome was good. Conclusions: Tarsal tunnel syndrome can be easily overlooked due to the rarity and nonspecific symptoms of this pathology and a tumour in the tarsal tunnel is an exeptional cause [2]. Insightful electrodiagnostic testing can help identify the site of injury. When combined with imaging, it constitutes a proper therapeutic regimen. References: [1] Emeryk-Szajewska B, Niewiadomska-Wolska M. Neurofizjologia kliniczna. Medycyna Praktyczna, Krakow, 2008, pp. 229-231. [2] Ahmad M, Tsang K, Mackenney PJ, Adedapo AD. Tarsal tunnel syndrome: a literature review. Foot Ankle Surg 2012; 18: 148-152. [3] Binnie CD, Cooper R, Mauguiere F, Osselton JW, Prior PF, Tedman BM. Clinical Neurophysiology, Elsevier, 2004, pp. 136-138.
O. Vysata 1 , M. Valis 1 , P. Kunc 1 , A. Prochazka 2 , L. Pazdera 3 1 Faculty Hospital Hradec Kralove, Dept. of Neurology, Hradec Kralove, Czech Republic; 2 Institute of Chemical Technology, Department of Computing and Control Engineering, Prague, Czech Republic; 3 Neurocenter caregroup LTD., Rychnov nad Kneznou, Czech Republic Question: To determine if parameters of conductive studies are significantly affected by age. Methods: This retrospective study included 258 hands of patients with idiopathic carpal tunnel syndrome subjected to surgical treatment according to the open carpal tunnel release method. We compared differences in distal motor latency (DML), the amplitudes of compound muscle action potential (CMAP) and sensory conduction velocity (SCV) before and 3 months after the surgery. Age dependency of measured parameters were analyzed by the Pearson correlation coefficients. Because preoperative DML significantly depends on age, latency differences were compared using paired t-test for patients with the same preoperative distal motor latency and minimal age difference of 20 years. Results: There were detected statistically significant difference of the recovery of DML between the younger and older group of patients (1.4±1.5 ms versus 0.8±0.9 ms). No significant difference of the recovery of the amplitude of CMAP and SCV were found. Preoperative DML was significantly increased in older patients while CMAP amplitude and SRV were significantly decreased. Conclusions: Slower recovery after carpal tunnel syndrome surgery in the elderly is an argument for early diagnosis and therapy to this disease. However, is not an argument against the surgical treatment of the carpal tunnel syndrome in this group of patients.
P420 EMG in pediatric population: was it worth it?
P422 Prevalence of Martin Gruber anastomosis in healthy subjects
E. Kocasoy Orhan 1 , L. Baysal Kirac 1 , P. Yalınay Dikmen 2 , Z. Matur 3 , M.B. Baslo 1 , M. Ertas¸ 1 , A.E. Öge 1 , F. Deymeer 1 , J. Yazıcı 1 1 Istanbul University, Istanbul Medical Faculty, Neurology, Istanbul, Turkey; 2 Acıbadem University, Neurology, Istanbul, Turkey; 3 Bilim University, Neurology, Istanbul, Turkey
E. Ehler, J. Latta, P. Didzon, P. Urban Regional Hospital Pardubice, Neurology, Pardubice, Czech Republic
Question: Electrodiagnostic evaluation provides an important extension to the neurological examination for the evaluation of pediatric neuromuscular disease. Many pediatric neuromuscular diseases are anologous to those seen in the adult, however, the relative frequency of these illnesses varies greatly when different age populations are compared. The purpose of the present study is to provide analysis of children referred to our electromyography (EMG) laboratory for electrophysiological examinations. Method: We retrospectively reviewed electrodiagnostic records of patients aged between 0 and 15 years, attending our electromyography (EMG) laboratory with suspicion of a neuromuscular disease and a referring diagnosis on the referral form between years January 2004 and June 2013. Patients were classified as having plexopathy,nerve root lesions, polyneuropathy, myopathy, mononeuropathy, anterior horn cell disease, neuromuscular transmission disorder, facial nerve palsy and other rare disorders. Results: We reviewed 5563 pediatric records, which was 578 studies per year. It was about 14% of the all EMG examination perfomed in our laboratory. When we looked at the all procedures, 3271 of the records were including needle EMG, 170 of them were single fiber EMG, 100 of them were repetitive nerve stimuation, and 52 of them were evoked potentials. The results were normal in 55% of the cases. The common diagnosis were plexopathy (28.6%), polyneuropathy (PNP) (7.4%), and myopathy (6.6%) in patients aged between 0–5 years (41.2% of all records). Between 6 and 10 years (28.2% of all records) the common diagnosis were myopathy (9.4%), PNP (8.5%), mononeuropathy (6.4%) and plexopathy (5.9%) and between 11 and 15 years (30.6% of all records) the common diagnosis were PNP (11.3%), myopathy (6.6%), and mononeuropathy (5.6%). Conclusion: Nearly half of the examinations were normal. Infants and toddlers were mostly suffered from brachial plexopathy which can be prevented by proper obstetrical management. Nerve conduction studies
Background: Martin Gruber anastomosis (MGA) is an anatomical connection on the forearm between the median and ulnar nerves. Some ulnar motor fibers are joining the median nerve in the elbow region. There are 3 types of MGA - motor fibers for ADM (MGA-I), for FDI (MGA-II), and for adductor pollicis (MGA-III). The prevalence of MGA is reported between 15% and 35%. Methods: To carry out normative conduction study of the ulnar nerve at the elbow, 292 healthy volunteers were investigated in five different EMG laboratories. The group consisted of 166 women (256 arms) and 126 men (201 arms), aged 20-67 years (average 39.4 years). Motor and sensory neurographies of the median and ulnar nerves were performed. The ulnar nerve was examined in 90° flexion in the elbow, 10 cm elbow segment, registration from ADM and FDI. The ulnar nerve was stimulated 4 cm distally of the line connecting middle of olecranon and medial epicondyle, and 6 cm proximally. Motor nerve conduction velocities and CMAP were evaluated in all tested nerve segments. If the amplitude of CMAP bellow elbow was at least 20% lower than A-CMAP at the wrist, the finding was evaluated as MGA. Results: In our sample we found MGA in 79 arms. There was the drop of A-CMAP for ADM (MGA-I) in 22 arms, for FDI (MGA-II) in 49 arms, and for both ADM and FDI in 8 arms. In 12 persons we found MGA (always type II) on both sides, including one woman with concurrent MGA-I on the right side. The persons with MGA had to be excluded from further analyses to establish normal conduction values of the ulnar nerve. Conclusion: In a group of 292 healthy persons (459 evaluated arms) we found MGA-I and/or MGA-II in 79 arms (17.2%). Because we have not investigated adductor pollicis muscle, we could not assess prevalence of MGA-III.
Abstracts of Poster Presentations / Clinical Neurophysiology 125, Supplement 1 (2014) S1–S339
P419 Benign tumour as a rare cause of tarsal tunnel syndrome – case report
and EMG yielded diagnostic importance for demyelinating neuropathy and myopathy in patients older than 6 years of age.
K. Macek 1 , K. Tomczykiewicz 2 1 Private Neurological Practice, Warsaw, Poland; 2 Medical Military Institute, Neurology, Warsaw, Poland
P421 Age influences recovery after carpal tunnel syndrome surgery
Question: Tarsal tunnel syndrome is the most frequent entrapment neuropathy of the posterior tibial nerve [1]. It may involve also its plantar and/or calcaneal branches [3]. It is a rare and frequently underdiagnosed condition leading to motor, sensory and autonomic complications affecting the sole. Early decompression in the symptomatic cases promotes good recovery [2]. Methods: We present the case of a 59-year-old female who was admitted to our Clinic with a 2-month-history of progressive weakness and burning of the right foot. The diagnosis of the symptomatic tarsal tunnel syndrome was made based on electrodiagnostic testing and magnetic resonance imaging of the right foot. Results: Electroneurography revealed a severe right tibial nerve injury in the tarsal tunnel. MRI showed a polycyclic cystic mass medially to the lower ankle joint distorting the swollen tibial nerve. The postoperative outcome was good. Conclusions: Tarsal tunnel syndrome can be easily overlooked due to the rarity and nonspecific symptoms of this pathology and a tumour in the tarsal tunnel is an exeptional cause [2]. Insightful electrodiagnostic testing can help identify the site of injury. When combined with imaging, it constitutes a proper therapeutic regimen. References: [1] Emeryk-Szajewska B, Niewiadomska-Wolska M. Neurofizjologia kliniczna. Medycyna Praktyczna, Krakow, 2008, pp. 229-231. [2] Ahmad M, Tsang K, Mackenney PJ, Adedapo AD. Tarsal tunnel syndrome: a literature review. Foot Ankle Surg 2012; 18: 148-152. [3] Binnie CD, Cooper R, Mauguiere F, Osselton JW, Prior PF, Tedman BM. Clinical Neurophysiology, Elsevier, 2004, pp. 136-138.
O. Vysata 1 , M. Valis 1 , P. Kunc 1 , A. Prochazka 2 , L. Pazdera 3 1 Faculty Hospital Hradec Kralove, Dept. of Neurology, Hradec Kralove, Czech Republic; 2 Institute of Chemical Technology, Department of Computing and Control Engineering, Prague, Czech Republic; 3 Neurocenter caregroup LTD., Rychnov nad Kneznou, Czech Republic Question: To determine if parameters of conductive studies are significantly affected by age. Methods: This retrospective study included 258 hands of patients with idiopathic carpal tunnel syndrome subjected to surgical treatment according to the open carpal tunnel release method. We compared differences in distal motor latency (DML), the amplitudes of compound muscle action potential (CMAP) and sensory conduction velocity (SCV) before and 3 months after the surgery. Age dependency of measured parameters were analyzed by the Pearson correlation coefficients. Because preoperative DML significantly depends on age, latency differences were compared using paired t-test for patients with the same preoperative distal motor latency and minimal age difference of 20 years. Results: There were detected statistically significant difference of the recovery of DML between the younger and older group of patients (1.4±1.5 ms versus 0.8±0.9 ms). No significant difference of the recovery of the amplitude of CMAP and SCV were found. Preoperative DML was significantly increased in older patients while CMAP amplitude and SRV were significantly decreased. Conclusions: Slower recovery after carpal tunnel syndrome surgery in the elderly is an argument for early diagnosis and therapy to this disease. However, is not an argument against the surgical treatment of the carpal tunnel syndrome in this group of patients.
P420 EMG in pediatric population: was it worth it?
P422 Prevalence of Martin Gruber anastomosis in healthy subjects
E. Kocasoy Orhan 1 , L. Baysal Kirac 1 , P. Yalınay Dikmen 2 , Z. Matur 3 , M.B. Baslo 1 , M. Ertas¸ 1 , A.E. Öge 1 , F. Deymeer 1 , J. Yazıcı 1 1 Istanbul University, Istanbul Medical Faculty, Neurology, Istanbul, Turkey; 2 Acıbadem University, Neurology, Istanbul, Turkey; 3 Bilim University, Neurology, Istanbul, Turkey
E. Ehler, J. Latta, P. Didzon, P. Urban Regional Hospital Pardubice, Neurology, Pardubice, Czech Republic
Question: Electrodiagnostic evaluation provides an important extension to the neurological examination for the evaluation of pediatric neuromuscular disease. Many pediatric neuromuscular diseases are anologous to those seen in the adult, however, the relative frequency of these illnesses varies greatly when different age populations are compared. The purpose of the present study is to provide analysis of children referred to our electromyography (EMG) laboratory for electrophysiological examinations. Method: We retrospectively reviewed electrodiagnostic records of patients aged between 0 and 15 years, attending our electromyography (EMG) laboratory with suspicion of a neuromuscular disease and a referring diagnosis on the referral form between years January 2004 and June 2013. Patients were classified as having plexopathy,nerve root lesions, polyneuropathy, myopathy, mononeuropathy, anterior horn cell disease, neuromuscular transmission disorder, facial nerve palsy and other rare disorders. Results: We reviewed 5563 pediatric records, which was 578 studies per year. It was about 14% of the all EMG examination perfomed in our laboratory. When we looked at the all procedures, 3271 of the records were including needle EMG, 170 of them were single fiber EMG, 100 of them were repetitive nerve stimuation, and 52 of them were evoked potentials. The results were normal in 55% of the cases. The common diagnosis were plexopathy (28.6%), polyneuropathy (PNP) (7.4%), and myopathy (6.6%) in patients aged between 0–5 years (41.2% of all records). Between 6 and 10 years (28.2% of all records) the common diagnosis were myopathy (9.4%), PNP (8.5%), mononeuropathy (6.4%) and plexopathy (5.9%) and between 11 and 15 years (30.6% of all records) the common diagnosis were PNP (11.3%), myopathy (6.6%), and mononeuropathy (5.6%). Conclusion: Nearly half of the examinations were normal. Infants and toddlers were mostly suffered from brachial plexopathy which can be prevented by proper obstetrical management. Nerve conduction studies
Background: Martin Gruber anastomosis (MGA) is an anatomical connection on the forearm between the median and ulnar nerves. Some ulnar motor fibers are joining the median nerve in the elbow region. There are 3 types of MGA - motor fibers for ADM (MGA-I), for FDI (MGA-II), and for adductor pollicis (MGA-III). The prevalence of MGA is reported between 15% and 35%. Methods: To carry out normative conduction study of the ulnar nerve at the elbow, 292 healthy volunteers were investigated in five different EMG laboratories. The group consisted of 166 women (256 arms) and 126 men (201 arms), aged 20-67 years (average 39.4 years). Motor and sensory neurographies of the median and ulnar nerves were performed. The ulnar nerve was examined in 90° flexion in the elbow, 10 cm elbow segment, registration from ADM and FDI. The ulnar nerve was stimulated 4 cm distally of the line connecting middle of olecranon and medial epicondyle, and 6 cm proximally. Motor nerve conduction velocities and CMAP were evaluated in all tested nerve segments. If the amplitude of CMAP bellow elbow was at least 20% lower than A-CMAP at the wrist, the finding was evaluated as MGA. Results: In our sample we found MGA in 79 arms. There was the drop of A-CMAP for ADM (MGA-I) in 22 arms, for FDI (MGA-II) in 49 arms, and for both ADM and FDI in 8 arms. In 12 persons we found MGA (always type II) on both sides, including one woman with concurrent MGA-I on the right side. The persons with MGA had to be excluded from further analyses to establish normal conduction values of the ulnar nerve. Conclusion: In a group of 292 healthy persons (459 evaluated arms) we found MGA-I and/or MGA-II in 79 arms (17.2%). Because we have not investigated adductor pollicis muscle, we could not assess prevalence of MGA-III.