缅北禁地 Connect
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Pre vs postganglionic lesion? or conduction bloc neuropathy?
-A patient who was referred to me for a deficit in the left hand with numbness of the inner side of the forearm….
Motor Amplitude of median nerve with wrist stimulation was 3.5mV, at the palm stimulation amp 7.5mV (simultaneous recording of the first interosseous, there is no diffusion) a block at the wrist, palm stimulation in the other side was 14.
- Motor ulnar amplitude at the wrist was 10 and symmetrical to the contralateral without any conduction bloc (wrist, below and above elbow and axilla), the sensory D1, D3 and D5 are normal and symmetrical, the left cutaneous brachii medialis 20uV and hard to get it and on the other side at the first attempt I get 34, mixed cubital 45 and 65 on the other side….
The Needle electromyography: Was neuropathic: The abductor digiti minimi detection poor to intermediate recruitment (accelerated trace) same for the 1st interosseous, abductor policis brevis simple reduced recruitment too, only a single MUAP that was firing, the flexor carpi radialis and flexor carpi ulnaris were in good strength (5/5).
-History: Stress and important weight loss according to the patient, He is a smoker
-Cervical MRI: Degenerative changes, uncarthrosis C5 and C6
---> What are your opinions dear colleagues about this presentation? Are we allowed to consider it as postganglionic rather then preganglionic lesion because the cutaneous brachii of the affected limb is significantly reduced compared to the contralateral?
What about the distal bloc in the wrist? Could this be the onset of neuropathy with conduction bloc, proximal and distal?
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