Faculty Bibliography

In accessory neuropathy electrodiagnosis, upper trapezius compound muscle action potential (CMAP) latencies and amplitudes are commonly measured. The few prior reports describing middle and lower trapezius recording have traditionally emphasized latency value determination. The utility of amplitude measurement with middle and lower trapezius recording has not, to our knowledge, been previously described in individual patients with accessory neuropathy. We report three patients (A-C) who developed unilateral accessory neuropathy following surgical procedures. Accessory nerve conduction studies were performed with surface recording over the upper, middle, and lower trapezius muscles. Latency values were normal except for a prolonged lower trapezius latency value in patient B. Side-side trapezius amplitude comparisons revealed striking asymmetries from all three recording sites in patients A and B (71-95% CMAP amplitude decrements) and in the lower trapezius recording of patient C. Middle and lower trapezius side-side CMAP amplitude comparisons may increase the sensitivity of accessory neuropathy electrodiagnosis

OBJECTIVES: Routine carpal tunnel electrodiagnosis frequently includes median (MPW) and ulnar (UPW) palm-wrist mixed nerve conduction latency determinations over 8 cm. Despite widespread use, normative palmar latency difference (PLD) and UPW values, and the relative utility of onset latency (OL) or peak latency (PL) measurements are controversial. The current study was conducted to determine normative values for these parameters. METHODS: MPW and UPW studies were performed unilaterally in 33 normal controls. The PLD-OL and PLD-PL were calculated. The mean, range, standard deviation, and upper limits of normal were determined. 74 hands (50 patients) with both clinical and electrophysiologic median neuropathy were also studied. RESULTS: The abnormal MPW and UPW cut-offs were both 1.8 ms (OL), and 2.3 ms (PL). The abnormal PLD cut-offs were 0.5 ms (OL and PL). Using either OL or PL, PLD parameters were similar within controls, and also within CTS patients. Using either OL or PL, UPW parameters were similar between controls and CTS patients. CONCLUSIONS: An abnormal PLD cut-off of 0.5 is recommended. This is slightly higher than some prior recommendations, however it should minimize the likelihood of false positive studies. Onset and peak latency measurements are likely to have similar clinical utility

The causes of prolonged requirement for mechanical ventilation in the intensive care unit (ICU) are currently a subject of investigation. Critical illness polyneuropathy (CIP), an axonal polyneuropathy that frequently occurs with prolonged sepsis and multi-organ failure, has been cited as a frequent cause of difficulty with weaning from a ventilator. The relative contribution of diaphragmatic denervation in ICU patients with and without CIP has not been definitively determined. We reviewed 102 ventilator dependent intensive care unit (ICU) patients. Critical illness polyneuropathy (CIP) was diagnosed based upon electrodiagnostic criteria. Electrodiagnostic studies included diaphragmatic needle electromyography (EMG) to evaluate for diaphragmatic denervation. The medical charts of the patients with diaphragmatic denervation were reviewed for etiologies other than CIP for the diaphragmatic denervation. Our results suggest: 1) Respiratory impairment in ICU patients may often be unrelated to either CIP or diaphragmatic denervation; 2) Only about half of ventilator dependent CIP patients have diaphragmatic denervation; 3) Diaphragmatic denervation in ICU patients frequently may be attributable to causes other than CIP

We describe two modified methods for median-to-ulnar motor conduction comparison in the diagnosis of median neuropathy at the wrist: the median-thenar to ulnar-thenar latency difference (TTLD), and the median-thenar to ulnar-hypothenar latency difference (THLD). We also describe an F-wave ulnar-to-median comparative test, the F-wave latency difference (FWLD). The abnormal cutoffs based upon 34 normal controls are: TTLD, 0.8 ms; THLD, 1.2 ms; FWLD, 0.6 ms. In 50 patients (79 hands) with clinically defined carpal tunnel syndrome and electrophysiological evidence of median neuropathy at the wrist (based upon a prolonged median nerve palm-wrist latency), the diagnostic sensitivities were: 95-98%, 85-88%, and 75-78%, respectively. These tests are therefore highly sensitive. They are easily performed and require minimal additional effort to incorporate into commonly used clinical electrodiagnostic routines. They may be advantageous when a concomitant polyneuropathy is present, and they may also help avoid technical pitfalls and aid in identification of anatomic variants