Faculty Bibliography

Objective/UNASSIGNED:Carpal tunnel syndrome (CTS) is diagnosed with electrodiagnostic (EDx) studies. Investigations have examined US cross sectional-area (CSA) and wrist to forearm ratio (WFR) cut-offs for screening EDx abnormalities in patients with suspected CTS. The objective of this study is to determine if these US parameters are effective in a real world population. Methods/UNASSIGNED:and/or wrist-to-forearm ratio of >1.4. EDx studies were the gold standard for diagnosis. Results/UNASSIGNED:A total of 670 patients and 1,021 extremities were studied. US was positive in 97.6% of EDx confirmed CTS. Conclusion/UNASSIGNED:Median nerve US is nearly as sensitive as the gold standard for EDx testing for the diagnosis of CTS. Significance/UNASSIGNED:The data here suggest that US may have use as a screening tool prior to performing EDx testing for CTS.

INTRODUCTION:At our institution, core muscle biopsies are performed on muscles selected using electromyography (EMG). Ultrasound (US) guidance is not used routinely. The aim of this study was to determine if US guidance of EMG selected muscles would increase the diagnostic yield of the biopsy as compared to the current practice standards. METHODS:Two trained physicians performed 40 randomized biopsies (US guided or traditional approach). The amount of tissue obtained in each biopsy was recorded (volume and mass), along with the final pathologic diagnosis in each case and incidence of complications. RESULTS:Forty patients were studied. Sixteen muscle biopsies were done with US guidance; 50% had a definitive diagnosis, and 38% did not. In the non-US guidance group, 58% had a definitive diagnosis, and 33% did not. CONCLUSIONS:US did not provide any additive advantage when used to guide biopsy in a muscle previously selected for biopsy with EMG. Muscle Nerve 54: 786-788, 2016.

INTRODUCTION/BACKGROUND:Continuous EEG (cEEG) monitoring is used in the intensive care unit (ICU) setting to detect seizures, especially nonconvulsive seizures and status epilepticus. The utility and impact of such monitoring in non-ICU patients are largely unknown. METHODS:Hospitalized patients who were not in an ICU and underwent cEEG monitoring in the first half of 2011 and 2014 were identified. Reason for admission, admitting service (neurologic and nonneurologic), indication for cEEG, comorbid conditions, duration of recording, EEG findings, whether an event/seizure was recorded, and impact of EEG findings on management were reviewed. We evaluated the impact of the year of recording, admitting service, indication for cEEG, and neurologic comorbidity on the yield of recordings based on whether an event was captured and/or a change in antiepileptic drug management occurred. RESULTS:Two hundred forty-nine non-ICU patients had cEEG monitoring during these periods. The indication for cEEG was altered mental status (60.6%), observed seizures (26.5%), or observed spells (12.9%); 63.5% were on neuro-related services. The average duration of recording was 1.8 days. EEG findings included interictal epileptiform discharges (14.9%), periodic lateralized discharges (4%), and generalized periodic discharges (1.6%). Clinical events were recorded in 28.1% and seizures in 16.5%. The cEEG led to a change in antiepileptic drug management in 38.6% of patients. There was no impact of type of admitting service; there was no significant impact of indication for cEEG. CONCLUSIONS:In non-ICU patients, cEEG monitoring had a relatively high yield of event/seizures (similar to ICU) and impact on management. Temporal trends, admitting service, and indication for cEEG did not alter this.

Seizures are common among patients with brain tumors. Transient, postictal magnetic resonance imaging abnormalities are a long recognized phenomenon. However, these radiographic changes are not as well studied in the brain tumor population. Moreover, reversible neuroimaging abnormalities following seizure activity may be misinterpreted for tumor progression and could consequently result in unnecessary tumor-directed treatment. Here, we describe two cases of patients with brain tumors who developed peri-ictal pseudoprogression and review the relevant literature.