EMG Pearls

EMG Pearls

By Steven A. Greenberg, MD, Assistant Professor of Neurology, Harvard Medical School, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts; and Anthony A. Amato, MD, Associate Professor, Department of Neurology, Harvard Medical School, Chief, Neuromuscular Division, Director, Clinical Neurophysiology, Laboratory, Vice-Chairman, Department of Neurology, Brigham and Women's Hospital, Associate Neurologist and Neuromuscular Consultant, Massachusetts General Hospital, Boston, Massachusetts


SECTION I. FOCAL NEUROPATHIES


Introduction


Case 1. A 60-year-old man with numbness and tingling in his hands for 1 year
Case 2. A 48-year old woman with numbness and tingling in both hands
Case 3. A 68-year-old woman with numbness and tingling in her hands
Case 4. A 53-year-old woman with right hand weakness and numbness after an axillary dissection
Case 5. A 36-year-old man with 2 years of numbness in his left hand digits 4 and 5
Case 6. A 55-year-old man with numbness in hand digits 4 and 5
Case 7. A 53-year-old woman with left hand weakness
Case 8. A 40-year-old woman referred for left carpal tunnel syndrome or ulnar neuropathy
Case 9. A 23-year-old woman with progressive weakness, atrophy, and numbness in one hand
Case 10. A 68-year-old man with metastatic melanoma and progressive left wrist drop for several months
Case 11. A 43-year-old man with scapular winging after a cervical lymph node biopsy
Case 12. A 51-year-old man with scapular winging after arthroscopic shoulder surgery
Case 13. A 23-year-old man with right arm weakness after a motorcycle accident
Case 14. 56-year-old woman 2 days after a left shoulder dislocation and closed reduction with diffuse left arm weakness
Case 15. A 56-year-old man with painful left hand weakness
Case 16. A 71-year-old man with left arm weakness for 1 month
Case 17. A 61-year-old woman with breast cancer, and right neck and shoulder pain and hand weakness and numbness 3 months prior to evaluation
Case 18. A 64-year-old man with right foot drop 6 weeks prior
Case 19. A 70-year-old woman with right foot drop after hip replacement
Case 20. A 38-year-old man with left foot weakness and numbness after prior treatment for a posterior thigh sarcoma
Case 21. A 73-year-old man with right leg numbness, weakness, and pain
Case 22. A 46-year-old woman with right leg pain and intermittent paresthesias
Case 23. A 57-year-old man with right leg weakness after repair of abdominal aortic and internal iliac artery aneurysms


SECTION II. GENERALIZED NEUROPATHIES


Introduction


Case 24. A 73-year-old man with an IgG-k paraprotein and several years of progressive numbness and weakness in the feet and hands
Case 25. A 43-year-old man with diabetes and multiple neurologic symptoms
Case 26. A 73-year-old man with diabetes and several months of chest pain
Case 27. A 55-year-old woman with 6 months of progressive numbness in her feet
Case 28. A 71-year-old woman with several years of progressive numbness in her hands and feet
Case 29. A 38-year-old man with numbness and weakness in the hands and feet and a skin rash
Case 30. A 64-year-old woman with left severe shoulder pain and weakness of shoulder abduction for 3 days, followed by progressive neurologic deficits
Case 31. A 38-year-old man with fever and acute generalized weakness and distal numbness
Case 32. A 66-year-old woman with numbness in her hands and feet and progressive generalized weakness
Case 33. 43-year-old woman with progressive generalized weakness and numbness for 5 months
Case 34. A 48-year-old man with acute progressive numbness and paresthesias in his hands and feet and generalized weakness
Case 35. A 49-year-old woman with numbness in her right hand and both feet
Case 36. A 35-year-old woman with numbness in her hands and feet for 3 weeks and a right facial palsy for several days
Case 37. A 68-year-old woman with slowly progressive weakness in her legs without paresthesias
Case 38. A 32-year-old woman with a severe neuropathy since childhood
Case 39. A 33-year-old woman with long-standing asymmetric weakness in all four limbs and a family history of neuropathy
Case 40. A 72-year-old woman with 12 years of progressive numbness and paresthesias in her hands and feet and mild gait ataxia
Case 41. A 41-year-old woman with an 11-year history of progressive numbness in her limbs
Case 42. A 43-year-old woman with acute generalized weakness developing 1 month into her intensive care unit stay for sepsis and multiorgan failure


SECTION III. NEUROMUSCULAR JUNCTION DISEASE


Introduction


Case 43. A 17-year-old woman with progressive dysarthria and dysphagia for 4 months
Case 44. A 71-year-old man with subacute symmetrical proximal weakness
Case 45. A 34-year-old woman with generalized weakness since infancy


SECTION IV. MOTOR NEURON DISEASE AND MOTOR NEUROPATHIES


Introduction


Case 46. A 55-year-old man with progressive left hand weakness for 6 months
Case 47. A 3-month-old boy with congenital hypotonia and weakness
Case 48. A 66-year-old man with a 5-year history of progressive weakness and wasting of his distal right leg
Case 49. A 45-year-old woman with a 5-year history of cramps and twitching in and 2-year history of weakness in her left forearm


SECTION V. MYOPATHIES


Introduction


Case 50. A 49-year-old woman with progressive proximal leg weakness for 3 years
Case 51. A 6-month-old girl with generalized weakness since birth
Case 52. A 29-year-old man with a cardiomyopathy
Case 53. A 62-year-old man with slowly progressive weakness
Case 54. A 46-year-old woman with a 2-year history of proximal leg and arm weakness
Case 55. A 59-year-old woman with proximal weakness and a rash
Case 56. A 70-year-old man with difficulty climbing stairs for several years
Case 57. A 50-year-old woman with HIV infection and weakness of her arms and legs for 6 months
Case 58. An 85-year-old woman with progressive leg weakness and myalgias
Case 59. A patient with acquired rippling muscle disorder
Case 60. A 75-year-old woman with difficulty holding her head up


SECTION VI. EMG-GUIDED BOTULINUM TOXIN THERAPY OF FOCAL DYSTONIAS


Introduction


Case 61. A 39-year-old woman with 3?4 years of progressive difficulty using her right hand for writing but no difficulty buttoning, typing, or using utensils
Case 62. A 47-year-old man with progressive difficulty in writing for 5 years
Case 63. A 45-year-old woman with several years of difficulty with her right hand limited to writing