Chronic Neurogenic Changes Research Articles

Sciatic pain in a young sportsman

A 33-year-old man was referred to the neurological department at our hospital in May, 1996, with an 8-year history of right sciatic pain, exacerbated by physical activity. He was an enthusiastic skier, trekker, and soccer player, and his sciatica caused him severe physical and psychological distress. There was no history of trauma. He had sought several opinions and undergone radiography, computed tomography scans, and magnetic resonance imaging of the lumbosacral spine; pelvic ultrasound; and blood tests—none of which had shown any abnormality. An electromyogram showed chronic neurogenic changes in muscles innervated by L5 and S1 nerve roots. Neither physiotherapy nor anti-inflammatory and muscle-relaxant drugs provided any relief. When he was admitted to hospital, neurological examination showed diminution of the right Achilles tendon reflex, straight-leg raising evoking pain along the posterior aspect of the limb at 70°, and there was reduced sensation to pain and light touch on the dorsum of the foot. There was pain on deep digital palpation of the ischial notch. Pain was not worsened by Valsalva's manoeuvre. Magnetic resonance imaging of the sacral plexus and of the sciatic nerve from the greater ischial foramen to just above the popliteal fossa was normal. Severe pain was elicited by internal rotation of the extended leg and by resisted abduction and external rotation of the thigh in the sitting position or in lateral decubitus. 1 Beatty RA The piriformis muscle syndrome: a simple diagnostic maneuver. Neurosurg. 1994; 34: 512-514 Crossref PubMed Scopus (87) Google Scholar

A family of McLeod syndrome, masquerading as chorea-acanthocytosis

A man, aged 52, is reported to show (1) adult onset, (2) progressive orofacial dyskinesia and choreic movements of the extremities, (3) tongue biting, (4) denervation of the peripheral nerves, (5) acanthocytosis, and (6) increased serum creatine kinase, which are characteristic of chorea-acanthocytosis. The Kell blood group examination on erythrocytes disclosed that the propositus had McLeod phenotype, and his mother and one of his sisters werecarriers of the McLeod phenotype. Thus, he was diagnosed as having McLeod syndrome. A criterion of exclusion of McLeod phenotype on erythrocytes should be added to the diagnostic criteria of chorea-acanthocytosis. Moreover, chronic neurogenic changes instead of myogenic changes were electromyographically and histopathologically verified in the muscle.

Syringomyelia: electrophysiologic aspects.

The clinical and EMG findings in 44 patients with syringomyelia who were seen at the Mayo Clinic between 1976 and 1985 are presented. In 10 of the patients, somatosensory evoked potentials (SEPs) of the upper and lower extremities were obtained. All 44 patients had radiographic or surgical evidence of a cervical syrinx. The most common abnormality on nerve conduction studies was a reduced hypothenar compound muscle action potential amplitude (23 patients). Abnormal findings on needle electromyography were present in 33 patients and included sparse fibrillation potentials, reduced motor unit potential (MUP) recruitment, and chronic neurogenic MUP changes in muscles innervated by the C-5, T-1 roots, with the most pronounced changes in small hand muscles. Ulnar and median nerve SEPs were usually normal in the presence of a dissociated sensory loss and were usually abnormal when all sensory modalities were impaired. Abnormalities of tibial nerve SEPs were frequent and were related to impaired proprioceptive sensation in the lower extremities.