Could Helicobacter pylori play an important role in axonal type of Guillain-Barré Syndrome pathogenesis?

In this case-control study, ELISA and Western blot with whole bacterial protein lysate were performed on serum and cerebrospinal fluid (CSF) of 15 controls and 15 patients. According to Griffin subtypes, 10 of our patients were in acute inflammatory demyelinating polyradiculoneuropathy (AIDP) group, 3 in acute motor axonal neuropathy (AMAN) group, and 2 in acute motor sensory axonal neuropathy (AMSAN) subtype. 86.6% of patients were positive for Helicobacter pylori (H. pylori) IgG. Serum anti-H. pylori IgG of patients and controls were significantly different. CSF anti-H. pylori IgG was significantly higher in patients than controls. In patients, the titer of anti-H. pylori IgG in serum was significantly higher than CSF, which may indicate extra-neural antibody synthesis. CSF IgG titer was higher in patients having axonal pattern. Western blot was positive in CSF of 13 patients and negative in all controls. There was a correlation between the number of antibody types against H. pylori particles and the titer of anti-H. pylori IgG in CSF and serum. Also, antibody against cytotoxin associated protein (CagA) was associated with primary axonal pattern.     

Complete recovery of herpes zoster radiculopathy based on electrodiagnostic study: A case report

BACKGROUNDHerpes zoster is a painful infectious disease caused by the varicella zoster virus. Herpes zoster radiculopathy, which is a type of segmental zoster paresis, can complicate the disease and cause motor weakness. This complication should be considered when a patient with a rash complains of acute-onset motor weakness, and the diagnosis can be verified via electrodiagnostic study. CASE SUMMARYA 64-year-old female with a history of asthma presented to the emergency department with stabbing pain, an itching sensation, and a rash on the right anterior shoulder that had begun 5 d prior. Physical examination revealed multiple erythematous grouped vesicles in the right C4-5 and T1 dermatome regions. Because herpes zoster was suspected, the patient immediately received intravenous acyclovir. On the third hospital day, she complained of motor weakness in the right upper extremity. Magnetic resonance imaging of the cervical spine revealed mild intervertebral disc herniation at C4-C5 without evidence of nerve root compression. On the 12^th hospital day, electrodiagnostic study revealed right cervical radiculopathy, mainly in the C5/6 roots. Six months later, monoparesis resolved, and follow-up electrodiagnostic study was normal. CONCLUSIONThis case emphasizes that clinicians should consider the possibility of post-herpetic paresis, such as herpes zoster radiculopathy, and that electrodiagnostic study is useful for diagnosis and follow-up.     

A further critical evaluation of requests for electrodiagnostic examinations

Abstract The aim of this study was to evaluate the impact of electrophysiological (EDX) tests in the clinical management and diagnosis of patients, and the appropriateness of the referral diagnosis. A study was carried out in three electrodiagnostic services in the Torino area, over a 12-month period. In our study 3,900 individuals (2,340 females, 1,560 males) were evaluated. Patients underwent EDX examinations including nerve conduction study, electromyography and repetitive stimulation test. Most patients had been sent for EDX tests by specialists. Specialists suspected mainly polyneuropathy, whilst general practitioners suspected mainly carpal tunnel syndrome. Seventy-two percent of the requests were correctly formulated, 55% by general practitioners and 77% by specialists. There was a concordance between the results of the EDX tests and diagnostic hypothesis 40% of the time. This study confirms the usefulness and diagnostic impact of EDX examinations and evidences the amount of time and resources wasted as a result of incorrect or incomplete requests.     

A case of Lambert-Eaton myasthenic syndrome associated with atypical bronchopulmonary carcinoid tumor

The Lambert-Eaton myasthenic syndrome (LEMS) is typically recognized as a paraneoplastic syndrome associated with a small cell lung carcinoma (SCLC), whereas LEMS with other neuroendocrine lung tumors, including carcinoids or large cell lung carcinoma, are highly unusual. Here, we report a rare case of LEMS with atypical bronchopulmonary carcinoid tumor: a 65-yr-old man presented with progressive leg weakness and a diagnosis of LEMS was made by serial repetitive nerve stimulation test. Chest CT revealed a lung nodule with enlargement of paratracheal lymph nodes, and surgically resected lesion showed pathological features of atypical carcinoid tumor. We concluded that LEMS could be associated with rare pulmonary neuroendocrine tumor other than SCLC, which necessitates pathologic confirmation followed by aggressive treatment for optimal management in these rare cases.     

A comparison of electroneuronography with facial nerve latency testing for prognostic accuracy in patients with Bell's palsy

The purpose of this study was to evaluate the ability of electroneuronography (ENOG), also called evoked electromyography (EEMG), and facial nerve latency testing (FNLT) to assess the prognosis of facial nerve palsy, using the House-Brackmann facial nerve grading system as criterion. From 1988 to 1994 these tests were employed at the ORL Clinic of the University of Ioannina in 250 patients with idiopathic facial nerve palsy. The ENOG test results indicated that when the amplitude of the compound muscle action potentials ranged from 51% to 95% of the normal value, 97% of the patients achieved complete functional recovery (grade 1) within at least 2 months. When the muscle action potential decreased to a value below 51% of normal values, prognosis for recovery was considerably worse. FNLT test results indicated that as the latency time extended, the recovery grade of the facial nerve worsened. When latency time was within the normal range (group A patients), about 92% of patients had complete functional recovery. In contrast all patients having either a very extended latency time or unable to be monitored (groups C and D) demonstrated incomplete functional recoveries that ranged from grade 11 to grade VI. Comparing each test with the House-Brackmann facial nerve grading system, we ascertained that the percent accuracy for ENOG was 97.6%, and that for FNLT was 94.4%.     

Association of Occupational and Non-occupational Risk Factors with the Prevalence of Work Related Carpal Tunnel Syndrome

PURPOSE: Several occupational and personal risk factors cause the development of carpal tunnel syndrome (CTS). The purpose of the study was to evaluate both non-occupational and occupational factors associated with CTS in industrial workers. METHODS: A cross sectional study was designed with 400 industrial workers (77% male, 23% female) randomly selected. Workers' upper extremities were examined and related signs and symptoms were assessed. Questionnaires about personal and occupational risk factors were completed and suspicious cases were referred for NCV (nerve conduction velocity) testing and documentation of diagnosis. RESULTS: About 395 workers from automobile industry factories in Iran were assessed by interview and electrodiagnostic studies. Among 395 workers, 47 met the definition of CTS to yield a prevalence of 11.9%. These 47 workers averaged 29.85 years of age (SD = 6.28), and the mean age of the healthy group was 27.95 (SD = 4.86). 395 workers included 91 women (23%) and 304 men (77%). Using multivariate logistic regression model the largest adjusted odds ratios of personal and occupational factors for CTS were: exertion of force over one kilogram 6.38 (1.91-2.02); bending/twisting of the hands/wrists > 30 degrees , 5.62 (0.56-55.6); history of cigarette smoking 4.68 (1.80-11.80); rapid movement of hands 4.44 (1.41-14.02); and use of vibrating tools 3.23 (1.46-7.15). CONCLUSION: Some occupational factors including force exertion, bending/twisting of the hands, rapid movement of the hands and vibration are associated with CTS.     

Interexaminer repeatability of antidromic ulnar sensory nerve conduction velocity measurements

OBJECTIVE: To determine the interexaminer repeatability of the ulnar antidromic sensory nerve conduction velocity (NCV). DESIGN: Test-retest design. Based on a randomization list of various combinations and sequences from 2 of a total of 3 examiners, the measurement was repeated within half an hour by a second examiner blinded to the results of the first examiner. SETTING: Outpatient department. PARTICIPANTS: Twenty-four consecutive healthy subjects (mean age, 38 y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The intraclass correlation coefficient (ICC) and the coefficient of repeatability (CR) were determined for the below elbow to wrist (BE-to-W), above elbow to below elbow (AE-to-BE), and axilla to above elbow (AX-to-AE) segments. RESULTS: The ICC was .42 for the BE-to-W, .15 for the AE-to-BE, and -.05 for the AX-to-AE segment. The CR was 12.2m/s for the BE-to-W, 16.2m/s for the AE-to-BE, and 21.4m/s for the AX-to-AE segment. CONCLUSIONS: During the assessment of the antidromic sensory NCV of the ulnar nerve, a moderate amount of interexaminer variability must be taken into account for the BE-to-W segment. More proximally, an extremely large amount of interexaminer variability must be taken into account. This calls into question the usefulness of the antidromic ulnar sensory NCV for the AX-to-AE and AE-to-BE segments.     

Peroneal mononeuropathy: predisposing factors, and clinical and neurophysiological relationships

The most common mononeuropathy in the lower extremity involves the nerve. We retrospectively evaluated the etiological predisposing factors and clinical-neurophysiological features of 36 patients affected by peroneal mononeuropathy (PM). In 30 patients, a clear predisposing factor was identified. PM was more frequently perioperative (11 cases), associated with axonal involvement. Unexpectedly, PM was not only due to surgery close to the peroneal region, but was mostly associated with hip surgery and, rarely, with thoracic-abdominal surgery. A postural predisposing factor of PM was also frequently observed, usually associated with a pure conduction block. Conversely, most patients with bedridden predisposing factor presented axonal involvement, which was rarely associated with conduction block. In 25 of 36 PM cases, a long-term follow-up lead to an improvement (12 cases) or to good recovery (13 cases) of PM. In conclusion, our study shows that: (1) in most PM cases it is possible to identify a predisposing factor; (2) there is a good correlation between predisposing factor and neurophysiological involvement, and (3) PM usually has usually a good prognosis. Received: 10 December 2000 / Accepted in revised form: 31 May 2000