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Interesting EMG case
EMG of the bilateral lower extremities was performed on 8/16/21.
Physical exam: 0/5 strength in the bilateral lower extremities (hip flexors, hip adductors, hip abductors, knee flexors, knee extensors, ankle dorsiflexors, ankle plantar flexors), absent sensation to light touch distal to the groin bilaterally, and absent patellar and achilles reflexes bilaterally. There was significant pitting edema in the bilateral lower extremities to the knee bilaterally.
NCS: Sural and superficial sensory responses were unobtainable bilaterally. Fibular and tibial motor responses were unobtainable bilaterally. Right median sensory, ulnar sensory, and superficial radial sensory responses were normal. Right ulnar motor and median motor responses were normal. Right ulnar F wave was slightly prolonged at 33.2ms.
Needle EMG: There was active denervation in proximal (TFL) and distal lower extremity muscles (vastus lateralis, tibialis anterior, fibularis longus, medial gastrocnemius, and short head of biceps femoris) bilaterally with no evidence of axonal continuity in any sampled muscles of the bilateral lower extremities. There was active denervation in the right middle/lower lumbar paraspinal muscles. The left middle/lower lumbar paraspinal muscles were normal. The right first dorsal interosseous and right deltoid muscle were normal.
Conclusion:
- Abnormal study. Technically challenging study due to significant bilateral lower extremity edema and limited mobility due to bilateral paraplegia.
- Bilateral lower extremity sural sensory, superficial fibular sensory, fibular motor, and tibial motor nerve conduction studies showed no response. Needle EMG examination of the bilateral lower extremities showed diffuse active denervation in proximal and distal muscles with no evidence of axonal continuity in any sampled muscles. Taken together, these findings localize the pathologic process distal to the level of the dorsal root ganglion, and could be explained by severe bilateral lumbosacral plexopathies vs. a severe axonal, sensorimotor peripheral polyneuropathy.
- There is a possible superimposed right lumbosacral radiculopathy that is non-localizable.
- There is no electrodiagnostic evidence of a superimposed left lumbosacral radiculopathy.
- There is no definitive electrodiagnostic evidence of median neuropathy, ulnar neuropathy, or myopathy in the right upper extremity.
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