AANEM Connect

Today I saw a 25-year-old woman complaining of generalized numbness, tingling and itching over her trunk, extremities and scalp. This started a year ago , and she was treated as if this were an allergic reaction since she had severe allergic reactions to medications in the past. She was treated with antihistamines, IV steroids, etc. with only temporary improvement. She was seen by several dermatologist and neurologists , initially without change in her symptoms. She was started on gabapentin for the possibility that this was a neuropathy. This finally did markedly improve her symptoms . Most of the paresthesias in her trunk and extremities cleared, although they  are  still present over her face and scalp. Her physical exam today was essentially normal. The electrodiagnostic studies done today showed normal electromyography of all extremities. The nerve conduction study showed normal motor and sensory conduction studies in the distal extremities. Median and ulnar sensory amplitude's were 60 to 80 µV, and sural amplitude's were greater than 30 µV. Medial and lateral plantar sensory studies were easily obtainable and also showed large amplitudes. However, when testing proximal sensory conduction, a completely different picture arose. I was unable to obtain medial or lateral antebrachial cutaneous sensory studies in either arm. I have always found these easy to obtain in young patients who have large distal sensory responses. Since I began doing  the procedure for lateral antebrachial cutaneous sensory conduction in 1978, I was sure I was performing this correctly. In the lower extremities, I could not obtain a response in the lateral femoral cutaneous nerve, although it too  is usually obtainable in thin patients  with large distal sensory responses.