Time again for #NeuromuscularQandA? RT. #neurology #medtwitter #MedEd #medstudent #neurologyresident Join me in discussing/learning/educating with #passion and #humor @WNGtweets @MonicaDhakar @MadSattinJ @NinaRiggins @AaronLBerkowitz @RachelSalasMD @melfel6 @StavrosKara
Q: Doc doc, a conundrum. Gotta patient with old mets which resolved after RT to the lumbosacral area ages ago. There’s enhancement of the cauda equina on MRI. Is this cancer or RT damage?
A: Aye, an important question which changes management. Now enhancement could mean either or both, that it could. Does it hurt? RT damage is painless whereas cancer invasion is painful.
Q: Forgot to mention doc. He got a fall and then the pain so we thought it was run of the mill degenerative lumbar radiculopathy. It sure hurts after the fall - he’s got shooting pain and L5 weakness.
A: Time for EMG. We gonna look specifically for one thing. What could it be? Teaching PEARLS appreciated #medtwitter #MedEd @melfel6 @AaronLBerkowitz @Tracey1milligan @MonicaDhakar @RachelSalasMD @NinaRiggins @EricLawson90 @MarcusVPinto @MadSattinJ @StaceyLClardy @WNGtweets
A: Excellent! EMG shows myokymia in RT damage - specificity around 90 percent and sensitivity around 70 percent. If you see it, you know it’s likely RT damage, but if you don’t, test might not be sensitive enough. Then get CSF with cytology to look for malignant cells.
A: Myokymia sounds like marching soldiers - classically march-march-march. I think it sounds like a very regular fart-fart-fart. What do you think? m.youtube.com/watch?v=SXhmV3…
And when else might you see myokymia?
Excellent! All and sundry which causes demyelination can cause myokymia. Facial myokymia can be seen in all those cases.
@threadreaderapp pls unroll
