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Abstract Details

Utility of Diagnostic Neuromuscular Ultrasound in Unrevealing Electrodiagnostic Studies: Case Series
Neuromuscular and Clinical Neurophysiology (EMG)
P1 - Poster Session 1 (8:00 AM-9:00 AM)
10-012
NA
Case series highlighting utility of neuromuscular ultrasound (NMUS) in diagnosis of various peripheral nerve pathologies with inconclusive or normal EMG/NCS results 
Case Series
Case 1. 43-year-old man with history of left arm trauma in childhood presented with numbness in left 4th and 5th fingers. EMG/NCS showed mild left median neuropathy at the wrist and a poorly localized left ulnar neuropathy. NMUS showed a post-traumatic neuroma in the ulnar nerve in the upper arm.

 

Case 2. 49-year-old woman presented with left 4th and 5th finger pain, numbness, weakness in left mid-forearm after a recent left arteriovenous graft revision surgery. EMG/NCS showed left ulnar nerve dysfunction with unclear localization. NMUS demonstrated pseudoaneurysm of ulnar artery compressing the ulnar nerve.

 

Case 3. 62-year-old man with stable chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), not on IVIg, presented with worsening grip strength and numbness. EMG/NCS showed bilateral focal compressive ulnar neuropathies at the elbows. NMUS confirmed ulnar neuropathy and patchy multifocal enlargement in bilateral median nerves at atypical sites for compression, consistent with CIDP.


Case 4. 81-year-old woman with a leiomyoma on right leg presented with intermittent shock-like pain. EMG/NCS was normal. NMUS revealed the mass’s proximity and positive sonographic Tinels’ sign over tibial nerve reproducing the patient’s symptoms.

 

Case 5. 67-year-old woman with neurofibromatosis 1 presented with multifocal right upper arm pain and radiating paresthesia. EMG/NCS was normal. NMUS showed abnormal plexiform changes at ulnar nerve and small schwannomas at radial nerve with positive sonographic Tinel’s sign reproducing the patient’s symptoms.

NMUS is a reliable and non-invasive tool that can add information that cannot be obtained from electrodiagnostic studies. This case series shows that when electrodiagnostic tests are unclear and a high clinical suspicion is present, NMUS helps establish accurate diagnosis of a wide variety of peripheral nerve pathologies and can meaningfully impact management.
Authors/Disclosures
Eonjung Kim, MD
PRESENTER
Dr. Kim has nothing to disclose.
Shanna Patterson, MD (Mount Sinai West Department of Neurology) Dr. Patterson has nothing to disclose.
Rory Abrams, MD (Icahn School of Medicine At Mount Sinai) Dr. Abrams has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Averitas Pharmaceutical.