70 year old female with numbness in the toes of both feet for the past few months without significant back pain or sciatica, and without a history of diabetes or hypothyroidism or ethanol abuse.
The directed clinical neurologic examination of the lower extremities was essentially normal, including vibratory and position sense.
Non-enhanced MRI scan of the lumbar spine was essentially unremarkable, and nothing to explain the diffuse denervation in the paraspinal musculature.
Non-enhanced MRI scan of the thoracic spine showed diffuse
degenerative changes from about T6-T12 but no cord compression.
1) Do the EMG/NCS findings warrant a CSF study to rule out an infiltrative process such as lymphoma?
2) Does the study suggest a peripheral neuropathic process instead of or in addition to radiculopathies? (Note the preserved sural sensory potential in the foot.)
Rec Site: EDB Lat (ms) Dur (ms) Amp (mV) Dist (mm) C.V. (m/s)
Ankle 4.6 6.5 3.9 0
Fib.Head 12.0 6.9 2.8 300 40.2
Pop.Fos. 13.6 6.4 2.4 70 45.7
Rec Site: ADQ Lat (ms) Dur (ms) Amp (mV) Dist (mm) C.V. (m/s)
Ankle 4.7 2.9 0.900 0Pop.Fos. 13.3 4.6 0.467 410 47.7
Right Peroneal Nerve
Rec Site: dors.ft Lat (ms) Pk Lat (ms) Amp (uV) Dist (mm)
Lower leg 2.8 3.8 3.1 140
Stim Site: calf Lat (ms) Pk Lat (ms) Amp (uV) Dist (mm)
Ankle 3.3 3.8 4.5 140
Stim Site: Ankle Lat (ms) Pk Lat (ms) Amp (uV) Dist (mm)
dors.ft 3.9 4.3 4.6 0
Name Ins Act Fibs PSW Fascics Polyph MU Amp MU Dur Recruit Nascents
R. Tibialis An norm none none none inc norm inc decr none
R. Peroneus Ln norm none none none inc norm inc norm none
R. Gastroc.Med Normal
R. Rectus Fem. Normal
R. Gluteus Med Normal
L. Tibialis An norm none none none inc norm inc norm none
L. Peroneus Ln norm none occ none none norm norm decr none
L. Gastroc.Med Normal
L. Gluteus Med inc none none none none norm norm norm none
R. LumbarParas norm none 3+ none
L. LumbarParas norm none 2+ none
R. UpperThorPa norm none 2+ none
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