This study shows that nerve ultrasound is abnormal in all cases of electrophysiologically verified TTS. The pattern of nerve abnormality is varied. This, and the fact that in the majority of patients causation was identified, suggests nerve ultrasound should form part of standard work-up for TTS. Muscle Nerve 53: 906-912, 2016.
Peripheral nerve torsion is increasingly recognized due to the widespread availability of nerve ultrasound imaging.1,2 A 31-year-old man presented with acute onset complete left wrist drop after prolonged sleeping on his outwardly rotated arm. There was severe conduction block across the spiral groove and nerve ultrasound showed 2 areas with increased diameter (figure 1). On operation, there was radial nerve trunk torsion at the level of the intermuscular septum just distal to the spiral groove (figure 2). Two months after operation there was no improvement of the complete wrist drop.This case illustrates the ultrasound imaging features of radial nerve torsion. The mechanism is thought to initiate with focal nerve inflammation resulting in loss of elasticity, leading to ratcheting of rotational forces exerted on the nerve. Disclosure: The authors report no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.Correspondence to Dr. Wilder-Smith: mdcwse@nus.edu.sg Ultrasound of radial nerve torsion shows characteristic waistLongitudinal ultrasound image across the spiral groove. Large arrows indicate site of axial imaging shown below in the smaller images. Smaller arrows point to the radial nerve. A is at entry B midsection and C after exit from spiral groove. The star lies above the deep brachial artery. NEUROIMAGES
Objectives: To evaluate Guillain-Barre syndrome (GBS) subtypes in Sri Lanka. Design setting:The patients satisfying established criteria for diagnosis of GBS were included. The cases were classified into GBS subtypes based on electrodiagnostic findings. Patient intervention: NoneMeasurements: Clinical neurophysiological evaluations were done. The studies were repeated as appropriate. Results:The evaluations were done between 2 and 143 days from onset (median = 7 days). There were 1153 patients (Male: Female = 1.4 :1) with age 1 to 86 years (mean = 43.7). Of them 191 (16.6%) were below 13 years (Male: Female = 1.2:1). GBS subtypes were demyelinating type 577 (50%), axonal forms 475 (41.2%), Miller-Fisher syndrome 5 (0.4%) and unclassifiable 96 (8.3%). Among the children there were 99 (51.8%) with demyelinating type, 82 (42.9%) with axonal forms, 10 (5.2%) with unclassifiable findings and none with MFS. There was some clustering of both demyelinating and axonal cases in the early and late months of the year whereas in children there is excessive occurrence of GBS cases of both types in the first 5 months of the year. There is a second peak of axonal GBS later in the year. Overall tendency of reduction in the number of cases, especially axonal forms, is noticeable over the years. Interpretation:The age and sex distribution of the cases is similar to that of other countries. The occurrence of axonal subtypes is prominent. The proportions of GBS subtypes and case clustering in children may be related to the preceding infection.
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