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Biomedical subjects

P Seror

Publications and source records attributed to P Seror.

At least 19 recordsLinked to original sources
PubMed2006

The long thoracic nerve conduction study revisited in 2006.

OBJECTIVE: To compare the reliability and feasibility of recording long thoracic nerve (LTN) conductions either with surface or needle electrodes. METHODS: The nerve conduction studies were carried out bilaterally on 40 control subjects. The LTN was first stimulated at the axilla and recorded with surface electrodes located on the 7th or 8th digitations of the serratus anterior (SA), then stimulated at Erb's point and recorded with a needle inserted in the 6th or 7th digitations of the SA. For each method, the latency and amplitude of the motor action potential were recorded. RESULTS: Responses were recorded on both sides for each patient. With surface recording, the mean latency was 2.2 +/- 0.30 ms, and the mean amplitude was 5.3 +/- 2.4 mV. With needle recording, the mean latency was 3.65 +/- 0.45 ms, and the mean amplitude was 8.95 +/- 4 mV. CONCLUSIONS: This study demonstrates that both techniques are reliable, feasible, and correlate well. SIGNIFICANCE: Our study shows surface recording of nerve conduction should be favored because it is non-traumatic, less uncomfortable for the patient, and less prone to pitfalls. Nevertheless, in pathological cases, both techniques should be used at initial and follow-up examinations in order to better assess axonal loss and nerve conduction impairment.

Adolescent↗
PubMed2006

Meralgia paresthetica: clinical and electrophysiological diagnosis in 120 cases.

We report the results of clinical and electrophysiological examinations in 131 cases of meralgia paresthetica (MP) among 120 unselected patients, 69 men and 51 women, aged 15-81 years. All patients experienced permanent or intermittent pain, and all but one had permanent sensory impairment of the thigh. The lateral aspect of the thigh was solely involved in 88 cases and the anterior aspect was also or exclusively involved in 32 cases. The right thigh was involved 62 times and the left 58 times. Symptom duration varied from 2 weeks to 20 years. The initial diagnosis was meralgia paresthetica in 47 cases (39%), root disease in 35 cases, and osteoarthritis in 6 cases; no diagnosis was proposed in the 32 remaining cases. Two cases had undergone previous spine surgery for disk herniation, with no benefit. A precise cause could explain the lateral femoral cutaneous nerve (LFCN) lesion in 46 cases, the other 74 cases being considered idiopathic (25% of patients were obese). Only one case required surgery to relieve symptoms. LFCN conduction was studied orthodromically, distally from the anterior superior iliac spine. The side-to-side amplitude ratio (ssRatio) was greater than 2.3 in 118 of 120 patients (98.3%) and was a better index to confirm a lesion of the LFCN than SNAP amplitude, which was abnormal (less than 3 microV) in 88 cases (73.3%). Only two of the 11 bilateral cases had an ssRatio lower than 2.3 (they were both 2.0). An ssRatio of 2.3 or more and a SNAP amplitude lower than 3 microV provided a specificity of 98.75% or more. The mean axonal loss was 88%. These clinical and electrophysiological data highlight the central role the neurophysiologist should play in diagnosing MP by means of an LFCN conduction study.

Adolescent↗
PubMed2005

[Idiopathic lumbosacral plexopathy].

INTRODUCTION: Lumbosacral plexopathy is the equivalent in the lower limbs of neuralgic amyotrophy (also known as Parsonage-Turner syndrome) in the upper limbs. It is well-known in patients with diabetes mellitus, when it is known as Bruns-Garland syndrome. CASE: We report the case of a 47-year-old woman who developed a unilateral neuropathy of the leg, neither radicular nor truncal in origin. The slow continuous improvement was not affected by any of the treatments administered. DISCUSSION: Lumbosacral plexopathy is characterized by intense pain in one or both legs, associated with motor and sensory deficits. Recovery is usually slow (6 to 36 months) and often incomplete. The electrodiagnostic examination shows important acute motor and sensory axonal loss, characterized by denervation and low-amplitude sensory action potential. Treatment generally combines analgesics with narcotic agents, neuropathic pain medication, short-term corticosteroids, and rehabilitation. In the most severe cases, long-term corticosteroids and other immunosuppressive agents may be required. This diagnosis cannot be reached until all other radicular, plexal and truncal origins have been ruled out.

Female↗
PubMed2005

Frequency of neurogenic thoracic outlet syndrome in patients with definite carpal tunnel syndrome: an electrophysiological evaluation in 100 women.

OBJECTIVE: The aim of this work was to evaluate the frequency of lower brachial plexus lesions as true neurogenic thoracic outlet syndrome (NTOS) in women with carpal tunnel syndrome (CTS). METHODS: This was a prospective and descriptive study. The CTS was clinically and electrodiagnostically defined in each patient. The conduction of ulnar and medial antebrachial cutaneous nerves (MABCN) was bilaterally studied to evaluate the function of lower brachial plexus. One hundred women with 176 median nerve lesions at wrist were studied. Patients with ulnar nerve lesion at elbow or wrist were excluded. The sensory nerve action potential (SNAP) of ulnar nerve was abnormal when the interside amplitude ratio was greater than 1.66 or when its amplitude was smaller than 8 microV. The SNAP of MABCN was abnormal when the interside amplitude ratio was greater than 1.66 with both techniques (antidromic and orthodromic) or when its amplitude was smaller than 8 and 6 microV for non-obese patients, respectively, less and more than 60 years old. RESULTS: The mean SNAP amplitude of ulnar and MABC nerves was normal compared with control subjects, and none of the 100 women with CTS had an abnormal interside amplitude ratio for one or both nerves. In 7-10 cases, all of which were either obese or elderly patients, SNAP amplitude of MABCN was decreased, but the interside amplitude ratio remained normal. CONCLUSIONS: On the basis of tests considered quite sensitive (70%) and specific (100%), the occurrence of true NTOS is lower than 1/100 in woman with definite CTS. SIGNIFICANCE: These results demonstrate that there is no appreciable link between CTS and true NTOS. There is no need for the systematic MABCN testing had in CTS patients.

Action Potentials↗
PubMed2005

Symptoms of thoracic outlet syndrome in women with carpal tunnel syndrome.

OBJECTIVE: To evaluate the frequency of symptoms and signs suggestive of thoracic outlet syndrome (TOS) in women aged 60 years or less, with unambiguous carpal tunnel syndrome (CTS). METHODS: The CTS was clinically and electrodiagnostically defined in 100 upper limbs. Clinical and electrophysiological symptoms and signs suggestive of TOS, true neurogenic TOS (NTOS) and disputed NTOS were tested in each upper limb. The 100 idiopathic median nerve lesions at the wrist occurred in 61 successive and unselected women. Women with ulnar nerve entrapment, root lesions and polyneuropathies were excluded. The main outcome measures were clinical symptoms and signs suggestive of TOS and NTOS as electrodiagnostic evaluation of the lower brachial plexus. RESULTS: In the 100 upper limbs with definite CTS, no major symptoms and signs suggestive of TOS and NTOS were found. On the contrary, moderate and mild clinical symptoms and signs suggestive of disputed NTOS were frequently found, even if no electrodiagnostically definite major or minor lower brachial plexus lesion was found. CONCLUSIONS: This study demonstrates the low specificity of clinical symptoms and signs suggestive of disputed NTOS, as they were frequently found in women with unselected and unambiguous CTS, despite no patients had definite lower brachial plexus lesion. SIGNIFICANCE: Our study shows why CTS can easily be misdiagnosed as disputed NTOS, and stresses the importance of systematic electrodiagnosis with median, ulnar, and medial antebrachial cutaneous nerve conduction studies, in order to rule out CTS, ulnar nerve, root lesion, and to establish lower brachial plexus lesion before treating NTOS.

Adult↗
PubMed2004

Isolated sensory manifestations in neuralgic amyotrophy: report of eight cases.

A series of eight patients with isolated clinical and electrophysiological sensory deficit related to neuralgic amyotrophy (NA) is reported. NA was diagnosed by clinical and electrodiagnostic features and disease course. Imaging and laboratory investigations excluded other disorders. The results showed mild to severe involvement of eight individual sensory nerves: lateral antebrachial cutaneous nerve lesions in three instances and partial lesions of the median nerve in five cases. Our findings suggest that isolated clinical and electrodiagnostic sensory involvement in NA is not exceptional but rather is unrecognized. The pattern of these nerve lesions agrees with the most typical pattern of NA, which is a mononeuritis or mononeuritis multiplex. The present study also shows that the spectrum of NA is diverse and may vary from pure motor to pure sensory deficit, according to the nature of the involved nerve fibers.

Action Potentials↗
PubMed2004

Somatosensory evoked potentials for the electrodiagnosis of meralgia paresthetica.

The aim of this study was to evaluate the diagnostic utility of somatosensory evoked potential (SSEP) studies of the lateral femoral cutaneous nerve (LFCN) in assessing patients with meralgia paresthetica. Twenty-one consecutive patients with unilateral meralgia paresthetica, as defined clinically (sensory impairment of lateral aspect of the thigh) and electrodiagnostically (abnormal sensory nerve conduction), and 21 control subjects were studied with two SSEP methods. SSEPs were elicited by stimulation of the LFCN below the anterior superior iliac spine (ASIS stimulation) and by cutaneous stimulation of the lateral aspect of the distal third of the thigh (thigh stimulation). Abnormalities were defined by the SSEP interside latency difference, interside amplitude ratio, or an absent response. The SSEP with ASIS stimulation had a sensitivity of 5% and a specificity of 95%, whereas with thigh stimulation it had a sensitivity of 52% and a specificity of 76%. Overall, SSEP after ASIS stimulation had no diagnostic value. Recording of the SSEP after thigh stimulation is recommended in obese patients only when sensory nerve conduction cannot be determined.

Adolescent↗
PubMed2004

Medial antebrachial cutaneous nerve conduction study, a new tool to demonstrate mild lower brachial plexus lesions. A report of 16 cases.

OBJECTIVE: This was to demonstrate the ability to electrodiagnosed mild lower brachial plexus lesion only through abnormal medial antebrachial cutaneous nerve (MABCN) conduction study. METHODS: We report 16 cases of unilateral, atypical pains and paresthesias of the upper limbs without motor deficit or atrophy. Patients were referred as carpal tunnel syndrome in 12 cases. All patients had needle examination of the impaired upper limb from C5 to T1. Motor and sensory conductions of median and ulnar nerves were bilaterally studied. MABCN was antidromically (16 cases) and orthodromically (9 cases) studied at the elbow in the both sides. MABCN abnormality was defined by an interside amplitude ratio of the sensory nerve action potential equal or greater than 2 (mean + 3 SD). RESULTS: No patient had a definitive and accurate diagnosis, before MABCN abnormality determination. MABCN testing was abnormal in all the 16 cases with a mean interside amplitude ratio of 7.2 (mean + 25 SD), when all other motor and sensory nerve conductions were normal. All except four patients showed normal needle examination from C5 to T1. In 5 cases, an obvious cause (traumatic and neoplastic) explained the mild lower brachial plexus lesion. In 2 cases, a mild neurogenic thoracic outlet syndrome (NTOS) was confirmed by surgical findings. In the 9 other cases, the mild lower brachial plexus lesion defined by MABCN findings, was without cause and was considered as a mild NTOS. CONCLUSIONS AND SIGNIFICANCE: These 16 cases, support a new electrodiagnostic pattern to define a mild lower brachial plexus lesion: comparatively low or low MABCN SNAP amplitude, normal median and ulnar SNAP/Compound motor action potential amplitudes and normal or slightly reduced interference pattern in some C8-T1 innervated muscles. This pattern can be found in patients with 'carpal tunnel syndrome like' symptoms who have normal electro-diagnostic examination, or in patients with clinical features suggesting a lower brachial plexus lesion.

Action Potentials↗
PubMed2004

[Anterior interosseous nerve lesions revisited in 2004].

When the anterior interosseous nerve (AIN) is involved, a motor deficit of the distal pinch appears. It usually occurred suddenly, with or without pain and the deficit may be complete or partial. Other nerve lesions and some precipitating conditions can be noticed and are important to assess the exact mechanism of the nerve lesion. Partial AIN lesion is frequently misdiagnosed as tendon rupture. The electrodiagnostic examination should always study the pronator quadratus or another muscle innervated by the AIN, the AIN conduction and the motor and sensory median nerve conduction. Thus electrodiagnosis will always assess the AIN lesion and precise its axonal or compressive mechanism. Mononeuritis as neuralgic amyotrophy is the most frequent cause of AIN palsy and never requires surgery. Traumatic lesions are less frequent and usually recover spontaneously. Thus, surgery is rarely required before 12 to 18 months except when no recovery occurs after trauma.

Diagnosis, Differential↗
PubMed2002

Anterior interosseous nerve and multifocal motor neuropathy.

We report the case of a 47-year-old woman with a left anterior interosseous nerve palsy. Surgical release of the anterior interosseous nerve was initially proposed, but electrodiagnostic evaluation demonstrated that the neuropathy was due not to compression or to neuralgic amyotrophy but to a proximal conduction block. At that time, the conduction block could be defined only by indirect electrodiagnostic criteria. A multifocal motor neuropathy with persistent conduction block was subsequently diagnosed, and the patient was treated with intravenous immunoglobulins. The efficacy of this treatment and the subsequent disclosure of conduction block in the right posterior interosseous and peroneal nerves definitively confirmed the multifocal motor neuropathy.

Female↗
PubMed2001

Brachial plexus neoplastic lesions assessed by conduction study of medial antebrachial cutaneous nerve.

Two cases of neoplastic involvement of the lower brachial plexus are reported. This condition was due to recurrence of lymphoma in one case and to axillary node spread of breast cancer in the other. The neuropathic origin and the location of the lesion in the lower brachial plexus between the T-1 root and the axilla was demonstrated by the presence of abnormalities on testing of the medial antebrachial cutaneous nerve in the symptomatic upper limb and comparing it to the healthy one. All other electrodiagnostic tests were normal. Such a finding suggests the need for imaging of the lower brachial plexus region by computed tomography or magnetic resonance imaging.

Adult↗
PubMed2001

Simplified orthodromic inching test in mild carpal tunnel syndrome.

This prospective study was undertaken to determine the clinical relevance, reliability, sensitivity, and specificity of the orthodromic inching test with 2-cm incremental study of the median nerve over the four intracarpal centimeters in 50 control and 50 successive (unselected) patient wrists with mild carpal tunnel syndrome (CTS). In controls, the mean maximum conduction delay per 2 cm (CD/2cm) was 0.445 +/- 0.04 ms, and abnormality was defined as at least one CD/2cm exceeding the mean + 2.5 SD of the normal CD/2cm. This yielded a specificity of 98%. In patients with mild unselected CTS, this simplified orthodromic inching test (SOIT) detected the median nerve lesion at the wrist in 47 cases (sensitivity = 94%). The SOIT detected 15 more CTS cases than did the orthodromic median-ulnar latency difference of the 4th digit (Chi square = 13; P =.002). Thus, the SOIT was as effective as an incremental study every centimeter over 10 cm, and the time required for the test allows its routine use when other electrodiagnostic tests fail to reveal any median nerve impairment.

Adult↗
PubMed2000

Comparative diagnostic sensitivities of orthodromic or antidromic sensory inching test in mild carpal tunnel syndrome.

OBJECTIVES: To compare the reliability, sensitivity, and specificity of the "inching test" (IT) or "centimetric test," performed orthodromically (OIT) and antidromically (AIT). METHODS: Incremental palmar study of the sensory fibers of the median nerve was evaluated over 10cm across the wrist in 20 patients with mild carpal tunnel syndrome (CTS) and in 20 controls. Mild CTS was defined as clinical features of CTS with normal electrophysiologic findings by standard methods. The CTS patients were preselected with abnormal orthodromic median-ulnar latency difference of the fourth digit (mean .66+/-.21ms; nl < .40ms). RESULTS: In controls, the mean conduction delay per centimeter (CD/cm) was .192ms for OIT and .191ms for AIT; the mean maximum conduction delay per centimeter (MCD/cm) was .250+/-.032ms for OIT and .344+/-.10ms for AIT. MCD/cm was located inside the carpal tunnel in 85% of patients (OIT) versus 80% for AIT. No MCD/cm was greater than .32ms (OIT) or .60ms (AIT). With corresponding pathologic thresholds of .36ms (mean + 3.4 standard deviation [SD]) for OIT and .64ms (mean + 2.6 SD) for AIT, IT was abnormal in 20 patients (100%) with OIT compared with only 4 patients (20%) with AIT. CONCLUSIONS: The orthodromic method was superior to the antidromic method in controls and in patients (chi2 = 23; p = 1.8 x 10(-6)). These findings suggest that orthodromic IT should be used when standard electrodiagnostic tests fail to reveal median nerve sensory abnormality in persons with mild CTS.

Adult↗
PubMed2000

Ulnar nerve compression at the wrist by a synovial cyst successfully treated with percutaneous puncture and corticosteroid injection.

A case of ulnar nerve palsy due to a conduction block in the deep motor branch at the wrist is reported. The cause was a rapidly growing synovial cyst. Ultrasonography and computed tomography were performed to determine the exact location of the cyst, which was punctured and injected with corticosteroid. Function promptly returned to normal after this procedure.

Adrenal Cortex Hormones↗