P206 Isolated traumatic musculocutaneous distal branch neuropathy

Abstracts of the 13th European Congress of Clinical Neurophysiology / Clinical Neurophysiology 119 (2008), S1–S131

P204 Predictive value of electrophysiology in idiopathic peripheral facial paralysis Özgür Arslan, Semai Bek, Ümit Hidir Ula¸s, Ya¸sar Kütükçü, Zeki Odaba¸si Gülhane Military Medical Academy, Neurology Department Introduction: Idiopathic peripheral facial paralysis (IPFP) is a disease that causes residual facial nerve dysfunction and resolves by 85% in a low rate of patients (4 -14%). In the early period, determination of prognosis is important to inform the patient accurately and predict prognosis. To this end, this study aimed to determine the predictive value of electrophysiological evaluations for prognosis. Methods: The study was performed on 65 patients with IPFP. Clinical evaluation comprised House-Brackmann grading system and electrophysiological tests (nerve excitability, nerve conduction study, needle EMG, and blink reflex) conducted on the 5th, 20th, and 90th days. Results: The results showed that the prognosis of the patients with nerve excitability test difference higher than 2 mA in the first 5 days and the patients with ≥75% difference in the combined muscle action potential (CMAP) on the 20th day was poor. The blink reflex studies performed in the acute and subacute periods indicated that the patients with poor prognosis had no R1 or R2 responses, and the patients presenting denervation findings on the 20th day in needle EMG had a poor prognosis. Conclusion: The difference in the stimulus thresholds obtained from nerve excitability test is useful in determining the prognosis in acute period. In nerve conduction studies, any CMAP amplitude difference above 75% between the intact side and paralytic side in the subacute period implies poor prognosis. Similarly, absence of R1 and R2 responses in the blink reflex studies within the first 3 weeks is associated with poor prognosis. In the subacute period, determination of fibrillation potentials is helpful in predicting poor prognosis. To predict prognosis, nerve excitability tests (in the acute period) recorded from m.frontalis, m.orbicularis oculi and m.orbicularis oris, evaluation of CMAP through m.frontalis, m.orbicularis oculi and m.orbicularis oris (in the subacute period), blink reflex (in the acute and subacute periods) and EMG evaluation (in the subacute period) provide statistically significant results. Prognosis may be determined with performing the accurate test in the proper period. Unnecessary electrophysiological tests should be eliminated.

P205 Accessory nerve palsy: evaluation of four unusual cases and review of the literature Cengiz Bahadir, Sena Topatan, Burcu Önal, Duygu Kurtulus Haydarpa¸sa Numune Training and Research Hospital, Physical Medicine and Rehabilitation Clinic Purpose: Isolated accessory nerve palsy is a rare focal neuropathy. The majority of the lesions of the spinal accessory nerve occurs as an iatrogenic injury usually after lymph node biopsy and various tumor resection in the posterior cervical triangle. In these iatrogenic cases, the accessory nerve palsy can be diagnosed without any difficulties. There are many etiologic factors responsible for non-iatrogenic palsies and most commonly trauma is the cause. Any reason can not be figured out in some patients. Method: In this report, four cases of isolated accessory nerve palsy whom are 12, 26, 27 and 37 years old are presented. In one of them, accessory nerve palsy developed interestingly after the surgery for reduction mammoplasty and abdominoplasty. In one of the rest three patients, accessory nerve palsy was thought to be strech injury due to weigth lifting. In the other two patients etiology remained unclear. Electrophysiologic evaluation revealed that all three segments of trapezius muscle were affected in three patients and only superior segment was affected in the other with strech injury. Patients were followed during 14-18 months and their clinical courses were monitorized. Conclusion: Complaints emerging as a result of trapezius muscle weakness can be attributed to shoulder joint or cervical root pathologies mistakenly and the accessory nerve injury can be overlooked. Except the well-known iatrogenic and traumatic reasons, it should be kept in mind that there can be some unique cases.Clinical and electrophysiological monitorization of the patients with accessory nerve palsy is cruical. It is imperative to promptly diagnose this condition in the early stage to avoid long-term impairment and to have a better functional outcome. Knowing the good prognosis is impor-

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tant especially for non-iatrogenic cases not being exposed to the unnecessary surgical attempts.

P206 Isolated traumatic musculocutaneous distal branch neuropathy Tülay Kurt, Yaprak Seçil, Nevin Gürgör, Ye¸sim Beckmann, Mustafa Ba¸so˘glu, Cumhur Ertekin Izmir Atatürk Training and Research Hospital, Izmir, Turkey Purpose: Isolated musculocutaneous neuropathy is a rare disorder but isolated brachialis muscle wasting is very very rare disorder. We report a case with an isolated traumatic distal musculocutaneous branch neuropathy of brachialis muscle. Case report: 21 years old male person doing military service has been examined because he could’t bear any strenuous stretching exercise for long time. He had operation scar tissue in his left arm as he had an operation because of broken ulnar and radial bones on the left elbow at he was nine. After that operation, he had broken his bones again two times at the same year. A small another scar on brachialis muscle localization was observed on the elbow not related with first operation. On his neurological examination, medial part of left elbow showed an localized atrophy at the place of brachialis muscle. In electrophysiological examination, nerve conduction studies on left arm were all normal, all muscles except left brachialis muscle were normal. In brachialis muscle there were neurogenic motor unit potentials and loss of motor units. On right side, brachialis muscle was normal. Conclusion: According to our knowledge this is the first report of isolated musculocutanous branch neuropathy related with traumatic causes in the literature.

P207 Retrospective view to refferals in EMG diagnostics in Macedonia Merita Ismajli Marku, D. Nikodijevic, E. Cvetkovska University Hospital, Neurology Clinic Clinical neurophysiology department have observed a number of examines referred to electromyography (EMG) laboratory without symptoms or signs of the peripheral nervous system, disorder or with the wrong and inadequate diagnose on referral. Such referrals do not improve patient management, and only burden examines and laboratory personal. The aim of the present study was to check the appropriateness of referrals to EMG, look for reasons for these problems and suggest possible improvement. From the database of the Clinic of neurology, neurophysiology department in Skopje all the patients where evaluated in EMG laboratory for the period of six months. Data on examines, referral doctors, diagnoses, clinical symptoms and signs, and electrodiagnostic findings were evaluated using statistical parameters. 491 patients, 254 man (51, 73%) and 237 (48, 28%) women were included. The age was a wide range: the youngest patient was 6 month old and 83 y the oldest. Neurological diagnosis was provide in most of the referrals; without referral diagnose: 18 patient (3,66%), with a diagnose and the normal result: 38 patients (7,73%). Half of the patients (49, 69%) had radicular and compressive neuropathies (CTS). Another half include: myopathies, myasthenia gravis, poliradiculopathies, other mononeuropathies (facials, ulnaris). The patients are regruted to our laboratory from neurologists and another specialists (orthopedists, otorinolaringologists, neurosurgeons, GP, pediatricians), Conclusion: difficulties often occur because 1) the first contact with a specialist is EMG evaluation, 2) large turnover of patients per day, 3) patient without working diagnose. Eventual identified solutions will be subject of the extended paperwork.