Guillain-Barr� syndrome and adenocarcinoma of the gall bladder: A paraneoplastic phenomenon? (original) (raw)
Related papers
Journal of Clinical Neuroscience, 2018
Background: Our study aims to evaluate the reliability of clinical findings in diagnosing carpal tunnel syndrome (CTS), with the help of nerve conduction studies (NCSs) and the detection of comorbidities likely to be risk factors. Methods: 512 patients were included in the study who described pain or paresthesia in the median nerve sensory distribution. Sensory and motor NCSs were performed on the median and ulnar nerves of all patients. 49 patients who showed pathological abnormalities of the ulnar nerve were excluded. Demographic information, clinical findings and comorbidities were recorded. According to the results of the NCSs, the patients were divided and analyzed as either positive and negative for the diagnosis of CTS. Results: The highest sensitivity was seen from the Durkan test (95.6%) and the lowest was from thenar atrophy (22.1%). The highest specificity and positive predictive values were seen for thenar atrophy (100%) and the lowest were from the Tinel test (40.9% and 59.1%). The highest negative predictive value was the Durkan test (94%) and thenar atrophy was the lowest (57.4%). There was a significant difference in NCSs groups for clinical findings and comorbidities. Conclusions: Thenar atrophy and sensory loss were highly specific in CTS but had limited value in early detection. Due to their low specificity, provocative tests do not appear sufficient enough to establish a definite CTS diagnosis. Only Durkan's test could possibly be considered initially as it has more balanced values. Diabetes, obesity, rheumatoid arthritis, hypothyroidism and gout significantly increase the risk of CTS.
Archives of Hand and Microsurgery, 2023
This study aimed to correlate the severity of carpal tunnel syndrome (CTS) in terms of the clinical picture with electrophysiological studies to determine whether the severity could be predicted through one measure based on correlations with another. Methods: This cross-sectional correlational study enrolled 96 patients (139 hands) whose nerve conduction studies (NCS) confirmed the diagnosis of CTS, and to whom the Boston Carpal Tunnel Questionnaire (BCTQ) was administered to determine the subjective and clinical CTS severity. The severity of both measures was correlated. Results: The patients' mean age was 49.84±12.23 years. Most (67.7%) were female. The NCS severity grades were as follows: mild, 46%; moderate, 32.4; severe, 9.4%; and very severe, 12.2%. The sensory and motor NCS parameters were significantly correlated with the BCTQ severity. The patients' overall mean scores for symptom severity had substantive predictive accuracy for the patients' CTS severity measured with the NCS. Similarly, most of the functional severity score items had significant predictive accuracy for the patients' NCS-based carpal tunnel severity score. Conclusion: The clinical severity of CTS was strongly correlated with the severity based on nerve conduction. This correlation was more notable for symptom severity scores than for functional status scores. Night pain and numbness demonstrated the strongest associations of all BCTQ items with the NCS. Although clinical severity (based on the BCTQ) predicts the nerve conduction severity, we still recommend performing NCS for patients with a clinical diagnosis of CTS as a confirmatory objective measure and for medico-legal reasons.
Open Journal of Therapy and Rehabilitation, 2014
This service evaluation and pilot study was designed to establish whether a clinical questionnaire could be incorporated within our Secondary Care Carpal Tunnel Service. The purpose of the questionnaire is to predict the positive and negative results of Nerve Conduction Studies (NCS) in those patients with suspected Carpal Tunnel Syndrome. The hand specialist, preceding NCS administered the questionnaire; it was then scored at a later date. Results showed a sensitivity of 86% and specificity of 84% referring to the ability to predict a positive NCS when using a predetermined cutoff score. When analysed with Receiver Operating Characteristics, a threshold score could be determined in order to obtain 100% sensitivity/specificity. This questionnaire can be used as a useful adjunct to assessment of those presenting with suspected Carpal Tunnel Syndrome. Using the questionnaire to identify those patients scoring outside a predetermined threshold range would reduce the need for NCS by nearly 50%, with significant cost and clinical practice implications.
Clinical Neurophysiology, 2005
Objective: To present criteria for pathophysiological interpretation of motor and sensory nerve conduction studies and for pathophysiological classification of polyneuropathies suggested by a group of European neurophysiologists. Methods: Since 1992 seven neurophysiologists from six European countries have collected random samples of their electrodiagnostic examinations for peer review medical audit in the ESTEEM (European Standardized Telematic tool to Evaluate Electrodiagnostic Methods) project. Based on existing criteria in the literature, the experience with a patient material of 572 peer reviewed electrodiagnostic examinations, and productive discussions between the physicians at workshops, the collaboration has produced a set of criteria now routinely used at the centres involved in the project. Results: The first part of the paper considers pathophysiology of individual nerve segments. For interpretation of motor and sensory nerve conduction studies, figures showing change in amplitude versus change in conduction velocity/distal latency and change in F-wave frequency versus change in F-wave latency are presented. The suggested boundaries delimit areas corresponding to normal, axonal, demyelinated, or neuropathic nerve segments. Criteria for motor conduction block in upper and lower extremities are schematically depicted using the parameters CMAP amplitude and CMAP duration. The second part of the paper suggests criteria for classification of polyneuropathies into axonal, demyelinating, or mixed using the above-mentioned criteria. Conclusions: The suggested criteria are developed during many years of collaboration of different centres and may be useful for standardization in clinical neurophysiology. Significance: Consistent interpretation of nerve conduction studies is an important step in optimising diagnosis and treatment of nerve disorders.
BMC Musculoskeletal Disorders
Background: The aim of this study was to evaluate the effectiveness of two diagnostic tests routinely used for diagnosing carpal tunnel syndrome (CTS)-ultrasonography (US) and nerve conduction studies (NCS)-by comparing their accuracy based on surgical results, with the remission of paresthesia as the reference standard. Methods: We enrolled 115 patients, all of the female gender with a high probability of a clinical diagnosis of CTS. All patients underwent US and NCS for a diagnosis and subsequent surgical treatment. As a primary outcome, the accuracy of the US and NCS diagnoses was measured by comparing their diagnoses compared with those determined by the surgical outcomes. Their accuracy was secondarily evaluated based on before and after scores of the Boston Carpal Tunnel Questionnaire (BCTQ). Results: Overall, 104 patients (90.4%) were diagnosed with CTS by the surgical reference standard, 97 (84.3%) by NCS, and 90 (78.3%) by US. The concordance of NCS and surgical treatment (p < 0.001; kappa = 0.648) was superior to that of US and surgical treatment (p < 0.001; kappa = 0.423). The sensitivity and specificity of US and NCS were similar (p = 1.000 and p = 0.152, respectively: McNemar's test). The BCTQ scores were lower after surgery in patients diagnosed by both US and NCS (p < 0.001and p < 0.001, respectively: analysis of variance). Conclusions: US and NCS effectively diagnosed CTS with good sensitivity but were not effective enough to rule out a suspicion of CTS. Trial registration: This study was registered at September, 10 th, 2015, and the registration number was NCT02553811.
INTRODUCTION: The most prevalent compressive neuropathy affecting the upper extremities is carpal tunnel syndrome. There are several causes contributing to the etiology of this illness, including systemic, occupational, and anatomical aspects. AIMS AND OBJECTIVES: In order to determine if nerve conduction velocity may be used as a diagnostic tool in cases of both symptomatic and asymptomatic carpal tunnel syndrome, as well as to investigate the connection that exists between BMI and the diagnosis of carpal tunnel syndrome. METHODOLOGY: A total of thirty individuals, mostly employed at Uka Tarsadia University, participated in the nerve-conduction investigation. The Boston Questionnaire and Nerve Conduction Velocity were employed as measurement tools for outcomes. RESULTS: Nerve conduction research studies have been undertaken on a total of 29 recipients. The research study employed the Mann-Whitney U test, and the test's descriptive data indicates that there is no discernible difference between the symptomatic and asymptomatic NCS. As a result, the results of that research did not demonstrate a meaningful link between carpal tunnel syndrome and BMI. There was no discernible difference in NCS between the symptomatic and asymptomatic groups, which is according to the discoveries of nerve conduction due diligence. CONCLUSION: This study's findings did not demonstrate a strong link between carpal tunnel syndrome and BMI. There was no discernible difference in NCS between the symptomatic and asymptomatic groups, according to the results of nerve conduction investigations.
The Journal of the American Board of Family Medicine, 2007
Nerve conduction studies (NCS) are increasingly being performed at the point-of-service by family medicine, primary care, and internal medicine (FM/PCP/IM) physicians. Carpal tunnel syndrome (CTS) is a common neuropathy often diagnosed with the aid of NCS. Methods: A retrospective analysis of a point-of-service NCS data registry was conducted; 1190 patients who underwent NCS by 613 FM/PCP/IM physician practices, for evaluation of CTS were analyzed. Utility measures included demographic and electrophysiological characteristics of study population, adherence to evidence-based testing guidelines, and relevance of diagnostic outcomes. Results: Tested patients tended to be over 40, female, and overweight or obese. The median nerve distal motor latency was 4.4 ؎ 1.2 ms; 92.6% of studies met the testing guideline; 30.5% of tested limbs yielded normal results; 53.1% CTS; 5.4% ulnar neuropathy; and 11.0% nonspecific upper extremity neuropathy. Discussion: This study demonstrated that point-of-service NCS by FM/PCP/IM physicians for CTS was applied to appropriate patient subpopulations, was performed in accordance with evidence-based testing parameters, and generated relevant diagnostic outcomes.
Diagnostic properties of nerve conduction tests in population-based carpal tunnel syndrome
BMC musculoskeletal disorders, 2003
Numerous nerve conduction tests are used for the electrodiagnosis of carpal tunnel syndrome (CTS), with a wide range of sensitivity and specificity reported for each test in clinical studies. The tests have not been assessed in population-based studies. Such information would be important when using electrodiagnosis in epidemiologic research. The purpose of this study was to compare the diagnostic accuracy of various nerve conduction tests in population-based CTS and determine the properties of the most accurate test. In a population-based study a questionnaire was mailed to a random sample of 3,000 persons. Of 2,466 responders, 262 symptomatic (numbness/tingling in the radial fingers) and 125 randomly selected asymptomatic responders underwent clinical and electrophysiologic examinations. A standardized hand diagram was administered to the symptomatic persons. At the clinical examination, the examining surgeon identified 94 symptomatic persons as having clinically certain CTS. Nerv...