Journal List > Ann Clin Neurophysiol > v.20(2) > 1099794

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Seong, Bae, and Ryu: Electrophysiological and radiological evidence for the multifocal nature of a case of multifocal acquired demyelinating sensory and motor neuropathy
Case Report

Ann Clin Neurophysiol 2018;20(2):101-104.

Published online: 20 January 2018

DOI: https://doi.org/10.14253/acn.2018.20.2.101

Electrophysiological and radiological evidence for the multifocal nature of a case of multifocal acquired demyelinating sensory and motor neuropathy

Gi-Hun Seong1, Jong Seok Bae2, Sanghyo Ryu3,

1Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea

2Department of Neurology, Kangdong Sacred Heart Hospital, Seoul, Korea

3Department of Neurology, Haedong Hospital, Busan, Korea

Correspondence to Sanghyo Ryu Department of Neurology, Haedong Hospital, 133 Taejong-ro, Yeongdo-gu, Busan 49035, Korea Tel: +82-51-410-6300 Fax: +82-51-413–7764 E-mail: sanghyoryu@gmail.com

Received 18 June 2018       Revised 4 July 2018       Accepted 4 July 2018

Copyright © 2018 The Korean Society of Clinical Neurophysiology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Multifocal acquired demyelinating sensory and motor (MADSAM) neuropathy is a variant of chronic acquired demyelinating polyneuropathy. A 65-year-old women presented with up-per arm weakness. A nerve conduction study showed conduction blocks over intermediate segments with sparing of distal compound action potentials. Magnetic resonance imaging revealed asymmetric hypertrophy of the brachial plexus on the affected side. These findings represent important electrophysiological and radiological evidence of MADSAM neuropathy. The condition of the patient began to improve after starting intravenous immunoglobulin administration.

Keywords: Polyneuropathy, Chronic inflammatory demyelinating, Neural conduction, Magnetic resonance imaging

References

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Fig. 1.
Findings of the motor nerve conduction study of the right ulnar nerve. The distal motor latency and the compound muscle action potentials were normal at the wrist and below the elbow. Conduction block was observed between above and below the elbow. NCV, nerve conduction velocity.
acn-20-101f1.tif
Fig. 2.
Brachial plexus magnetic resonance imaging (Short T1 Inversion Recovery Image, non-contrast enhanced) revealed fusiform hypertrophy of the right C5-C8 roots, and plexus was observed (arrows). No hypertrophy was observed on the left side.
acn-20-101f2.tif
Table 1.
Findings of the nerve conduction study of the patient
Motor (recording site) Distal motor latency (ms) Amplitude (mV) Conduction velocity (m/s)
Right median (APB)      
 Wrist 3.7 8.5  
 Elbow   NR  
Left median (APB)      
 Wrist 3.1 10  
 Elbow   5.8 48
Right ulnar (ADM)      
 Wrist 2.9 8.8  
 Below elbow   7.8 52
 Above elbow   1.6 27
Left ulnar (ADM)      
 Wrist 2.3 9  
 Below elbow   8.1 49
 Above elbow   4.6 50
Right radial (EIP)      
 8 cm above wrist 3.3 1.7  
 Upper arm   NR  
Left radial (EIP)      
 8 cm above wrist 2.1 6.9  
 Upper arm   2.7 40
Right peroneal (EDB)      
 Ankle 4.3 10.4  
 Below FH   9.3 48
Left peroneal (EDB)      
 Ankle 3.8 5  
 Below FH   4.1 43
Right tibial (AH)      
 Ankle 3.6 13.1  
 Knee   2.5 45
Left tibial(AH)      
 Ankle 4.1 9.4  
 Knee   0.8 43
Sensory (recording method) Amplitud (μV) Conduction velocity (m/s)
Right median (orthodromic) Wrist NR NR
Left median (orthodromic) Wrist NR NR
Right ulnar (orthodromic) Wrist NR NR
Left ulnar (orthodromic) Wrist NR NR
Right radial (antidromic) Wrist NR NR
Left radial (antidromic) Wrist NR NR
Right sural (antidromic) Ankle 9.6 50
Left sural (antidromic) Ankle 6 52
Right superficial peroneal (antidromic) Ankle 8.6 48
Left superficial peroneal (antidromic) Ankle 14.4 40
F-waves Latency (ms)  
Right median NR  
Left median NR  
Right ulnar NR  
Left ulnar NR  
Right peroneal 47.99  
Left peroneal NR  
Right tibial 73.39  
Left tibial NR  
H-reflex Latency (ms)  
Right H-reflex NR  
Left h-reflex NR  

NR, not recordable; APB, abductor pollicis brevis; ADM, abductor digiti minimi; AH, abductor hallucis; EDB, extensor digitorum brevis; EIP, Exten-sor Indicis Proprius; FH, fibular head.

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