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case_images: Magnetic resonance imaging of lumbar spine showing multilevel spinal canal stenosis, most severe at L1-L2 level.
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case_images: Patient had a past history of lumbar spinal stenosis and a new magnetic resonance imaging (MRI) of the lumbar spine was done which noted degenerative changes, L1-L2 and L3-L4 moderate to severe canal stenosis, and multilevel bilateral neural foraminal narrowing:including moderate to severe neuroforaminal stenosis at L4-L5 (see Figure 1).
case_images: MNC and F wave summary for Case 1. The right ulnar and bilateral tibial nerves demonstrate normal distal motor latency, evoked response amplitude and conduction velocity. The bilateral fibular nerves show prolonged distal motor latency, low evoked response amplitude and conduction velocity at the EDB. The right fibular nerve at the TA shows low evoked response amplitude and conduction block at the fibular head while the left fibular nerve at the TA shows normal evoked response amplitude, conduction block at fibular head and slow conduction velocity.. Abbreviations: MNC, motor nerve conduction; R Ulnar, right ulnar nerve; ADM, abductor digiti minimi muscle; R Fib, right fibular nerve; L Fib, left fibular nerve; EDB, extensor digitorum brevis muscle (EDB); R Tibial, right tibial nerve; L Tibial, left tibial nerve; AH, abductor hallucis muscle; F Lat, F latency; M Lat, M latency; F-M LAT, F-M latency.
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case_images: Figures 2-3 for full nerve conduction and EMG tables). Further evaluation included ultrasounds of the peroneal nerves showing slightly increased neural vascularity of the nerves bilaterally which was of uncertain significance, but ultrasound was otherwise unremarkable.
case_images: SNC and EMG summary for Case 1. SNC demonstrates normal ulnar sensory evoked response and conduction velocity while there is no sensory evoked response in the bilateral sural and superficial fibular nerves. The EMG shows 2+ t0 3+ fib and discrete or reduced recruitment in the left and right tibialis anterior and fibularis longus while the exam of the remaining muscles were within normal limits.. Abbreviations: SNC, sensory nerve conduction; EMG, electromyography; MUAP, motor unit action potential; NR, no response; NP, negative peak; P-T, peak to threshold.
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case_images: Figures 2-3 for full nerve conduction and EMG tables). Further evaluation included ultrasounds of the peroneal nerves showing slightly increased neural vascularity of the nerves bilaterally which was of uncertain significance, but ultrasound was otherwise unremarkable.
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case_images: Initial NCS and EMG summary for Case 2.. Abbreviations: NCS, nerve conduction study; EMG, electromyography; NR, no response; O-P, onset to peak; P-T, peak to trough.
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case_images: Her NCS/EMG confirmed evidence of a moderately severe right peroneal neuropathy at the fibular head (see Figure 4).
case_images: Second NCS and EMG for Case 2.. Abbreviations: NCS, nerve conduction study; EMG, electromyography; NR, no response; O-P, onset to peak; P-T, peak to trough.
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case_images: Of note, the EMG also showed the left vastus lateralis had increased motor unit amplitude and slightly increased polyphasic potentials, the significance of which was not known (see Figure 5).