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50 y/o WM with no sig PMH. Seen in consult 5 months after sudden onset of right foot drop. No surgery, no trauma, only leg crosssing behaviors present. He awoke with strange sensation in his whole right leg and within a few hours had weakness in his ankle, but not in the hip or knee flex/ext.
He has inversion as well as eversion weakness tested in dorsiflexion.
3/5 EHL 3/5 DF 3/5 inverters 3+/5 everters
Studies: MRI knee, pelvis, brain (all normal-but all had a reason to order based on addition clinical history and exam)
EMG x2- waveforms not available, Abnormal activity in b/l paraspinals, right gluteus medius, right edb, right ta, normal: left edb, left ta, b/l med and lat gastroc, vastus med, vastus lat, tfl, bflh, bfsh.
Sural left 1.5 / 7.8 right 4.25 / 19
Sup Per left 1.75 / 6.2 right 1.8 / 7.6
F's and H's normal
Motor:
Right EDB ankle 4.4 / 2.5 knee amp 2.7 vel 42.1
Left EDB ankle 2.15 / 8.2 knee 3.5 40.2
Right AH 3.0 10.1
Left AH 4.25 0.6
Has been doing home exercise program and is now 4/5 strength. Still unable to play golf or jog, but otherwise does not effect him much.
Idiopathic, compressive neuropraxic, ALS, MS, ???
From top to bottom, no clear answer in the imaging. EMG maybe misleading, I did not do it and do not have waveforms to look at, and I trust the Neurologist who performed them.
Thoughts?
He has inversion as well as eversion weakness tested in dorsiflexion.
3/5 EHL 3/5 DF 3/5 inverters 3+/5 everters
Studies: MRI knee, pelvis, brain (all normal-but all had a reason to order based on addition clinical history and exam)
EMG x2- waveforms not available, Abnormal activity in b/l paraspinals, right gluteus medius, right edb, right ta, normal: left edb, left ta, b/l med and lat gastroc, vastus med, vastus lat, tfl, bflh, bfsh.
Sural left 1.5 / 7.8 right 4.25 / 19
Sup Per left 1.75 / 6.2 right 1.8 / 7.6
F's and H's normal
Motor:
Right EDB ankle 4.4 / 2.5 knee amp 2.7 vel 42.1
Left EDB ankle 2.15 / 8.2 knee 3.5 40.2
Right AH 3.0 10.1
Left AH 4.25 0.6
Has been doing home exercise program and is now 4/5 strength. Still unable to play golf or jog, but otherwise does not effect him much.
Idiopathic, compressive neuropraxic, ALS, MS, ???
From top to bottom, no clear answer in the imaging. EMG maybe misleading, I did not do it and do not have waveforms to look at, and I trust the Neurologist who performed them.
Thoughts?