Muscle & nerve
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To discuss the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM)'s Top Five Recommendations in the Choosing Wisely campaign educating physicians and patients on high quality electrodiagnostic and neuromuscular medicine. The AANEM published its Top Five Recommendations in February 2015 in collaboration with the American Board of Internal Medicine Foundation and Consumer Reports. ⋯ Recommendation 1: Don't do a needle electromyography (EMG) test for isolated neck or back pain after a motor vehicle accident, as a needle EMG is unlikely to be helpful. Recommendation 2: Don't perform dermatomal somatosensory evoked potentials (SEPs) for a pinched nerve in the neck or back, as they are an unproven diagnostic procedure. Recommendation 3: Don't do a four limb needle EMG/nerve conduction study (NCS) testing for neck and back pain after trauma. Recommendation 4: Don't do nerve conduction studies without also doing a needle EMG for testing for radiculopathy, a pinched nerve in the neck or back.Recommendation 5: Don't do a magnetic resonance imaging(MRI) scan of the spine or brain for patients with only peripheral neuropathy (without signs or symptoms suggesting a brain or spine disorder).
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The pathophysiology of neuropathic pain (NeP) in diabetic peripheral neuropathy (DPN) is unclear. A potential pathological feature associated with intraepidermal nerve fiber density (IENFD) loss in DPN is axonal swellings. ⋯ There was no clinical relationship to pain or clinical neuropathy severity for axonal swellings in DPN.
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Case Reports
Severe motor neuropathy or neuronopathy due to nitrous oxide toxicity after correction of vitamin B12 deficiency.
Nitrous oxide (N2 O) toxicity can cause a sensory predominant myeloneuropathy identical to subacute combined degeneration caused by vitamin B12 deficiency. We describe a patient with a typical vitamin B12 deficiency syndrome after N2 O abuse who recovered and then developed a severe lower motor neuron syndrome following vitamin B12 correction. This suggests N2 O toxicity independent of functional vitamin B12 deficiency. ⋯ This case illustrates that N2 O-associated severe motor neuropathy or neuronopathy can develop separately from typical vitamin B12 deficiency dorsal column myelopathy. This syndrome can present when functional measures of vitamin B12 deficiency have normalized.