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What Does My Lab Test Result Indicate?

Posted on Mon, 22 Aug 2016

Question: I had EMG and NCS. Slow conduction velocities of the motor nerves throughout. Conduction block of bilateral tibial nerves on proximal stimulation. What is this?

Answered by Dr. Ishu Bishnoi (1 hour later)

Hi! It can show demyelination disorders or problems at neuromuscular junctions. It needs a detailed neurological assement and it can be due to many serious neurological dirorders leading to problem with nerve conduction. Needs prompt treatments so should be immediately referred. Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ishu Bishnoi (3 days later)

This was the results. The MRI showed no seizures. Any guess on what this is or may be?Thanks

Any guess on what this is or may be?

Thanks

Answered by Dr. Ishu Bishnoi (39 hours later)

Brief Answer:
Cause of disease

Detailed Answer:
Hi XXXX, thanks for asking from HCM.

I can understand your concern. Your findings have mentioned the pathology
" Motor neuropathy due to demyelination"

You should consult neurologist to rule out its causes like

: Diabetic neuropathy

: Alcohol induced neuropathy

: Vitamin B12, pyridoxine deficiency

: Drug induced neuropathy like anti tubercular therapy, metronidazole

: Pesticides or chemical neuropathy

There are many more causes.

The doctor will advise few investigations like
: Blood sugar
: B12 level
: Serum calcium, sodium, potassium, magnesium
: Nerve biopsy to confirm

Further treatment will depend upon confirmation of diagnosis. Hope it will help you. If still in doubt, do let me know.

Thanks. Take care.

Above answer was peer-reviewed by : Dr. Priyanka G Raj

Follow up: Dr. Ishu Bishnoi (5 hours later)

Can this be Chronic inflamatory demeylinating polineuropathy?

Answered by Dr. Ishu Bishnoi (21 hours later)

Brief Answer:
Chronic inflammatory demyelinating neuropathy

Detailed Answer:
Hi XXXX, welcome back.

The answer is "It may be". The NCV can only tell you

: presence of nerve damage - partial or complete
: Pre-ganglionic or postganglionic
: Sensory or motor
: Root or main nerve involvement

It can not diagnose "Inflammatory etiology" as the cause. To know about the cause, detailed history of symptoms and physical examination are needed like
Symptoms reported include the following:

Preceding infection (infrequent)
Initial limb weakness, both proximal and distal
Sensory symptoms (eg, tingling and numbness of hands and feet)
Motor symptoms (usually predominant)
In about 16% of patients, a relatively acute or subacute onset of symptoms
In children, usually a more precipitous onset of symptoms
Symptoms of autonomic system dysfunction (eg, orthostatic dizziness)

Accordingly few investigations are advised to confirm it likeLaboratory studies that may be helpful include the following:

:Cerebrospinal fluid analysis: Elevated protein levels are common (80% of patients); 10% of patients also have mild lymphocytic pleocytosis and increased gamma globulin
:Complete blood count (CBC), erythrocyte sedimentation rate (ESR), antinuclear antibody (ANA) level, biochemistry profile, and serum and urine immunoelectrophoresis (to exclude associated systemic disorders)
:MRI of the spine with gadolinium enhancement
:Electromyography (EMG) is a critical test to determine whether the disorder is truly a peripheral neuropathy and whether the neuropathy is demyelinating
: Peripheral (sural) nerve biopsy (see the image below)

By this approach, we can confirm findings. Hope it will help you. If still in doubt, do let me know.

Thanks. Take care.

Above answer was peer-reviewed by : Dr. Veerisetty Shyamkumar

Follow up: Dr. Ishu Bishnoi (33 hours later)

My syptoms are those of loss of prorioception. Is this the motor nervous system or the sensory nervous system that does this?

Answered by Dr. Ishu Bishnoi (9 hours later)

Brief Answer:
Proprioception

Detailed Answer:
Hi XXXX, welcome back.

The proprioception is a sensory symptom. It is the sensation by virtue of which a person can sense his joint, muscle and tendons position.
It is carried by posterior column of spinal cord.

Loss of proprioception manifests as

: Frequent fall while walking in dark
: Not able to sense own limb position in dark.
: If a person with closed eyes, is asked to adjust finger/hand or arm just like other limb, he will not be able to do it.

Loss of proprioception is managed by vision. Thats why, its loss mainly manifests in dark or with eyes closed.

Hope it will help you. If still in doubt, do let me know.

Thanks. Take care.

Above answer was peer-reviewed by : Dr. Sonia Raina

Follow up: Dr. Ishu Bishnoi (8 hours later)

Does this indicate sensory nerve problems?

Answered by Dr. Ishu Bishnoi (7 minutes later)

Brief Answer:
Sensory nerve problem

Detailed Answer:
Hi XXXX, welcome back.

The answer is yes. Proprioception loss can occur due to sensory nerve disease.

Sensory nerve damage can cause

: Numbness in affected area
: Inability to feel hot or cold, pain, touch
: Painless burn or wound
: tingling sensations
: Sometimes hypersensitivity problems like increased pain or touch sensitivity.

Hope it will help you. If still in doubt, do let me know.

Thanks. Take care.

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Ishu Bishnoi (3 hours later)

But my question is that i know those results show me having a motor neuropathy but do these results show a sensory neuropathy?

Answered by Dr. Ishu Bishnoi (32 hours later)

Brief Answer:
Sensory nerve problem

Detailed Answer:
Hi XXXX, welcome back.

Your NCS and EMG findings are suggestive of bilateral tibial nerve block. Tibial nerve is both sensory and motor nerve. Its involvement is suggestive of involvement of both sensory and motor.

However, motor nerve alone can be diagnosed by EMG study. Sensory nerve alone is usually diagnosed by nerve biopsy study of concerned nerve. It can also be suspected by clinical features as mentioned in previous answer.

Hope it will help you. If still in doubt, do let me know.
Thanks. Take care.

Above answer was peer-reviewed by : Dr. Veerisetty Shyamkumar