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Research ArticleClinical Notes
Open Access

Ischemic monomelic neuropathy obscured by diabetes and stroke after thoracic endovascular aortic repair

Ahmad J. Abdulsalam, Biju Gopinath, Buthaina M. Alkandari, Diaa Shehab and Salem A. Alkandari
Neurosciences Journal July 2021, 26 (3) 300-302; DOI: https://doi.org/10.17712/nsj.2021.3.20200023
Ahmad J. Abdulsalam
From the Department of Physical Medicine and Rehabilitation (Abdulsalam, Alkandari), Physical Medicine and Rehabilitation Hospital, Andalous, Department of Physical Medicine and Rehabilitation (Gopinath, Shehab), Mubarak Al-Kabeer Hospital, Jabriya, and from the Department of Medical Imaging (Alkandari), Jaber Al-Ahmad Hospital, South Surra, Kuwait.
MD
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  • For correspondence: [email protected]
Biju Gopinath
From the Department of Physical Medicine and Rehabilitation (Abdulsalam, Alkandari), Physical Medicine and Rehabilitation Hospital, Andalous, Department of Physical Medicine and Rehabilitation (Gopinath, Shehab), Mubarak Al-Kabeer Hospital, Jabriya, and from the Department of Medical Imaging (Alkandari), Jaber Al-Ahmad Hospital, South Surra, Kuwait.
MD
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Buthaina M. Alkandari
From the Department of Physical Medicine and Rehabilitation (Abdulsalam, Alkandari), Physical Medicine and Rehabilitation Hospital, Andalous, Department of Physical Medicine and Rehabilitation (Gopinath, Shehab), Mubarak Al-Kabeer Hospital, Jabriya, and from the Department of Medical Imaging (Alkandari), Jaber Al-Ahmad Hospital, South Surra, Kuwait.
MD, FFRRCSI
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Diaa Shehab
From the Department of Physical Medicine and Rehabilitation (Abdulsalam, Alkandari), Physical Medicine and Rehabilitation Hospital, Andalous, Department of Physical Medicine and Rehabilitation (Gopinath, Shehab), Mubarak Al-Kabeer Hospital, Jabriya, and from the Department of Medical Imaging (Alkandari), Jaber Al-Ahmad Hospital, South Surra, Kuwait.
MD, FRCP
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Salem A. Alkandari
From the Department of Physical Medicine and Rehabilitation (Abdulsalam, Alkandari), Physical Medicine and Rehabilitation Hospital, Andalous, Department of Physical Medicine and Rehabilitation (Gopinath, Shehab), Mubarak Al-Kabeer Hospital, Jabriya, and from the Department of Medical Imaging (Alkandari), Jaber Al-Ahmad Hospital, South Surra, Kuwait.
MD, FBPRM
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  • Figure 1
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    Figure 1

    - Post-TEVAR CT MIP images demonstrating a) proper apposition of the graft, b,c,d) MRI brain (diffuse weighted images) revealing small high signal intensity lesions of both cerebral hemispheres.

Tables

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    Table 1

    - Motor conduction study showed absent CMAP for left median nerve. Left ulnar nerve showed markedly reduced CMAP amplitude with mild reduction in conduction velocity.

    Motor side to side comparison
    NerveStimulusRecordingDist (mm) LatOn (ms) B-Pamp (mV) B-PArea (mVms) CV (m/s) 
       LRLRLRLRLR
    MedianWristAPBNR80NR4.50NR6.67NR22.8NRn/a
    ElbowNR225NR9.00NR5.71NR21.2NR50.0
    UlnarWristADM80803.583.330.374.271.311.4n/an/a
    B. Elbow2552309.427.670.213.930.711.143.753.1
    A. Elbow10010011.929.580.344.181.311.840.052.2
    • APB - abductor pollicis brevis, ADM -abductor digiti minimi, mVms - millivoltmillisecond, R - right, L - left, CV - conduction velocity, CMAP - compound muscle action potentia

    • View popup
    Table 2

    - Sensory conduction study showed absent SNAP for left median, radial and ulnar nerves. Right side showed low amplitude SNAP.

    Sensory Side-To-Side Comparison
    NerveStimulusRecordingDist (mm) LatOn (ms) LatNPk (ms) B-PAmp (µV) CV (m/s) 
       LRLRLRLRLR
    Med/Uln/RadWristR ThumbNR100NR1.92NR2.47NR4.74NR52.2
    M ThumbNR100NR2.85NR3.45NR7.18NR35.1
    5th dig.NR140NR2.93NR3.68NR4.28NR47.7
    • N - number, R- right, L- left, SNAP- Sensory nerve action potential, CV- conduction velocity,

    • View popup
    Table 3

    - Needle EMG of upper limb showed denervation potentials in the left biceps and bilateral first dorsal interosseous. Left upper limb showed neurogenic polyphasic MUAPs in all sampled muscles. Recruitment pattern was reduced with more reduction in distal muscles. Right side showed few polyphasic in extensor digitorum and first dorsal interosseous. Right deltoid was mostly unremarkable.

    Needle EMG Summary
    MuscleRootIns. ActFibs.PSWFascics.Polyp.MU amp.MU Dur.PatternRecruit
    Left
    DeltoidAxillary C5-C6Nor000+++++ReducedMod. Redu
    Biceps BrachiMusculocut C5-C6Nor1+00+++++ReducedMod. Redu
    TricepsRadial C6-C7Nor000++++ReducedMod. Redu
    Ext Dig. ComPost Inter C7-C8Nor000+++++ReducedSevere Redu
    First Dors. IntUlnar C7-T1Nor1+1+0+++ReducedPoor Activation
    Right
    DeltoidAxillary C5-C6Nor000+++FullNormal
    Ext. Dig. ComPost Inter C7-C8Nor000+++++FullNormal
    First Dors. IntUlnar C7-T1Nor1+00+++++FullNormal
    • PSW - Positive sharp waves, MU -Motor unit, EMG - Electromyography, MUAPs - Motor unit action potentials

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Neurosciences Journal: 26 (3)
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Ischemic monomelic neuropathy obscured by diabetes and stroke after thoracic endovascular aortic repair
Ahmad J. Abdulsalam, Biju Gopinath, Buthaina M. Alkandari, Diaa Shehab, Salem A. Alkandari
Neurosciences Journal Jul 2021, 26 (3) 300-302; DOI: 10.17712/nsj.2021.3.20200023

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Ischemic monomelic neuropathy obscured by diabetes and stroke after thoracic endovascular aortic repair
Ahmad J. Abdulsalam, Biju Gopinath, Buthaina M. Alkandari, Diaa Shehab, Salem A. Alkandari
Neurosciences Journal Jul 2021, 26 (3) 300-302; DOI: 10.17712/nsj.2021.3.20200023
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