Undiagnosed neuropathy

FACTS

  • there is a certain phenotype of consults typically from neurology which workup is negative and there is a request for a muscle / nerve biopsy. The most important part of executing these consults swiftly and successfully is to understand what workup has been done and what exact specimens / side is being requested.

HPI

universal ROS
  • timing weakness

Workup this far
  • infectious workup
  • typically an LP has been performed, know:
    • OP / cell count / glucose / protein / Cultures
  • serum labs:
    • TSH/T3/T4
    • Lyme
    • NMO/MOG
    • ACh receptor bindng, blocking modulating
    • Mayo autoimmune encephalopathy pane
    • Infectious: BCx, HSV, HIV, Hep B/C, syphillis, TB
    • Inflammatory: Anti-smith, RF, SSA, SSB, RNP, ANA
  • EMG: what did it show? what side(s) is the pathology.
  • B12 / B9 (can cause significant sensorimotor polyneuropathy)
  • Blood cultures

Treatments thus far
  • steroids?
  • IVIG?
  • antibiotics?

PHYSICAL EXAM

universal exam

IMAGING

varies, but MRI Brain and spine usually complete before consulting us.
A/P
  • OR plan
    • what side
    • what nerve (s)
    • what muscle (s)