Preface to the Third Edition vii
Preface to the First Edition ix
1. History of Clinical Neurophysiology
Classic Electrodiagnosis 2
Electromyography and Nerve Stimulation Technique 4
Evoked Potentials 6
Miscellaneous 7
References 7
2 . An Introduction to Electrodiagnostic Signals
and Their Measurements
Biophysics 11
Electrodes 11
Filter 13
Amplifi er 14
Averager 15
Display 15
Gain and Sweep Time 16
Signal Trigger and Delay Line 17
Stimulator 17
Referral Process 18
References 19
3 . Nerve Conduction Study
3.1. Principles of Nerve Conduction Study 21
Anatomy and Physiology 21
Axonal Transport 22
Impulse Propagation 23
Principles of Motor Nerve Conduction 24
Principles of Sensory Nerve Conduction 25
Variables Affecting the Nerve Conduction Study 27
References 29
3.2. Median Nerve 30
Anatomy 30
Nerve Conduction Study 30
Median Nerve Entrapment Syndromes 31
References 37
3.3. Ulnar Nerve 38
Anatomy 38
Nerve Conduction Study 38
Ulnar Neuropathy 40
References 44
3.4. Radial Nerve 45
Anatomy 45
Nerve Conduction Study 45
Radial Neuropathy 46
References 49
3.5. Brachial Plexus 50
Anatomy 50
Brachial Plexopathy 51
Neurophysiological Assessment of Brachial Plexus Lesions 52
Thoracic Outlet Obstruction 57
Brachial Neuritis 58
Radiation-Induced Plexopathy 59
Obstetric Brachial Plexopathy 59
References 61
3.6. Cervical Radiculopathy 63
Anatomy 63
Motor and Sensory Nerve Conduction 63
F Wave 63
Somatosensory Evoked Potentials 64
Nerve Root Stimulation 64
Needle Electromyography 64
Cervical Radiculopathy 66
References 67
3.7. Lumbar Plexus and Its Terminal Branches 68
Anatomy 68
Lumbosacral Plexopathy 68
Neurophysiological Evaluation 68
References 72
3.8. Sacral Plexus and Its Terminal Nerve
Branches 73
Anatomy 73
References 81
3.9. Lumbosacral Radiculopathy 83
Anatomy 83
L 2 , L 3 , and L 4 Radiculopathies 83
L 5 Radiculopathy 83
S 1 and S 2 Radiculopathy 84
Multiple Lumbosacral Radiculopathies 84
Diagnostic Utility of EMG and MRI in Radiculopathy 85
References 86
3.10. Anomalous Innervation of the Extremities 87
Median to Ulnar Nerve Communication (Martin – Gruber
Anastomosis) 87
Ulnar to Median Nerve Communication 88
Variations in the Innervations of Intrinsic Hand Muscles 88
Accessory Deep Peroneal Nerve 88
Tibial and Peroneal Nerve Communication 89
References 89
3.11. Nerve Conduction of Nonlimb Nerves 90
Phrenic Nerve 90
Facial Nerve 91
Contents
xii CONTENTS
Hypoglossal Nerve 94
Great Auricular Nerve 95
References 95
3.12. Late Response 97
H Refl ex 97
F Wave 100
Axon Refl ex 104
References 105
3.13. Autonomic Nervous System Testing 106
Anatomical and Functional Basis 106
Autonomic Function Tests 107
References 117
4 . Electromyography
4.1. Introduction to Electromyography 119
Anatomy of Muscle 119
Types of EMG Needle Electrodes 120
Recording Technique 121
References 132
4.2. Technique of Electromyography 133
Muscles of Hands 133
Muscles of Forearm 135
Muscles of Arm 140
Muscles of Shoulder Girdle and Trunk 141
Muscle of the Foot 144
Muscles of Leg 146
Muscles of Thigh 149
Muscles of Pelvic Girdle 151
Muscles of Face, Head, and Neck 153
5 . Clinical Application of EMG and Nerve
Conduction
5.1. Electromyographic Findings in Nerologic
Disorders 157
Neurogenic Disorders 157
Myopathic Disorders 166
References 193
5.2. Nerve Conduction and EMG Studies in
Polyneuropathies 198
Pathophysiological Basis of Nerve Conduction Study 198
Conduction Block and Temporal Dispersion 199
Neurophysiological Classifi cation of Polyneuropathy 200
Limitation of Nerve Conduction Studies 202
Hereditary Neuropathies 205
Acute Infl ammatory Demyelinating Polyneuropathy 214
Chronic Infl ammatory Demyelinating Polyneuropathy 217
Subacute Idiopathic Demyelinating Polyradiculopathy 220
Motor Neuropathy with Multifocal Conduction Block or
Multifocal Motor Neuropathy 221
Neuropathy Associated with AIDS 222
Leprosy 225
Diphtheritic Neuropathy 228
Metabolic Neuropathy 228
Carcinomatous Neuropathy 233
Nutritional Neuropathy 234
Critical Care Neuropathy 235
Toxic Neuropathy 237
Drug-Induced Neuropathy 237
Ischemic Neuropathy 239
Neuropathy Associated with Connective Tissue
Disorder 240
Overview of Investigations in Neuropathy 242
References 243
6 . Repetitive Nerve Stimulation
Neuromuscular Junction 251
Physiology of RNS Test 252
Variables Infl uencing Neuromuscular Transmission 253
Technique of RNS 254
Measurement 255
Interpretation of RNS Test 257
Clinical Application of RNS Study 260
References 269
7 . Single-Fiber Electromyography
Introduction 271
Method of SFEMG 271
SFEMG in Neurologic Diseases 276
Neuromuscular Transmission Disorders 277
SFEMG in Neurogenic Disorders 278
SFEMG in Myopathies 279
Macro-EMG 280
References 280
8 . Visual Evoked Potential
Anatomical Basis of VEP 283
Methods of Visual Evoked Potential 284
Variables Infl uencing VEP 287
Clinical Applications of VEP 289
References 296
9 . Brainstem Auditory Evoked Potential
Anatomical and Physiological Basis of BAEPs 301
Brainstem Electrical Activity and Its Correlation with BAEP 301
Patient-Related Variables Affecting BAEP 302
Method 303
Normal BAEP, Potential Field Distribution, Waveform
Recognition, and Normal Values 304
Abnormal BAEP 308
Clinical Neurophysiological Correlation 308
References 314
10. Somatosensory Evoked Potentials
Anatomical and Physiological Basis of SEP 317
Methods 317
Normal Median SEP 319
Reproducibility of SEP 323
Patient-Related Factors 323
Clinical Application of SEP 324
Surgical Monitoring 334
References 335
CONTENTS xiii
11. Motor Evoked Potential
Anatomy and Physiology of Corticospinal Tract 339
Physiological Basis of Motor Evoked Potential 340
Method of Motor Evoked Potential 342
Measurement of CMCT 344
CMCT Abnormalities and Their Basis 345
Comparison of Electrical and Magnetic Stimulation 346
Safety of Transcranial Electrical and Magnetic Stimulation 347
Clinical Applications 347
References 361
12. Cognitive Evoked Potential
P 3 365
Waveform Identifi cation and Measurement 366
Variables Affecting P 3 367
Generators of P 3 368
Clinical Application 368
References 373
13. Electrodiagnosis in Pediatric Practice
13.1. Nerve Conduction and Electromyography 376
Nerve Conduction Studies 376
Sensory NCS 378
Needle EMG 379
Repetitive Nerve Stimulation 381
References 381
13.2. Visual Evoked Potential in Pediatric Practice 382
Methodology 382
Maturation of VEP 382
Measurement of VEP 383
Clinical Application 383
References 385
13.3. Brainstem Auditory Evoked Potential in Pediatric
Practice 386
Methodological Considerations 386
Maturation of BAEP 387
Clinical Application of BAEP in Pediatrics 389
References 394
13.4. Somatosensory Evoked Potentials in Pediatric
Practice 396
Methodological Considerations 396
Maturational Changes 396
Clinical Applications 397
References 400
14. Role of Clinical Neurophysiology in the Prognosis
of Neuromuscular Disorders
Amyotrophic Lateral Sclerosis 403
Radiculopathy 404
Traumatic Nerve Injury 404
Polyneuropathy 405
Diseases of Neuromuscular Junction 410
Myopathy 410
References 413
Index 417
Clinical Neurophysiology: Nerve Conduction, Electromyography, Evoked Potentials 3rd Edition PDF Ebook
