A diagnostic conundrum

• Published in: Practical neurology Vol. 18; no. 2; pp. 137 - 142
• Main Authors: Keddie, Stephen, Jaunmuktane, Zane, Brandner, Sebastian, Shah, Sachit, Maddison, Paul, Rees, Jeremy H, Hanna, Michael G, Lunn, Michael P T, Reilly, Mary M, Rossor, Alexander M, Carr, Aisling S
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.04.2018
• Subjects: Adult; Age; Ankle; Brain cancer; Diagnosis, Differential; Fecal incontinence; Hearing loss; Histology; Humans; Magnetic Resonance Imaging; Male; Metastasis; Nerve Fibers - pathology; Neurologic Examination; Papilloma, Choroid Plexus - diagnosis; Papilloma, Choroid Plexus - pathology; Papilloma, Choroid Plexus - physiopathology; Pathology; Radiation therapy; Spinal Nerve Roots - pathology; neurooncology; neurophysiology; peripheral neuropathology
• ISSN: 1474-7758; 1474-7766
• DOI: 10.1136/practneurol-2017-001801

Mixed nerve conduction studies Right [micro]V m/s Radial (forearm-snuffbox) 43 60 Median (D3-wrist) 23 62 Superficial peroneal 13 50 Sural (calf-ankle) 12 51 Motor nerve conduction studies Distal motor latency Conduction velocity Compound muscle action potential Minimal F-wave latency ms m/s mV ms Median (SE on abductor pollicis brevis) 3.6 59 7.0 30 Common peroneal (SE on extensor digitorum brevis) No response No response No response No response Tibial (SE on abductor hallucis) 5.5 35 0.1 Absent Tragus-frontalis 8.4 0.2 EMG Spontaneous activity Motor unit action potential configuration Recruitment Interference Fibrillations/positive sharp waves Other Duration Amplitude Polyphasic L deltoid 0 0 N N N N N L flexor carpi radialis 0 0 N N N N N R vastus medialis 2+ CRD ↑↑ ↑↑ ↑↑ Reduced, large units recruiting early ↓ R gastrocnemius (mh) 2+ CRD ↑↑ ↑↑ ↑↑ Reduced, large units recruiting early ↓↓ CRD, complex repetetive discharges; EMG, electromyogram. Full blood count, erythrocyte sedimentation rate, serum C reactive protein, liver function and renal profile were normal; serum creatine kinase was elevated at 219U/L (24-195). There have been predictors of recurrence related to the extent of surgical resection, radiological and immunohistochemical findings, but information is limited by small numbers and short follow-up. 3 Reviewing 20 cases of drop metastasis from choroid plexus papilloma from 1980 to 2012 identified a variable prognosis (mortality at 2 months to stable at 4 years), most likely related to location, extent of disease and treatment. All authors work fulfilled the following: substantial contributions to the conception or design of the work or the acquisition, analysis or interpretation of data; drafting the work or revising it critically for important intellectual content; gave final approval of the version published; agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.