Emg and biopsy questions

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Scotty62

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Hello everyone. Need advice I had an EMG that was essential “Normal” but with abnormal muscle pulses of unknown origin. This was after a 10 day hospital stay cause every thing came on suddenly and I could no longer stand. I then had a muscle biopsy on both thighs. One thigh was cleared. Other thigh said denervation for the diagnoses. Waiting on an appointment at the Mayo Clinic. It also showed rare strophic fibers reacting. Thanks in advance.

Ooh the denervation was flagged as mild.
 

Nikki J

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Are you currently in a wheelchair? Did you receive any meds and did they help. Posting your test results with identifying data obscured might be helpful if you wish us to comment. What was your discharge diagnosis?
 

Scotty62

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No not in a wheel chair. Most everything has come back.
Diagnosis:
1. Denervation atrophy, mild.

Comments:
Rare atrophic fibers of either histochemical fiber type and
the atrophic fibers overreacting for nonspecific esterase
indicate mild denervation atrophy. The etiology of the
neurogenic process could not be determined on histologic
grounds.
 

Nikki J

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Sudden onset and quick recovery - neither point toward ALS . again did you receive any meds? If you did and they contributed to recovery that might give clues but it still would not be ALS. Do you have the emg report?
 

Scotty62

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Here is the emg. Yes they gave me prednisone, most of the functionality in my legs had come back.
COMMENT:
The EMG performed in the above samples areas revealed no denervation potentials. The recruitment pattern in indicated intermittent bursts of motor unit activity primarily in the right lower extremity. Unclear as to the etiology of the pattern of muscle activity. Normal nerve conduction studies

IMPRESSION:

  1. Essentially normal EMG of both lumbar paraspinals in both lower extremities
  2. Intermittent bursts of muscle activity in the right lower extremity unclear pattern.
  3. No evidence of radiculopathy, myopathy, polyneuropathy
  4. Recommendations are to proceed with a muscle biopsy targeting the left side
Here is full pathology report.
 

Scotty62

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Here is the full muscle biopsy. Thank you guys I know I haven’t ben diagnosed. So appreciate your insights. As I said I have recovered most of the functionality in my legs. A lot of burning in my legs and pain on sides of my back. Not in my spine.


Left Thigh

Frozen Sections:
Most muscle fibers vary from 25 to 125 micrometers in
diameter with rare atrophic fibers as small as 5
micrometers. Fibers smaller than 25 micrometers occur
singly or in pairs. A few fibers harbor internal nuclei.
Necrotic or regenerating fibers are not observed.
Inflammatory changes are absent. The connective tissue
elements are unremarkable.

In NADH dehydrogenase reacted sections, some fibers display
small focal central decreases of enzyme activity.
Extremely
rare cytochrome c oxidase negative fibers are detected.
ATPase reacted sections demonstrate a random distribution
of
the histochemical fiber types. The atrophic fibers are of
either histochemical fiber type. Increases of acid
phosphatase occur in subsarcolemmal lipofuscin granules.
Myophosphorylase reactivity is preserved. The muscle fiber
glycogen content is normal. Type 1 fibers have a slightly
increased number of small lipid droplets. Highly atroph
ic
fibers overreact for nonspecific esterase.

Paraffin Sections:
H and E and trichrome stained paraffin sections yield no
additional information. Congo red stained paraffin
sections
viewed rhodamine optics reveal no congophilic deposits.

Diagnosis:
1. Denervation atrophy, mild.

Comments:
Rare atrophic fibers of either histochemical fiber type and
the atrophic fibers overreacting for nonspecific esterase
indicate mild denervation atrophy. The etiology of the
neurogenic process could not be determined on histologic
grounds.
 

Nikki J

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Frightening as this all must have been it doesn’t sound at all like ALS. It also sounds treatable since prednisone helped. something autoimmune maybe. Mayo will figure it out I am sure. Will you please come back and let us know your diagnosis?
 

Scotty62

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Thank you Nikki I will let every one know.

Nikki, when I saw the deinnervation and how things reacted on the the staining I did the dr google. I know bad idea, and ALS kept popping up. I will let everyone know once Mayo gives me a diagnoses.
 

Scotty62

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Nikki, Mayo called and has an opening next week. So I am taking it. Will let you guys know what they find.
 
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