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47 yo female with bilateral hand numbness. I did EMG 2 weeks ago, had normal NCS of bilateral median and ulnar motor and sensory nerves, including F-waves, needle EMG was normal.
A few days ago she developed sudden left wrist drop - 2/5 strength of the wrist and finger extensors, normal triceps strength. I got asked to check the radial nerve. I told referring doc it was of limited value this early. NCS completely normal to EIP from forearm, elbow, below and above radial groove, radial sensory normal. Median motor was unchanged, used as a reference. Needle exam showed decreased voluntary motor activity of EDC, ECU, EIP, sort of rapid recruitment, normal MUAP morphology, no spontaneous waves or increased insertional activity.
Pt also recently had an episode of disorientation, was taken to ER, found on head CT to have non-communicating hydrocephalus. She reports no LOB, but some recent stress incontinence and some emotional lability. Neuro exam except the wrist drop basically normal except positive Hoffman's sign bilaterally but negative Babinski. Reflexes, stregth, sensation and other 3 limb coordination normal. CN exam normal.
I know that peripheral nerve findings won't normally show up for a few weeks, and CNS does not normally give EMG findings. Would anyone here think that NPH would cause the wrist drop? I've never seen it as a presenting symptom/sign for NPH. She sees a neurosurgeon next week.
A few days ago she developed sudden left wrist drop - 2/5 strength of the wrist and finger extensors, normal triceps strength. I got asked to check the radial nerve. I told referring doc it was of limited value this early. NCS completely normal to EIP from forearm, elbow, below and above radial groove, radial sensory normal. Median motor was unchanged, used as a reference. Needle exam showed decreased voluntary motor activity of EDC, ECU, EIP, sort of rapid recruitment, normal MUAP morphology, no spontaneous waves or increased insertional activity.
Pt also recently had an episode of disorientation, was taken to ER, found on head CT to have non-communicating hydrocephalus. She reports no LOB, but some recent stress incontinence and some emotional lability. Neuro exam except the wrist drop basically normal except positive Hoffman's sign bilaterally but negative Babinski. Reflexes, stregth, sensation and other 3 limb coordination normal. CN exam normal.
I know that peripheral nerve findings won't normally show up for a few weeks, and CNS does not normally give EMG findings. Would anyone here think that NPH would cause the wrist drop? I've never seen it as a presenting symptom/sign for NPH. She sees a neurosurgeon next week.