Electrodiagnostic Medicine in Practice : 50Challenging Cases > Cardiology

Key features include:
- The logical thinking process in every step of the diagnosis,
enabling readers to refine their own rationale in electrodiagnosis
- Challenging cases raising difficult yet interesting issues to electromyographers
- Three tables of contents to easily find interesting cases again
Edited by
Tai Ryoon Han, MD, PhD
Professor, Department of Rehabilitation Medicine
Seoul National University College of Medicine
Seoul National University Hospital
Preface
The value of experience is not in seeing much, but in seeing wisely.
(William Osler, 1894)
The start of this book, Electrodiagnostic Medicine in Practice: 50 Challenging Cases, can be traced back 25 years ago, when we embarked on a weekly electromyography case conference.
During the discussion on challenging cases of the previous week, it was the difficult and intriguing questions in the conference that made all our colleagues logic-based and technically refined. In recent decades, the diagnostic armamentarium available to physicians who treat patients with neuromuscular diseases has increased exponentially. Accordingly, our case conference has become more colorful with laboratory results, imaging studies and various genetic tests. However, we found that without a well-trained logical process, even a lot of information can lead to nowhere and sometimes to the wrong place.
Although there are excellent books of case studies, there is a paucity of literature on the purpose of a refinement of logic in electrodiagnostic medicine. For this purpose, we intentionally added a logical thinking process in every step of the diagnosis. Readers can follow the thought patterns of the contributors. Another unique feature of this book is its comprehensive coverage on the presented cases. It covers the initial presentation to the clinical course after adequate treatment or during regular visits. In addition, each case presents the results of the laboratory tests and imaging studies as well as the history and physical examination.
As noted in the title, the cases presented herein are challenging not simply because they are uncommon or unusual, but because they raised difficult issues to electromyographers. Although typical textbook cases are good educational materials for beginners, they are not intellectually interesting enough for experienced clinicians. This book poses challenging questions for physicians, fellows and residents who have practical experience in the diagnosis and treatment of patients with neuromuscular diseases. I hope this book will help readers refine and fine-tune both their understanding and practice.
The 50 cases are organized according to the presenting symptoms. Cases that manifested as focal problems of the upper and lower extremities are presented initially, followed by cases with generalized symptoms. Pediatric cases are placed in the end. The following three tables of contents are provided for the convenience of identifying the cases of concern: 1) table of content with the primary symptoms (in numerical order of case number), 2) with the final diagnosis and interesting aspects (in numerical order), and 3) with the final diagnosis (according to the disease categories).
Each case consists of pairs of unfolding information about the case and the subsequent development of a differential diagnosis. A list of differential diagnoses is made and revised after a description of the history, physical examination and laboratory results, electrophysiological data, and additional studies. The discussion and references were kept succinct.
I am very grateful to the contributors for their devotion to this book. In particular, I want to acknowledge the following colleagues for their reviews and comments: Byung-Mo Oh (one of the contributors), So-Ra Baek, Joon-Beom Hong, Jong-Yub Lim, and all the residents in our department. Special thanks go to the staff of Koonja publishing company.
Tai Ryoon Han, MD, PhD
Seoul, Korea

FOCAL-UPPER EXTREMITIES
CASE 1 A Man Unable to Flex the Thumb and Index Finger of His Left Hand / 1
CASE 2 A Woman with Acute Postpartum Hand Weakness and Tingling Sensation / 9
CASE 3 A Man with Left Arm Weakness / 17
CASE 4 A Man Who Has Difficulty in Releasing the Right Hand After Grasping / 23
CASE 5 A Woman with Left Ring and Little Finger Tingling Sensation / 29
CASE 6 A Man with Right Hand Weakness and Deformity / 35
CASE 7 A Woman Reporting Pins and Needles on the Fingertips of Both Hands / 41
CASE 8 A Man with Bilateral Upper Extremity Weakness / 49
CASE 9 A Man with Right Hand and Forearm Tingling Sensation / 55
CASE 10 A Man with Tingling Sensation in the Left Little Finger / 62
CASE 11 A Man with Bilateral Upper Extremity Weakness / 69
CASE 12 A Woman with Weakness of the Right Hand and Wrist After Childbirth / 77
CASE 13 A Man with Right Arm Weakness / 81
CASE 14 A Woman with Pain in the Posterior Neck and the Lateral Aspect of the Left Arm / 87
CASE 15 A Man with Weakness of the Right Hand / 93
CASE 16 A Man with Tingling Sensation in the Right Hand / 99
CASE 17 A Man with Arm Weakness After a Motorcycle Accident / 105
CASE 18 A Man with Tingling Sensation of His Left Ring and Little Fingers/ 111
FOCAL-LOWER EXTREMITIES
CASE 19 A Woman with Weakness and Sensory Loss in Both Lower Extremities / 117
CASE 20 A Young Man with Bilateral Foot Drop / 123
CASE 21 A Man with Right Lower Extremity Weakness/ 131
CASE 22 A Woman with Pain and Paresthesia on the Left Big Toe and Sole / 137
CASE 23 A Woman with Tip-toe Gait / 143
CASE 24 A Man with Recurrent Ulcerations on Both Feet / 149
CASE 25 A Man with Progressive Leg Weakness and Low Back Pain / 153
CASE 26 A Woman with Bilateral Lower Extremitrs Weakness / 161
CASE 27 A Woman with Unilateral Foot Drop After Childbirth / 167
CASE 28 A Man with Slowly Progressive Weakness of the Right Lower Extremity / 175
CASE 29 A Man with Low Back Pain and Right Lower Extremity Pain / 181
CASE 30 A Woman with Weakness in Her Right Lower Leg / 187
CASE 31 A Woman with Weakness of the Legs and Pain in the Right Heel / 193
CASE 32 A Young Man with Foot Deformities / 201
CASE 33 A Man with Weakness of the Left Leg / 209
GENERALIZED PRESENTATION
CASE 34 A Man with Four Extremity Weakness / 217
CASE 35 A Man with Persistently Elevated Levels of Muscle Enzymes / 223
CASE 36 A Man with Tingling in All Extremities of 3-month Duration / 229
CASE 37 A Woman with Progressive Right Side Weakness / 233
CASE 38 A Man with Paresthesias on Bilateral Fingers and Toes / 239
CASE 39 A Man with Tingling of the Four Extremities / 247
CASE 40 A Man with Facial Weakness and Swallowing Difficulty / 255
CASE 41 Three Patients with Hoarseness / 261
PEDIATRIC CASES
CASE 42 A Boy with Newly Developed Gait Disturbance / 269
CASE 43 A Girl with Right Foot Drop / 275
CASE 44 A Child with Sudden Weakness of Both Lower Extremities / 281
CASE 45 A Girl with Gait Disturbance and Lower Extremity Weakness / 287
CASE 46 A Girl with Generalized Muscle Cramp / 291
CASE 47 A Boy with an Elevated Serum Creatine Kinase / 295
CASE 48 Two Children with Developmental Delay / 301
CASE 49 A Boy with Limping Gait / 311
CASE 50 Two Boys with Weakness of the Lower Extremities / 317

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