Martin S. Tamler

Electromyographic detection of paraspinal muscle metastasis. Correlation with magnetic resonance imaging.

Electromyographic (EMG) examination demonstrating marked segmental compromise of the posterior primary ramus distal to the spinal root with relative sparing of the anterior ramus may be the earliest objective evidence of paraspinal muscle metastasis. Antecedent studies are often initially normal, failing to disclose the underlying cause of back pain. Although paraspinal muscle metastasis has been histopathologically demonstrated at postmortem, attempts to image the suspected malignancy with computed tomography have been unsuccessful because the tumor in muscle remains isodense. This study reports the use of magnetic resonance imaging (MRI) to substantiate the existence of EMG-suspected paraspinal muscle metastasis. An EMG pattern of segmental posterior primary ramus denervation is not pathognomonic of metastasis. A confirmatory MRI, however, does permit earlier treatment with palliative radiation therapy.

BEAUMONT LIFESTYLE INVENTORY OF SOCIAL SUPPORT: Can It Predict Disposition Prior to an Inpatient Rehabilitation Admission?

Predicting which rehabilitation patients will ultimately be discharged to a nursing home is a difficult task because methods used to evaluate preexisting home environment and quantify social support have been inadequate. To address this problem, the Beaumont Lifestyle Inventory of Social Support (BLISS) was developed. This questionnaire examines the familys willingness to care for, supervise and provide financial assistance to the patient. Organized into 10 weighted questions, BLISS results in a maximum score of 12. A prospective study was conducted to determine the correlation of the BLISS score with discharge disposition. Prior to rehabilitation admission, continuing care coordinators administered the BLISS to an involved family member of each patient. After 6 months, all BLISS forms were scored and compared with discharge disposition. Seventy-nine patients were included in this study and six (7.6%) were discharged to nursing homes. Comparison of BLISS scores obtained in patients discharged home versus nursing home revealed averages of 9.3 and 4.0, respectively (P < 0.0006). These findings indicate that BLISS can quantify a patients social situation and provide a predetermination of the social factors that lead to nursing home discharge. Consequently, BLISS will be a useful screening tool during the rehabilitation selection process.

Magnetic resonance imaging of the brain: are findings suggestive of amyotrophic lateral sclerosis of any diagnostic utility?

A 57-year-old woman presented with a 6-year history of progressive weakness and cachexia (her body mass index was 15.8). She also had diverse complaints that included tremors, hair loss, a 40-pound weight loss, fatigue, pain on the left side of the face, and chest pain. Pertinent physical examination findings revealed normal cranial nerves, mild proximal weakness (rated 4 /5), no fasciculations, normal muscle stretch reflexes bilaterally, and normal sensation. The diagnostic workup included magnetic resonance imaging (MRI) of the brain, brainstem, and spine, as well as a complete 4-extremity electrodiagnostic evaluation. The MRI of the spine revealed no evidence of demyelinating disease or cord compromise. The MRI of the brain demonstrated subtle increased signal intensity within the subcortical white matter, bilateral peritrigonal areas, and bilateral frontal lobes. In addition, the fluid attenuation inversion recovery (FLAIR) sequence revealed increased signal intensity within the bilateral posterior limb of the internal capsules, bilateral pons, and medulla (Figure 1). The radiologist reported that these findings could be seen in persons with amyotrophic lateral sclerosis (ALS), leading us to consider this diagnosis as a possible etiology, given the patient’s history of complaints and decline in function. Thorough electrodiagnostic testing

Poster 273: Validation of the Fibromyalgia Diagnosis and Monitoring Tool (FDMT)

was diagnosed with migraine headache. After headache recurrence, 16 of the 28 patients who had initially responded to treatment underwent selective injections to the C2,C3 spinal rami. All 16 patients experienced pain relief after treatment, which was comparable in magnitude and duration to that after the first set of injections. Eight of the 16 patients subsequently underwent radiofrequency ablation, and 7 underwent implantation of an occipital nerve stimulator. Conclusions: C1/2, C2/3 facet joint injections and C2, C3 spinal rami blocks were effective and well tolerated for the treatment of CeH in this study and provided significant and prolonged pain relief in more than 90% of the patients.

Poster 39: Electromyographic findings of west nile virus: a case report1

Abstract Objective: To present additional electromyography cases and findings of West Nile virus (WNV) sufferers in Michigan. Design: Prospective case studies. Setting: A 954-bed trauma level I community hospital. Participants: Patients within the hospital who contracted the WNV and who had obtained an electromyogram. Interventions: Not applicable. Main Outcome Measures: Electromyographic findings. Results: There were 401 cases of WNV in Michigan in 2002, 100 of which were identified and treated at our facility. Of those 100, only 9 received electromyography examination. There were 4 different groups of electromyographic findings noted: myopathic, 55.6%; demyelinating peripheral neuropathy, 22.2%; motoneuron disease or polio-like, 11.1%; and combined (peripheral neuropathy, myopathy, neuropathic), 11.1%. Conclusion: In the past couple of years, the United States has experienced an epidemic of WNV, which is thought to have originated from the West Nile region of Africa. More specifically, Michigan has experienced this epidemic over the 2002 calendar year. A previous report had revealed cases of West Nile virus from New York that demonstrated only Guillain-Barre syndome-like and polio-like findings during electrodiagnostic evaluation. This assessment of 9 patients, however, demonstrates 4 different groups of electromyographic findings; myopathic, demyelinating motor greater than sensory peripheral neuropathy, motoneuron disease, and a combination of the 3. Most important was the revelation that myopathy can develop in sufferers with WNV and this cohort represented the most commonly identified finding. There have been no reports to date of Arbo viruses in association with myopathy. There have been reports of various viruses causing myopathy, but none in the Arbo virus class.

From who's who to who's he? A quality of life survey for retired physiatrists and spouses.

Voluntary physiatric retirement, until recently, had been an unusual phenomenon. As one of the youngest medical specialties with a paucity of senior practitioners, relatively few physiatrists to date have reached retirement age. However, with a maturing of physical medicine and rehabilitation, an increasing number of physiatrists are beginning to seek even earlier retirement. This has been accelerated by the availability of secure retirement programs, the increasing “hassle factor” of managed care, and the ever present implied and real threat of accusations of governmental and legal improprieties. “Do it. . .you’ll like it!” For many, retirement, with its many uncertainties, continues to be viewed with a great deal of apprehension. Ending a life’s profession that has preoccupied most of one’s waking hours and that has also provided both emotional and intellectual satisfaction threatens many with a preconceived loss of personal gratification and self-validation. This life’s passage from “who’s who to who’s he?” may, in its worst scenario, be anticipated as only a prologue to another of life’s inevitable events—death! “Don’t listen to people who think retirement is stupid or that you just begin to fall apart—the opposite is true!” Once a decision to retire is finalized, a physiatrist must then face the reality of a dramatic lifestyle change. The manner in which he or she adopts to this transition significantly affects his or her subsequent levels of comfort and that of his or her spouse. Conversely, like an alchemist transmuting lead to gold, retirement can also be viewed as a continuum whereby previously established roles and associated identities will continue to influence the retiree as he or she proceeds to reevaluate his or herself and his or her societal relationships. Life after retirement is influenced by many variable factors. Three factors seem to be the most significant; retirement is invariably associ-