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Neurology (Expert Forum)
Competing opinions
This forum is for questions and support regarding neurology issues such as: Alzheimer's Disease, ALS, Autism, Brain Cancer, Cerebral Palsy, Chronic Pain, Epilepsy, Fibromyalgia, Headaches, MS, Neuralgia, Neuropathy, Parkinson's Disease, RSD, Sleep Disorders, Stroke, Traumatic Brain Injury.
Competing opinions
by Sue__0__0, Oct 25, 1998 12:00AM
I am an attorney looking to research the efficacy of certain opinions,
one given by a neurologist and the other by an orthopaedist. The patient
presented with low back pain radiating into her legs mostly on the right
side after lifting an object. The neurologist, upon clinical examination, concluded she had
lumbar radiculopathy and asked for an MRI, suspecting disc herniation. The MRI showed mild dessication
and minimal bulges at L4/L5. Nerve conduction studies of the lower extremities
were normal but emg of the lumbar area was significant at three levels. The
patient also had spina bifida as a child and certain congenital anomalies
were found. Despite the MRI being negative, the neurologist still believes
the patient has lumbar radiculopathy. The orthopaedist says that this
diagnosis cannot be made from the diagnostic testing. Can someone tell me
how one can test for malingering or feigning during a clinical neurological
examination. Also, are there diagnostic tests that bring out malingering?
===========================================================================
Thanks for your question. The electromyography (EMG) test has, as you pointed
out, two parts: Nerve Conduction Study (NCS), and Needle Electromyographic
Examinations (NEE). Each part gathers different types of information regarding
the integrity of the spinal cord, the nerves (from the nerve roots in the spine
to the terminal endings), the nerve-muscle interface, and the muscle.
You did not specify what type of "alterations" were present during the NEE
(at three levels). Such changes could be:
- Currently active and ongoing deinnervation lesion, a rather strong indication
for surgical intervention.
- Old, chronic deinnervation, much less clear indication for surgery - the
decision would significantly depend on the clinical discomfort/pain.
- Poor activation of the muscles during the NEE test, which can result from
a spinal cord lesion, but also be the result of poor patient effort due to
pain, lack of cooperation. To discerne amongst these possibilities, one
should investigate the contralateral limb, and much depend on the skills
of the electromyographer.
It is possible for lesions to NOT be detected by MRI scan of the spine,
particularly when they are subtle/minor in anatomical alterations.
I hope this information is helpful. Best of luck.
This information is provided for general medical education purposes only.
Please consult your doctor regarding diagnostic and treatment options.
