By Albert P. Galdi M.D. (auth.)
Neurologists and non-neurologists alike can now not forget about ailments of the neuromuscular approach. The outdated dogma that those problems are either unusual and untreatable has misplaced its validity. contemporary technological advances have enabled us to check extra accurately muscle and nerve anatomy, body structure and biochem istry. due to this growth, we're now spotting new neuromuscular di seases in addition to diagnosing extra refined situations of myasthenia gravis, myotonia, and metabolic myopathies. remedy of the neuromuscular ailments has additionally un dergone dramatic swap in line with new discoveries within the fields of immunology and pharmacology. not are myotonia, periodic paralysis, and malignant hyperthermia untreatable scientific curiosities. now not are instances of steroid-un responsive myositis given up as hopeless. due to these kind of advances, non-sur gical physicians and particularly neurologists needs to replace their wisdom regard ing the neuromuscular issues. This e-book, it's was hoping, may help such clinicians in facing this job. Emphasis has been put on the analysis and administration of those problems instead of on their pathophysiology. The extra unusual illnesses and people of doubtful life were passed over purposely and left to the bigger and extra encyclopedic reference works. bankruptcy 1 discusses the scientific signs and indicators of muscle affliction and is designed to permit the reader to formulate a differential prognosis at the foundation of the patient's heritage and actual examination.
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The entire process of neuromuscular transmission is rapid, requiring only milliseconds. Depolarization of the postsynaptic membrane is terminated by the removal of ACh from the cleft. This is accomplished principally by the action of an enzyme, acetylcholinesterase, located at the postsynaptic region. This enzyme hydrolyzes ACh to choline and acetic acid, neither of which is active as a chemical transmitter. Disorders of neuromuscular transmission, therefore, may result from either pre- or postsynaptic abnormalities.
With moderate degrees of axonal pathology, there may be a reduction in the number of motor units so that a partial interference pattern is seen with maximal effort. In severe disease, a single motor unit interference pattern is observed. ) Such a pattern is characteristic of chronic motor neuron disease. macrophages (myositis) positive staining of the connective tissue (myositis) "regen-degen" fibers alkaline phosphatase esterase cores cytoarchitectural changes small dark angular fibers target fibers dark angular fibers target fibers type grouping Reinnervation type grouping small angulated fibers Deinnervation Neuropathic Changes perifascicular atrophy (myositis) inflammatory infiltrates (myositis) "ragged-red" fibers rods Specific NADH-TR ATPase basophilic fibers modified Gomori trichrome increased endomysial connective tissue Non-Specific Stain Myopathic Changes Table 2-6.
When the EMG needle is moved briskly in the muscle, injury potentials are produced. These potentials called "positive sharp waves" are easily recognized by their initial sharp positivity (downward deflection) followed by a long duration negative (upward) component (see Table 2-1). In normal muscle, these potentials disappear abruptly when needle movement ceases. This is what is meant by normal insertional activity. Denervated muscle and myotonic muscle are characterized by prolonged insertional activity: that is, there are runs of positive sharp waves even after the EMG needle is no longer moving.