A Video Atlas of Neuromuscular Disorders

Aziz Shaibani, M.D. is the director of the Nerve and Muscle Center of Texas and a Professor at the Baylor College of Medicine, Houston, Texas. He is board certified in neurology, neuromuscular medicine, neurophysiology, neuromuscular pathology and electrodiagnostic medicine. He previously served as the President of the Texas Neurological Society and Vice President of the Neuromuscular section of the American Academy of Neurology.

• Foreword to the First Edition Richard J. BarohnForeword to the First Edition Anthony Amato Contributors List Introduction to the Third Edition Chapter 1 Gait DisordersCase 1.1 Bilateral Foot Drop Case 1.2 Sensory Ataxia Case 1.3 Spastic Gait Case 1.4 Painful Leg Spasms Case 1.5 Lateral Pelvic Tilting Case 1.6 Bizarre Gait Case 1.7 Proximal and Distal Weakness Case 1.8 Wide-Based Gait Case 1.9 Magnetic Gait Case 1.10 Frequent Falls Case 1.11 Chronic Progressive Gait Disorder With Ophthalmoplegia Case 1.12 Spastic Gait Case 1.13 Sensory Ataxia With Brisk Ankle Reflexes Case 1.14 Familial Gait Spasticity Case 1.15 Ataxia and Night Blindness Case 1.16 Neuropathy and Nystagmus Case 1.17 Progressive Bending Case 1.18 Progressive Ataxia Chapter 2 Ptosis Case 2.1 Ophthalmoplegia and Proximal Weakness Case 2.2 Delayed Eyes Opening Case 2.3 Ptosis in the Elderly Case 2.4 Unidirectional Diplopia Case 2.5 Eye Closure and Facial Grimacing Case 2.6 Symptoms Resolved After Prayer Case 2.7 Myasthenia With Dilated Pupil Case 2.8 Apraxia or Ptosis? Case 2.9 Myasthenic Symptoms Worsened With Steroids Case 2.10 Iatrogenic Ptosis Case 2.11 Fixed Ptosis Case 2.12 Familial Ptosis Case 2.13 Respiratory Failure Induced by Steroids Case 2.14 Watch Out for Steroids Complications Case 2.15 Droopy Eyelid and Anisocoria Case 2.16 A Wide Eye Chapter 3 DiplopiaCase 3.1 Weak Lateral Rectus Case 3.2 Medial Rectus Weakness Case 3.3 Positive Edrophonium Test Case 3.4 Myasthenia Gravis Mimicker Case 3.5 Unifying Diagnosis Is Not Always Possible Case 3.6 Penalty for Correction of Wrinkles Case 3.7 Oblique Diplopia Case 3.8 Ophthalmoplegia With Elevated CK Case 3.9 Which Extraocular Movement Is First Affected in Myasthenia Gravis? Case 3.10 Diplopia and Weight Loss Case 3.11 Diplopia and Retro-Orbital Pain Chapter 4 Ophthalmoplegia Case 4.1 Floppy Baby With Ophthalmoplegia Case 4.2 Bulgy Eyes and Heat Intolerance Case 4.3 How Long Should MG Be Treated? Case 4.4 Ophthalmoplegia and Respiratory Failure Case 4.5 Demyelinating Neuropathy With Ophthalmoplegia Case 4.6 Ptosis and Anisocoria Case 4.7 Fluctuating EOM Weakness Without Diplopia Case 4.8 Diplopia and Triceps Fatigability Case 4.9 Droopy Eyelids and Fainting Case 4.10 Ptosis Since Childhood Case 4.11 Familial Ptosis Case 4.12 Ophthalmoplegia With Cerebellar Ataxia and Demyelinating Neuropathy Case 4.13 Recurrent Ptosis Since Childhood Case 4.14 Ophthalmoplegia After Sinus Infection Case 4.15 Can't Move Eyes or Open Them Widely Case 4.16 Ophthalmoplegia Since Childhood Chapter 5 Facial Weakness Case 5.1 Muscle Stiffness and Syncope Case 5.2 Facial Weakness and Elevated CSF Protein Case 5.3 Resolution of Facial Weakness Case 5.4 Unilateral Facial Weakness Case 5.5 Facial Asymmetry After a Hurricane Case 5.6 Could Never Blow a Balloon Case 5.7 A Penalty for Facial Lift Case 5.8 Weakness of Face and Fingers Case 5.9 Nasal Speech Case 5.10 Facial Twitching Case 5.11 Inability to Sing and Kiss Case 5.12 Crooked Smile Since Childhood Case 5.13 Chronic Facial Weakness and Deafness Case 5.14 Anarthria and Facial Weakness Case 5.15 Facial Weakness and Inflammatory Myopathy Case 5.16 Facial Numbness and Weakness Chapter 6 Tongue Signs Case 6.1 Slurred Speech and Trouble Swallowing Case 6.2 Choking With Saliva Case 6.3 Just a Lisp Case 6.4 Grooved Tongue Case 6.5 Familial Muscle Stiffness Case 6.6 Tongue Twitching After Radiotherapy Case 6.7 Unexpected Electromyography Finding Case 6.8 Facial Twitching and Large Breasts Case 6.9 Restless Tongue Case 6.10 Neck Pain and Tongue Deviation Case 6.11 Muscle Stiffness and Winter Weakness Case 6.12 Ear Pain and Tongue Deviation Chapter 7 Dysarthria Case 7.1 Crying and Laughter Case 7.2 Spastic Dysarthria Case 7.3 Dysarthria Long After Radiotherapy Case 7.4 Familial Dysarthria, Sensory Ataxia, and Elevated CK Case 7.5 Cerebellar Ataxia and Tongue Fasciculations Case 7.6 A Lisp During Divorce Case 7.7 Thymectomy or Not? Case 7.8 Morbidity in ALS: Can It Be Improved? Case 7.9 A A Self-Medicated Myasthenic Case 7.10 B The Patient in Case 7 Case 7.11 Tongue Fasciculations and Positive MG Serology Chapter 8 DysphoniaCase 8.1 Fluctuating Nasal Speech Case 8.2 Chronic Nasal Speech Case 8.3 Vocal Cord Paralysis and Distal Weakness Case 8.4 Acute Hoarseness and Severe Arm Pain Case 8.5 Dysarthria and Spasticity Case 8.6 Refractory Dysphonia Chapter 9 Dyspnea Case 9.1 Persistent Respiratory Failure After a Car Accident Case 9.2 Dyspnea and Scapular Winging Chapter 10 Weakness of the Neck Muscles Case 10.1 Inability to Hold Head Up Case 10.2 Spotting Money in the Post Office Case 10.3 Progressive Head Drop Case 10.4 , B Dropped Head and Chewing Difficulty Case 10.5 Dropped Head Case 10.6 Fatal Familial Head Drop Case 10.7 Debilitating Painful Neck Flexion Chapter 11 Scapular Winging Case 11.1 Scapular Winging and Lobulated Fibers Case 11.2 Scapular Winging After Cervical Lymph Node Biopsy Case 11.3 Progressive Scapular Winging and Shortness of Breath Case 11.4 Scapular Winging and Deafness Case 11.5 Scapular Winging and Bilateral Foot Drop Case 11.6 Scapular Winging and Severe Shoulder Pain Case 11.7 Subacute Scapular Winging and Weakness of Finger Flexors Case 11.8 Familial Scapular Winging Case 11.9 Scapular Winging and a CK of 2,000 IU/L Chapter 12 Proximal Arm Weakness Case 12.1 Proximal Arm Weakness and Fasciculations Case 12.2 Proximal Weakness and Areflexia Case 12.3 The Patient in Case 12.2 After Treatment Case 12.4 Chronic Proximal Arm Weakness Case 12.5 Proximal Arm Weakness and Cardiomyopathy Case 12.6 Proximal Weakness and Hard Breasts Case 12.7 Recurrent Proximal Weakness and Areflexia Case 12.8 Progressive Proximal Weakness and Cardiomyopathy Case 12.9 Unilateral-Onset Severe Biceps Weakness Case 12.10 Chronic Unilateral Arm Atrophy Case 12.11 Arms Weakness After Trauma Case 12.12 Can't Raise Arms Case 12.13 Progressive Arm Weakness and Atrophy Case 12.14 Progressive Arm Weakness and Numbness Case 12.15 Muscle Weakness and Rimmed Vacuoles Chapter 13 Proximal Leg Weakness Case 13.1 Proximal Weakness With Non-Inflammatory Muscle Necrosis Case 13.2 Proximal Weakness and Sensory Ataxia Case 13.3 Resolution of Weakness With Plasma Exchange Case 13.4 Acute Myalgia and Elevated CK Level Case 13.5 Necrotizing Myopathy Responding to Treatment Case 13.6 A Diabetic With Thigh Pain and Weakness Case 13.7 Quadriceps Weakness and Calf Hypertrophy Case 13.8 Dystrophic Myopathy With Inflammation Case 13.9 Thigh and Intercostal Pain Case 13.10 Proximal Weakness and Hyperreflexia Case 13.11 Proximal Weakness After Bone Marrow Transplantation Case 13.12 Weakness Years After Thymectomy Case 13.13 Fatigue and Weakness Since Childhood Case 13.14 Toe Walking Since Childhood Case 13.15 Chronic Proximal Legs Denervation Case 13.16 Chronic Leg Weakness Case 13.17 Muscle Weakness and Consanguineous Marriage of the Parents Case 13.18 Progressive Leg Weakness Case 13.19 Muscle Weakness and Cognitive Decline Case 13.20 Weakness in a Patient With HIV Infection Case 13.21 Myalgia and Muscle Weakness Case 13.22 Muscle Weakness and Abnormal Genetic Testing Chapter 14 Quadriceps Weakness Case 14.1 Thigh Weakness and Big Calves Case 14.2 Thigh Weakness Case 14.3 IBM Diagnostic Criteria Were Met 15 Years Later Case 14.4 Big but Weak Calves Case 14.5 Progressive Weakness and Diffuse Denervation Case 14.6 Progressive Calf Atrophy and Elevated CK Case 14.7 Dancing Difficulty Case 14.8 Leg Weakness and Areflexia Case 14.9 Improved but Developed Swollen Legs After IVIG Case 14.10 Severe Thigh Pain in a Non-Diabetic Patient Case 14.11 Weakness and Atrophy of Quadriceps and Hamstrings Case 14.12 Big Calves and Wasted Thighs Case 14.13 Unusual Cause of Quadriceps Atrophy Case 14.14 Painful Cramps and Atrophy of the Quadriceps Muscles Case 14.15 Quadriceps Mitochondrial Myopathy Chapter 15 Distal Arm Weakness Case 15.1 Forearm Pain and Finger Weakness Case 15.2 Hand and Finger Flexor Weakness and Myopathic EMG Case 15.3 "Fish Mouth" Handshake and Facial Weakness Case 15.4 A Fisherman Who Could Not Peel Shrimp Any More Case 15.5 A Wrist Drop After a Long Flight Case 15.6 Weak Hands and Congenital Cataract Case 15.7 Finger Flexor Weakness and Quadriceps Sparing Case 15.8 Hand Muscles Atrophy and Mild CK Elevation Case 15.9 Right Hand Weakness Case 15.10 Chronic Dysphagia and Hand Stiffness Case 15.11 Chronic Bilateral Wrist Extensor Weakness Case 15.12 Severe Chronic Dysphagia and Facial Weakness Case 15.13 Loss of Pinch and Scapular Winging Case 15.14 Declining Golf Performance Case 15.15 Progressive Hand Weakness and Granuloma in Muscle Biopsy Chapter 16 Distal Leg Weakness Case 16.1 Foot Pain and Postural Syncope Case 16.2 Asymmetric Painful Foot Drop Case 16.3 Familial Distal Weakness Case 16.4 A Recliner and Foot Drop Case 16.5 Right Foot Drop and Inflammatory Muscle Biopsy Case 16.6 Calf Atrophy and Moderately High CK Level Case 16.7 Calf Atrophy and Mild CK Elevation Case 16.8 Chronic Calf Atrophy Case 16.9 Progressive Calf Atrophy and Hyperreflexia Case 16.10 Progressive Bilateral Foot Weakness Case 16.11 Familial Weakness of Plantar Flexors Case 16.12 Leg Weakness and Weight Loss Case 16.13 Chronic Bilateral Foot Drop Case 16.14 Bilateral Foot Drop After Weight Loss Chapter 17 Muscle Atrophy and Hypertrophy Case 17.1 Painless Muscle Twitching Case 17.2 Progressive Weakness and Abnormal Discharges Case 17.3 Chronic Bilateral Foot and Wrist Drop Case 17.4 Inability to Stand on Toes and High CK Level Case 17.5 Foot Numbness and Calf Hypertrophy Case 17.6 Calf Atrophy Case 17.7 Big Calves and Remarkably Elevated CK Level Chapter 18 Hyperreflexia Case 18.1 Jaw Clonus Case 18.2 Spastic Dysarthria Case 18.3 Inappropriate Crying and Laughter Chapter 19 Muscle Twitching Case 19.1 Facial Twitching Case 19.2 Stretching-Induced Muscle Contractions Case 19.3 Muscle Twitching and Hyperreflexia Chapter 20 Muscle Stiffness and Cramps Case 20.1 Cramping and Hypertrophy of the Calves Case 20.2 Stiff Back Muscles Case 20.3 Stiff Person Syndrome After Treatment Case 20.4 Muscle Cramps and Diarrhea Case 20.5 Left Leg Stiffness and Falls Case 20.6 Stiffness and Hypertrophy of the Thenar Muscles Case 20.7 Silent Muscle Cramps Case 20.8 Muscle Cramps and Foot Numbness Case 20.9 Familial Muscle Stiffness and Spasms Case 20.10 Muscle Cramps and Familial Bone Tumors Case 20.11 Muscle Cramps Responding to IVIG Chapter 21 Myotonia Case 21.1 A Family With Muscle Stiffness Case 21.2 Myalgia and Myotonia Case 21.3 Hand Numbness and Diffuse Abnormal Discharges Case 21.4 Persistent Hand Shaking Case 21.5 Familial Sensitivity to Cold Case 21.6 Stiffness That Gets Better With Use Case 21.7 Episodic Weakness and Muscle Stiffness Case 21.8 Muscle Stiffness and Abortions Case 21.9 Asymptomatic Paramyotonia Congenita Case 21.10 Familial Muscle Stiffness and Temporal Fullness Case 21.11 Familial Myotonia and Normal DMPK Gene Case 21.12 Stiffness of the Chewing Muscles Chapter 22 Pseudoneurologic Syndromes Case 22.1 Muscle Spasms and Facial Numbness Case 22.2 Tremor After Divorce Case 22.3 "Give Way" Weakness and Loss of Balance Case 22.4 Dysarthria After a Car Accident Case 22.5 Facial Weakness Chapter 23 Numbness Case 23.1 Intercostal Burning Pain Case 23.2 Burning Pain in a Diabetic Case 23.3 Patchy Sensory Loss Case 23.4 Foot Numbness and Normal Ankle Reflexes Case 23.5 Foot Pain and Orthostasis Case 23.6 Inhalation for Fun Case 23.7 Severe Proprioceptive Loss Case 23.8 Foot Pain and Numbness Chapter 24 Deformities Case 24.1 Multiple Masses and Proximal Weakness Case 24.2 Multiple Familial Masses and Foot Numbness Case 24.3 Multiple Ruptured Tendons Case 24.4 Tender Masses Chapter 25 Fatigability Case 25.1 Fatigability of Speech Case 25.2 Fatigable Neck Muscles Case 25.3 Myasthenia and Elevated CK Level Case 25.4 Inability to Chew a Steak Case 25.5 After Treatment With Plasma Exchange Case 25.6 Fatigability of Triceps Muscle Case 25.7 Familial Fatigue in Brothers Chapter 26 Clinical Signs Case 26.1 Eye Movement Case 26.2 Facilitated Reflexes Case 26.3 Hyperreflexia Case 26.4 Poor Arm Abduction Case 26.5 Triple Hump Sign and Bulging Abdomen Case 26.6 Moving Umbilicus Chapter 27 Skin Signs Case 27.1 CIDP With Hypogonadism Case 27.2 Skin Rash and Weight Loss Case 27.3 Puffy Eyes and Skin Rash Case 27.4 Foot Ulcer Case 27.5 Skin Rash and Neuropathy Case 27.6 Polymyositis and Ear Erosion Case 27.7 Dilated Capillaries and Proximal Weakness Case 27.8 Proximal Weakness, Asthma, and Skin Rash Chapter 28 Electromyogram Findings Case 28.1 Dysarthria and Paraspinal Spontaneous Activity Case 28.2 Leg Pain and Spontaneous Fast Activity Case 28.3 Skin Rash and Short-Duration Units Case 28.4 Familial Neurogenic Firing Case 28.5 Spontaneous Activity After Radiotherapy Case 28.6 Chronic Familial Weakness Case 28.7 Decelerating Motorcycle Engine Chapter 29 Diagnostic Ultrasound in Neuromuscular DisordersAuthors: Hans Katzberg, MD, FRCPC; Lubna Daniyal, MD; Hamid Sadeghian, MD, FRCPC; and Monica de Carvalho Alcantara, MD, PhDCase 29.1 Hand Numbness and Increased Median Nerve Cross-Sectional Area Case 29.2 Distal, Symmetric Weakness and Nerve Swelling Case 29.3 Leg Weakness, Atrophy, and Fasciculations Case 29.4 Hand Weakness and Delayed Muscle Contraction (Myotonia) Case 29.5 Ulnar Nerve and Increased Ultrasound Cross-Sectional Area Case 29.6 Ankle Dorsiflexion Weakness After Weight Loss Case 29.7 Ultrasound-Guided Muscle Biopsy Case 29.8 Ultrasound-Assisted Lumbar Puncture Case 29.9 Progressive Forearm Weakness, Atrophy, and Nerve Swelling Case 29.10 Shortness of Breath and Unilateral Diaphragm Thickening Case 29.11 Asymmetrical Shoulder Weakness, Atrophy, and Increased Echogenicity Case 29.12 Progressive Arm Weakness and Preferential Involvement of Deep Finger Flexors Case 29.13 Leg Weakness and Increased Ultrasound Echogenicity Case 29.14 Limb Girdle Muscular Dystrophy Type 2B Case 29.15 Muscle Cramps Case 29.16 Myasthenia Gravis Intercostal Muscle Case 29.17 GNE Myopathy Case 29.18 Neurofibromatosis Type 1 Case 29.19 Segmental Diaphragm Contraction Chapter 30 Muscle and Nerve Biopsies Case 30.1 Muscle Biopsy Case 30.2 Nerve Biopsy Chapter 31 Virtual Visits: Pros and ConsCase 31.1 Virtual Examination Challenges: Dysarthria Case 31.2 Remote Examination Challenges: Amyotrophic Lateral Sclerosis Case 31.3 Virtual Neuromuscular Exam Challenges: Diplopia Chapter 32 Neuromuscular Complications of COVID-19 Infection and Vaccinations Case 32.1 Progressive Symptoms After COVID-19 Case 32.2 Dizziness After COVID-19 Vaccination Case 32.3 Myasthenia Gravis After COVID-19 Vaccination Case 32.4 Right Arm Weakness After COVID-19 Case 32.5 Muscle Twitching Right After COVID-19 Vaccination