Standard median nerve ultrasound in carpal tunnel syndrome: A retrospective review of 1,021 cases

Objective: Carpal tunnel syndrome (CTS) is diagnosed with electrodiagnostic (EDx) studies. Investigations have examined US cross sectional-area (CSA) and wrist to forearm ratio (WFR) cut-offs for screening EDx abnormalities in patients with suspected CTS. The objective of this study is to determine if these US parameters are effective in a real world population. Methods: This is a retrospective review of patients presenting to the Duke Electromyography (EMG) Laboratory during 2013–2014 with a final diagnosis of CTS. US diagnosis of CTS was based upon median nerve cross-sectional area of >9 mm2 and/or wrist-to-forearm ratio of >1.4. EDx studies were the gold standard for diagnosis. Results: A total of 670 patients and 1,021 extremities were studied. US was positive in 97.6% of EDx confirmed CTS. Conclusion: Median nerve US is nearly as sensitive as the gold standard for EDx testing for the diagnosis of CTS. Significance: The data here suggest that US may have use as a screening tool prior to performing EDx testing for CTS. Keywords: Carpal tunnel syndrome, Ultrasound, Screening, Sensitivity, Median nerve, Diagnosi

Postictal Magnetic Resonance Imaging Changes Masquerading as Brain Tumor Progression: A Case Series

Seizures are common among patients with brain tumors. Transient, postictal magnetic resonance imaging abnormalities are a long recognized phenomenon. However, these radiographic changes are not as well studied in the brain tumor population. Moreover, reversible neuroimaging abnormalities following seizure activity may be misinterpreted for tumor progression and could consequently result in unnecessary tumor-directed treatment. Here, we describe two cases of patients with brain tumors who developed peri-ictal pseudoprogression and review the relevant literature