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LETTER TO EDITOR
Year : 2021  |  Volume : 69  |  Issue : 6  |  Page : 1867-1868

Pseudo-Myotonic Reaction and Pseudo-Polyneuropathy Type Sensory Disturbances in Chronic Cervical Compressive Myelopathy


1 Department of Neurology, IHBAS (Institute of Human Behaviour and Allied Sciences), New Delhi, India
2 Department of Radiology, IHBAS (Institute of Human Behaviour and Allied Sciences), New Delhi, India

Date of Submission09-Oct-2019
Date of Decision01-Dec-2019
Date of Acceptance26-Jul-2020
Date of Web Publication23-Dec-2021

Correspondence Address:
Dr. Aldrin Anthony
Departments of Neurology, Institute of Human Behaviour and Allied Sciences, New Delhi - 110 095
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.333514

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How to cite this article:
Anthony A, Maheshwari S, Kushwaha S, Patel P, Gunasekaran A, Chaturvedi M, Singh S. Pseudo-Myotonic Reaction and Pseudo-Polyneuropathy Type Sensory Disturbances in Chronic Cervical Compressive Myelopathy. Neurol India 2021;69:1867-8

How to cite this URL:
Anthony A, Maheshwari S, Kushwaha S, Patel P, Gunasekaran A, Chaturvedi M, Singh S. Pseudo-Myotonic Reaction and Pseudo-Polyneuropathy Type Sensory Disturbances in Chronic Cervical Compressive Myelopathy. Neurol India [serial online] 2021 [cited 2022 Jan 18];69:1867-8. Available from: https://www.neurologyindia.com/text.asp?2021/69/6/1867/333514




Dear Sir,

A 38-year-old man presented with a history of insidious onset gradually progressive weakness of right upper limb in the form of difficulty in relaxing fingers after a forceful grip for 1.5 years. This was also accompanied by a history of reduced superficial tactile sensations in both hands which was gradually progressive over the last one year. He had pain in legs with frequent cramps, stiffness, and increased difficulty in running with his right lower limb. On admission, neurological examination showed generalized hyperreflexia in limbs with slightly increased tone, bilateral Hoffmann sign, and mild weakness (4+/5) of the right leg. Flexion of fingers and wrist was normal but the following extension was delayed on the right side, especially third and fourth fingers. Wrist and finger extensor power was normal. This phenomenon was not present with percussion and also it was exaggerated by repeated fingers and wrist flexion on the right side [Figure 1]. It was not present when the patient was asked to relax the fingers after a tight grip but was present when the patient was asked to extend them actively. Magnetic resonance imaging (MRI) cervical spine with contrast was suggestive of multilevel disc disease [at C4-5, C5-6, C6-7] with foraminal stenosis (Right > Left) with canal stenosis and increased cord signals on T2 at same levels. i.e. compressive myelopathy [Figure 2]. Nerve conduction studies and F-wave latencies recorded were normal. Electromyography (EMG) was done to test abductor palmaris brevis, first dorsal interosseous, flexor carpi radialis, and extensor digitorumcommunis. EMG showed chronic denervation of the C5 to C7 innervated muscle – positive sharp wave (PSW) and fibrillation potentials, and reduced interference pattern (IP) with high amplitude action potentials. Slight persistence of motor action potentials after the voluntary contraction of flexor carpi radialis (FCR) to extensor digitorum communis (EDC). Recording of action potential from FCR during active extension of wrist and fingers. No myotonic discharges with normal insertional activity (IA).
Figure 1: Pseudo-myotonic reaction of the right hand

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Figure 2: Increased T2 signal at C4, C5, and C6

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In 1913, Tinel described a positive inversion reflex and a pseudo-myotonic contraction with spastic paraplegia due to a spinal tuberculoma. Later on, Frykholm described pseudo-myotonic phenomenon which is not identical to the myotonic phenomenon. In our case, the delayed extension of the finger was not prominent in the thumb and little finger. Besides, exaggeration by repeated movements, unilateral occurrence, and the absence of mechanical myotonia differentiate it from true myotonia. Further, the peculiar disturbance of antagonistic movements of the hand, finger, and wrist is another characteristic. The simultaneous contraction of antagonistic muscles results in clumsy movements of fingers or wrists. This phenomenon seems likely due to the neuronal innervation of different muscle groups, seen in other cases, and simply not due to weakness because finger extension and grip strength were preserved.[1] Collateral branches have been seen to enter denervated endplates, and even sprouting of nerve fibers in the spinal cord has occurred.[2] Neuronal misdirection leading to radial and median nerve misconnection could be one of the reasons in our case. Our patient also had subjective sensory disturbances in upper limbs which has been reported in other cases as “pseudo-polyneuropathy.”[3]

Financial support and sponsorship:

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Sunderland S. Observations on the course of recovery and late end results in a series of cases of peripheral nerve suture. ANZ J Surg 1949;18:264-341.  Back to cited text no. 1
    
2.
Bateman JE. Cervical nerve root compression resulting from disc degeneration and root-sleeve fibrosis.. By Ragnar Frykholm from the Department of Neurosurgery, Serafimerlasarettet, Stockholm. 9½×7 in. Pp. viii+149, with 23 figures and 6 tables. 1951. Stockholm: Acta Chirurgica Scandinavica (Supplementum 160). 1953.  Back to cited text no. 2
    
3.
Seddon HJ, Medawar PB, Smith H. Rate of regeneration of peripheral nerves in man. J Physiol 1943;102:191-215.  Back to cited text no. 3
    


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