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Difference between revisions of "Neuromuscular pathology"
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Neuromuscular pathology (view source)
Revision as of 01:52, 21 January 2012
, 01:52, 21 January 2012re-arr., sub-divide
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Muscle pathology is dealt together with neurologic disease as, at the presentation, they are not infrequently impossible to definitely distinguish. | Muscle pathology is dealt together with neurologic disease as, at the presentation, they are not infrequently impossible to definitely distinguish. | ||
=Work-up= | |||
===General=== | ===General=== | ||
#Clinical history, including family history. | #Clinical history, including family history. | ||
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#Myopathy - something is wrong with the muscle fibres. | #Myopathy - something is wrong with the muscle fibres. | ||
=Stains for muscle biopsies= | |||
===Standard=== | ===Standard=== | ||
{| class="wikitable" | {| class="wikitable" | ||
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***Same protein that that in implicated in [[ALS]] and [[frontotemporal dementia]]. | ***Same protein that that in implicated in [[ALS]] and [[frontotemporal dementia]]. | ||
=Inflammatory myopathy= | |||
DDx: | DDx: | ||
#Polymyositis. | #Polymyositis. | ||
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*Periodic paralysis. | *Periodic paralysis. | ||
=Specific entities= | |||
==Amyotrophic lateral sclerosis== | ==Amyotrophic lateral sclerosis== | ||
===General=== | ===General=== | ||
| Line 435: | Line 436: | ||
*A type of congenital myopathy. | *A type of congenital myopathy. | ||
*Paediatric thingy. | *Paediatric thingy. | ||
==Drug-induced rhabdomyolysis== | |||
*AKA ''drug-induced acute necrotizing myopathy''. | |||
===General=== | |||
Clinical:<ref name=pmid15021204>{{Cite journal | last1 = Coco | first1 = TJ. | last2 = Klasner | first2 = AE. | title = Drug-induced rhabdomyolysis. | journal = Curr Opin Pediatr | volume = 16 | issue = 2 | pages = 206-10 | month = Apr | year = 2004 | doi = | PMID = 15021204 }}</ref> | |||
*Myalgias. | |||
*Myoglobinuria. | |||
*Increased elevated serum creatine kinase (CK). | |||
Causes: | |||
*Ecstasy (MDMA). | |||
*Statins. | |||
===Microscopic=== | |||
Features: | |||
*Muscle [[necrosis]]. | |||
**Fibre collapse = increased staining on [[H&E stain|H&E]], [[HPS stain|HPS]]. | |||
**Karyolysis - loss of nuclei. | |||
**Macrophage (phagocytosis) clean-up = pale moth-eaten appearance (seen well on [[PAS stain|PAS]]). | |||
*No inflammation. | |||
*No perifascicular atrophy. | |||
Images: | |||
*[http://path.upmc.edu/cases/case184/micro.html Drug-induced rhabdomyolysis - several images (upmc.edu)]. | |||
===Stains=== | |||
*PAS +ve fibres (macrophages). | |||
===IHC=== | |||
*CD45 -ve (no lymphocytes). | |||
===EM=== | |||
*Negative for [[tubuloreticular inclusions]]. | |||
==Limb-girdle muscular dystrophy== | ==Limb-girdle muscular dystrophy== | ||
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*Inflammatory myopathies. | *Inflammatory myopathies. | ||
=Groups of disorders= | |||
==Mitochondrial disorders== | ==Mitochondrial disorders== | ||
===General=== | ===General=== | ||
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*[http://commons.wikimedia.org/wiki/File:Denervation_atrophy_-_atp94_-_high_mag.jpg Type 2 fibre atrophy - ATPase pH 9.4 - high mag. (WC)]. | *[http://commons.wikimedia.org/wiki/File:Denervation_atrophy_-_atp94_-_high_mag.jpg Type 2 fibre atrophy - ATPase pH 9.4 - high mag. (WC)]. | ||
=Nerve stuff= | |||
===General=== | ===General=== | ||
*Most common biopsy: sural nerve. | *Most common biopsy: sural nerve. | ||
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*Toxic polyneuropathy (drug toxicity).<ref>URL: [http://path.upmc.edu/cases/case173.html http://path.upmc.edu/cases/case173.html]. Accessed on: 8 January 2012.</ref> | *Toxic polyneuropathy (drug toxicity).<ref>URL: [http://path.upmc.edu/cases/case173.html http://path.upmc.edu/cases/case173.html]. Accessed on: 8 January 2012.</ref> | ||
=See also= | |||
*[[Neuropathology]]. | *[[Neuropathology]]. | ||
=References= | |||
{{reflist|2}} | {{reflist|2}} | ||
=External links= | |||
*[http://moon.ouhsc.edu/kfung/jty1/NeuroHelp/ZNEWWU10.htm How to work up a muscle biopsy (ouhsc.edu)]. | *[http://moon.ouhsc.edu/kfung/jty1/NeuroHelp/ZNEWWU10.htm How to work up a muscle biopsy (ouhsc.edu)]. | ||
*[http://neuromuscular.wustl.edu/lab/mbiopsy.htm Muscle biopsies (wustl.edu)]. | *[http://neuromuscular.wustl.edu/lab/mbiopsy.htm Muscle biopsies (wustl.edu)]. | ||
[[Category:Neuropathology]] | [[Category:Neuropathology]] | ||