DE LA SALLE UNIVERSITY MEDICAL CENTER

DEPARTMENT OF PHYSICAL AND REHABILITATION MEDICINE

Case Analysis
(EMG-NCV)
Nicolas, Aldwin
Rivera, Amira Vianca
Tanaka, Asa

September 24, 2020

Clinical Case
• 25/Male
• Had flu like symptoms few days PTA
• 2 days onset of gradual progressive numbness and weakness
• Started on lower extremities
• Later involve the upper extremities
• Difficulty of standing and doing overhead activities
• Few hours after admission
• Difficulty in breathing
• Transferred to ICU
• Known insulin dependent diabetic for 2 years
1. Enumerate other important details in the history that you want to
ask this patient based on the chief complaint mentioned above.

• Clarify the onset of symptoms

• Is the weakness symmetrical (involved muscles)?
• Is the weakness fluctuating, persistent, or intermittent
(duration)?
• Are there relieving and aggravating factors of the muscle
weakness?
• Are there sensory deficits? 
• Are there bulbar signs early? 
1. Enumerate other important details in the history that you want to
ask this patient based on the chief complaint mentioned above.

• Other associated symptoms

• Expand on what his flu-like symptoms were few days prior 
• Past Medical History
• Family history of similar complaint
• Personal and Social History
2. Enumerate focused physical examination and/or  special tests
that you will perform in this patient.
• Complete vital signs
• Cardiovascular exam
• Pulmonary exam
• GIT exam
• Musculoskeletal exam (ROMs)
• Neurologic exam
• Cranial Nerves
• Motor (Manual Muscle testing)
• Sensory
• Reflexes (I.e. Deep tendon reflexes, Babinski)
3. Based on the history and PE that you will perform , what
will be your primary impression and differential diagnoses.

Primary Impression

Guillain-Barre Syndrome, Insulin-Dependent

Diabetes Mellitus
Bases:
• Progressive ascending symmetrical weakness and paresthesia 
• Antecedent flu-like illness few days before onset of symptoms
• Insulin-dependent diabetic for 2 years
3. Based on the history and PE that you will perform , what
will be your primary impression and differential diagnoses.
Differential Diagnosis
Brainstem infarction
Acute myelopathies
Neuromuscular transmission
disorders
Muscle disorders
Periodic paralysis (electrolyte
imbalances, especially potassium
levels)
Rule In
(+) Bilateral muscle weakness
(+) Acute onset of symptoms
(+) Respiratory involvement
(+) Muscle weakness
(+) Paresthesia
(+) Acute onset of symptom
(+) Bilatera weakness
(+) Paresthesia
(+) Involvement of pulmonary
(+) Acute onset of symptoms
(+) Paresthesia
(+) Bilateral weakness
(+) Acute onset of symptoms
(+) Bilateral muscle weakness
Rule Out
(-)dysphagia
(-)dysarthria
(-) dizziness/vertigo
(-) Unilateral body weakness
(+) Upper extremities symproms
(+) Involvement of respiratory
muscles
(-) Problem holding materials
(-)  Ptosis
(-) Diplopia
(-)  comatose
(-) encephaloopathic
(-)  Respiratory involvement
(+) Progressive numbness and
weakness
(-) Spontaneous resolution
4. Enumerate your plan of management on this patient ( i.e. Diagnostic
tests,  Medications, Medical and Rehab management).  List potential
problems that may arise that would warrant referral to rehab med
service.
• Diagnostics • Diagnostics
• Clinical history and physical • EMG-NCV studies
examination • CSF studies (lumbar tap)
• Laboratory studies • Pulmonary function tests
• Thyroid panel  • MRI of the spine
• HBA1C
• ESR, CPK
• Liver function tests
• Electrolyte levels
4. Enumerate your plan of management on this patient ( i.e. Diagnostic tests, 
Medications, Medical and Rehab management).  List potential problems that may
arise that would warrant referral to rehab med service.

• Treatment management and medications

• Hospitalization
• Adequate pain control
• Prevent complications of immobilization
• Immunomodulators
4. Enumerate your plan of management on this patient ( i.e. Diagnostic
tests,  Medications, Medical and Rehab management).  List potential
problems that may arise that would warrant referral to rehab med
service.
• Potential Problems • Medical and
• Residual and relapsing muscle Rehabilitation Management
weakness • Respiratory care
• Incomplete respiratory recovery • Exercises, positionings, and splint
• Respiratory complications • Strength and endurance training
• Dysautonomia • Maintain normal range of motion and
• Dependence on everyday tasks circulation through passive
movements at full ROM
due to prolonged immobilization • Splints
• Venous thromboembolism • Functional training
• Fatigue and pain • Submaximal exercises
• Psychological trauma • Ambulation activities (Gait retraining)
5. What is EMG-NCV test?  Would you request this test
for this patient? 
• Electromyography with Nerve Conduction Velocity studies measure
the electrical activity of muscles and nerves
• They are electrodiagnostic tests that measure the electrical activity of
muscles and nerves. They are used to if there is problem related to muscles or
nerves, presence of nerve damage, the cause of nerve damage and whether
the damaged nerves are responding to the prescribed treatment.
• EMG looks at the electrical signals the muscles make when they are at rest
and when they are stimulated
• NCV measures how fast and how well the body’s electrical signals travel down
the nerves