New Clues: The Cyber-Stan Mystery
By Dr. Bruce Forciea
Crime Lab Report
Detective Jones received the following information from the crime lab.
Revolver was a Glock 37 pistol
5.5 lb trigger pull
45 caliber
Chemical analysis of the syringe shows traces of insulin
Chemical analysis of wine shows alcohol, citric acid, acetic acid, malic acid, resveratrol, succinic acid, tannins, and quercetin
Footprints show the person entered with limp
EMG Report
Detective Jones also obtained the following EMG report from a test given the week before Stan’s death.
Description
The patient is status post C4-C6 anterior cervical discectomy and fusion.
History
The patient is a 45-year-old status post C4-C6 anterior cervical discectomy and fusion. He had a marginal response to those surgeries. He was pain-free until about a year ago when He started noticing pain in his neck, both shoulders, and down his right arm. He noticed weakness in the right hand, especially with opening bottles, etc. The weakness has become worse. He feels that His pain is worsening. He denies any left arm or leg symptoms. No change in bladder function. Over the last year, he states that he has undergone physical therapy as well as steroid injections in his neck, but these were not effective. He states his right upper extremity symptoms are more severe than the lower extremity symptoms.
He has an extensive past medical history of hypertension, and hypercholesterolemia, and has also had bilateral carpal tunnel release.
On examination, normal range of movement of C-spine, he has full strength in upper and lower extremities. Normal straight leg raising. Reflexes are 2 and symmetric throughout. No Babinski. He has numbness to light touch in his right big toe.
Nerve Conduction Studies
The right median palmar sensory distal latencies are severely prolonged with severely attenuated evoked response amplitude. Bilateral tibial motor nerves could not be obtained (technical). The remaining nerves tested revealed normal distal latencies, evoked response amplitudes, conduction velocities, F-waves, and H. reflexes.
Needle EMG
Needle EMG was performed on the right arm and cervical paraspinal muscles. There was evidence of chronic denervation in the right first dorsal interosseous, pronator teres, abductor pollicis brevis, and left first dorsal interosseous.
Impression
This electrical study is abnormal. It reveals the following:
An active right C8/T1 radiculopathy. Electrical abnormalities are severe.
An active right C6/C7 radiculopathy. Electrical abnormalities are severe.
Evidence of chronic left C8/T1 denervation.
There is evidence of a moderate sensory carpal tunnel on the right (he has had previous carpal tunnel release).
Recent Neurological Tests
Numbness, tingling in the lateral 2 digits of the right hand and medial antebrachium
Dynamometer grip strength testing L = 28 lbs/R = 4 lbs
By Dr. Bruce Forciea
Crime Lab Report
Detective Jones received the following information from the crime lab.
Revolver was a Glock 37 pistol
5.5 lb trigger pull
45 caliber
Chemical analysis of the syringe shows traces of insulin
Chemical analysis of wine shows alcohol, citric acid, acetic acid, malic acid, resveratrol, succinic acid, tannins, and quercetin
Footprints show the person entered with limp
EMG Report
Detective Jones also obtained the following EMG report from a test given the week before Stan’s death.
Description
The patient is status post C4-C6 anterior cervical discectomy and fusion.
History
The patient is a 45-year-old status post C4-C6 anterior cervical discectomy and fusion. He had a marginal response to those surgeries. He was pain-free until about a year ago when He started noticing pain in his neck, both shoulders, and down his right arm. He noticed weakness in the right hand, especially with opening bottles, etc. The weakness has become worse. He feels that His pain is worsening. He denies any left arm or leg symptoms. No change in bladder function. Over the last year, he states that he has undergone physical therapy as well as steroid injections in his neck, but these were not effective. He states his right upper extremity symptoms are more severe than the lower extremity symptoms.
He has an extensive past medical history of hypertension, and hypercholesterolemia, and has also had bilateral carpal tunnel release.
On examination, normal range of movement of C-spine, he has full strength in upper and lower extremities. Normal straight leg raising. Reflexes are 2 and symmetric throughout. No Babinski. He has numbness to light touch in his right big toe.
Nerve Conduction Studies
The right median palmar sensory distal latencies are severely prolonged with severely attenuated evoked response amplitude. Bilateral tibial motor nerves could not be obtained (technical). The remaining nerves tested revealed normal distal latencies, evoked response amplitudes, conduction velocities, F-waves, and H. reflexes.
Needle EMG
Needle EMG was performed on the right arm and cervical paraspinal muscles. There was evidence of chronic denervation in the right first dorsal interosseous, pronator teres, abductor pollicis brevis, and left first dorsal interosseous.
Impression
This electrical study is abnormal. It reveals the following:
An active right C8/T1 radiculopathy. Electrical abnormalities are severe.
An active right C6/C7 radiculopathy. Electrical abnormalities are severe.
Evidence of chronic left C8/T1 denervation.
There is evidence of a moderate sensory carpal tunnel on the right (he has had previous carpal tunnel release).
Recent Neurological Tests
Numbness, tingling in the lateral 2 digits of the right hand and medial antebrachium
Dynamometer grip strength testing L = 28 lbs/R = 4 lbs
