I discuss issues pertaining to the practice of neuropathology -- including nervous system tumors, neuroanatomy, neurodegenerative disease, muscle and nerve disorders, ophthalmologic pathology, neuro trivia, neuropathology gossip, job listings and anything else that might be of interest to a blue-collar neuropathologist.
Wednesday, November 7, 2007
The problem with muscle biopsies in adults
By the time the adult patient comes to the point where they need a muscle biopsy, all other diagnostic maneuvers have been exhausted. Often, the biopsy is of little to no help and the clinician is left wondering what the diagnosis is. I often find muscle biopsies frustrating because I know that the patient had to undergo minor surgery to have the biopsy done, and then I cannot really do much with the biopsy to help the clinician. Part of it may be my own diagnostic limitations. But, I see the reports of other neuropathologists, and they are also often vague and non-specific as well. I suppose it is helpful when I can identify features consistent with polymyositis. But, when there is a clinical suspicion of polymyositis, what's the harm in a trial of steroids to see if the patient gets better? I realize that an unnecessary course of steroids is not worth the risk in some patients, but in many such a trial would be an acceptable route to go rather than subjecting the patient to biopsy.
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1 comment:
If a patient is diabetic, you really don't want to give him/her steroids without a tissue diagnosis.
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