Neurology & Neurosurgery

Series of CT scans of head with subdural hematoma

Advancing Science

Testing a New Embolic Material for Chronic Subdural Hematoma

Study offers a long-term view of middle meningeal artery embolization for chronic subdural hematoma.

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Complex Case Spotlight

Stiff-Person Syndrome: A Challenging Diagnosis


Ruling Out a Spinal Etiology

Because the signs and symptoms of stiff-person syndrome (SPS) overlap with those of several other disorders, diagnosis requires multiple steps. The first is a detailed medical history and physical exam. Examination of pre- and postoperative imaging of the patient’s cervical, thoracic, and lumbar spine revealed nothing that would explain the severe impairments to her gait.

Preoperative MRIs of the patient’s cervical spine.
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Testing for Antibodies

Between 70 to 80 percent of people with SPS have glutamic acid decarboxylase (GAD) antibodies, so the patient’s extremely high levels were suggestive of the disorder. Because such antibodies are also associated with several other autoimmune disorders, however, their presence alone was insufficient for a diagnosis. There is no single test that is dispositive for SPS.

Results from the patient’s bloodwork.
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Scanning for Telltale Muscle Contractions

During ankle dorsiflexion and plantar flexion, the patient’s electromyography (EMG) showed co-contraction of agonist and antagonist muscles—a characteristic sign of SPS. Combined with her elevated anti-GAD antibody levels, this finding confirmed the diagnosis.

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Readings from the patient’s needle EMG tests.
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