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Rationale Peripheral neuropathy is a rare complication of carbon monoxide intoxication. Peripheral neuropathy following carbon monoxide intoxication is known to completely recover within a few months. Patient concerns A 40-year-old man complained of motor weakness and hypoesthesia of the right lower extremity with swelling of his right thigh after carbon monoxide intoxication resulting from a suicide attempt. Diagnoses Following nerve conduction and electromyographic studies, the patient was diagnosed with sciatic neuropathy with severe axonopathy. Clinical and laboratory findings led to a diagnosis of rhabdomyolysis. Interventions The patient was treated conservatively for rhabdomyolysis and underwent comprehensive rehabilitation for sciatic neuropathy during hospitalization. Outcomes After discharge, he underwent serial follow-up tests with nerve conduction and electromyographic studies, which showed prolonged persistence of sciatic neuropathy; however, he showed significant improvement at his 26-month post-discharge follow-up. Lesson Patients presenting with peripheral neuropathy secondary to carbon monoxide intoxication may show variable recovery periods; however, a favorable prognosis can be expected regardless of the concomitant occurrence of rhabdomyolysis and/or compartment syndrome.

Rationale Scapular winging is caused by neuromuscular dysfunction of shoulder stabilizer muscles. Clinically, a winged scapula can be easily diagnosed by typical physical findings. We report a case of atypical winged scapula caused by dorsal scapular neuropathy combined with suprascapular neuropathy, which has rarely been reported. Patient concerns A 25-year-old right-handed male was admitted to the clinic due to right arm weakness for 1 year. On physical examination, right winged scapula with medially rotated inferior angle was observed on flexion. Diagnoses Under the diagnostic impression of a winged scapula due to long thoracic nerve injury based on physical examination, electrodiagnostic study was performed. However, the results showed right dorsal scapular neuropathy combined with suprascapular neuropathy. Interventions Neck and right shoulder MRI were also performed to rule out other causes of winged scapula, but these showed only a partial thickness tear of the rotator cuff tendon. The patient received rehabilitation. Outcomes The symptoms have not improved. Lessons In this case, combined suprascapular neuropathy might contribute to scapular winging and can confuse the diagnosis of winged scapula based on physical findings. This is the first report that indicates suprascapular neuropathy as a contributing factor of scapular winging.

Rationale Botulinum toxin A (BTX-A) injection is effective in treating focal dystonia. However, there are no prior reports regarding the treatment of progressive focal dystonia by a single BTX-A injection that affect a distant muscle. Patient concerns A 19-year-old male was referred to the rehabilitation clinic with a complaint of involuntary movement in his left big toe. The involuntary movement pattern was initially observed in the abduction direction only; however, it progressed to irregular mixed patterns in the flexion and abduction directions. Diagnoses In needle electromyography, abnormal dystonic patterns were observed in the left abductor hallucis (AH), flexor hallucis longus, and flexor hallucis brevis muscles. Interventions and outcomes These symptoms resolved with a single BTX-A injection to the AH muscle. Lessons In this case, a single BTX-A injection to 1 muscle for treating progressive focal dystonia was effective on a distant noninjected muscle.