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Neuromuscular ultrasound (NMUS) is a valuable tool in establishing a diagnosis of carpal tunnel syndrome (CTS), and can be particularly helpful in patients with clinical CTS but normal nerve conduction studies (NCS). This case involves the uncommon presentation of enlarged median nerves on NMUS with normal NCS in a breast cancer patient who developed chemotherapy induced peripheral neuropathy (CIPN) and CTS following taxane treatment. This case demonstrates that CTS should not be excluded based on electrodiagnostic studies alone, and comorbid CTS should be considered in patients receiving neurotoxic chemotherapy, even in the setting of normal NCS.

Wrist drop is a common presentation in neurology. To localize the lesion, clinicians can focus on testing finger extension, elbow flexion with semipronated forearm, and elbow extension among other muscle groups and identifying dermatomes of numbness. Once the lesion is localized, electrophysiology or imaging can guide to an underlying etiology. Here, we describe a case that illustrates the importance of using a stepwise approach to diagnose the etiology of wrist drop in a patient with a cancer history. A 65-year-old woman with diffuse large B-cell lymphoma in remission presented with new onset wrist drop, severe pain, numbness, and tingling concerning for peripheral nerve injury. Imaging findings from PET, venous ultrasound, nerve conduction velocity study, and MRI were conflicting favoring deep venous thrombosis, cancer recurrence, or peripheral nerve sheath tumor. A biopsy was ultimately required to confirm the diagnosis.

Neurologic care in lower- and middle-income countries is an increasing focus for the field and training of its next generation. The International Issues article features a guide for trainees seeking information on predeparture, funding, and postdeparture advice for global health rotations. The Clinical Reasoning and Teaching Image articles review the workup and management of reversible cerebral vasoconstriction syndrome, ataxia, and new-onset clonus in the setting of fever and confusion.