McCurdy Case Study

McCurdy anticipated that the court would apply the same reasoning to ABPS, which like ABMS had been served under Hawaii's long-arm statute. Therefore, McCurdy sought to moot the issue of personal jurisdiction under the state long-arm statute by reserving ABPS under the Clayton Act, which provides that process on a corporate defendant ""may be served in the district of which it is an inhabitant, or wherever it may be found."" 15 U.S.C. � 22 (1994). McCurdy believed that the October 4 filing of the first amended complaint initiated a new 120-day time period in which to serve ABPS, but even that period would have expired on February 3, 1997. On February 5, 1997, McCurdy filed an ex parte motion requesting the court to exercise its discretion under Fed. R.Civ.P. 4(m) to extend the 120-day period by nine days. On February 7, 1997, while the ex parte motion was pending, the amended complaint was personally served on ABPS. Although the first service was designated in counsel's cover letter as under the Hawaii long-arm statute, the February service was ostensibly under the nationwide service provision of the Clayton Act. A week later, the Hawaii magistrate judge denied without prejudice McCurdy's ex parte motion to enlarge the time in which to serve. On February 27, 1997, ABPS moved to quash the February 7, 1997 service on the ground that it was untimely under Rule 4(m). The record contains no indication of any ruling on that motion.

 

 

 Question 1

1. How often is leprosy a cause of mononeuritis multiplex?

2. How often is diabetes mellitus a cause of mononeuritis multiplex?

Question 2

What is the expected response of straight leg-raising if the meningeal

stretch test is positive? Is it back pain, pain in the sciatic distribution, or

limitation in the range of leg-raising?

Question 3

1. Does radiculopathy due to systemic disease produce positive

meningeal stretch signs or are these limited to radiculopathy as a

result of disc prolapse?

2. Where no cause is found for radiculopathy, is steroid treatment

indicated?

Question 4

What are the most common causes of radiculopathy?

Question5

1. Does the absence of a positive straight leg-raising test exclude

radiculopathy?

2. Can radiculopathy be diagnosed by meningeal stretch tests or is it

diagnosed electrophysiologically?

Question 6

Why does ascending paralysis occur in the Guillain-Barr� syndrome?

Question 7

Is systemic steroid therapy indicated in cases of carpal tunnel syndrome

not responsive to conservative measures?

Question 8

Is there a role for acetazolamide in the treatment of carpal tunnel

syndrome? What is the dose? How can paraesthesia induced by the drug

be overcome?

Question 9

Can an MRI scan of the cervical spine detect cervical rib or does this

merit an individual scan?

Question 10

Please explain the mechanism by which cervical spondylosis causes

acroparaesthesia without proximal sensory affection. Does this happen

by compromising the blood supply?200"

Question 1

 How frequent is leprosy as a cause of mononeuritis multiplex?

 

 Mononeuritis multiplex is a syndrome more commonly associated with arteritides but leprosy is one of the rare causes of this condition. It is more often observed in endemical regions or in patient with history of leprosy; however, is not a regular presenting pathology to the general practitioner.

 How frequent is diabetes mellitus as a cause of mononeuritis multiplex?

 

 Diabetes mellitus is a much more frequent etiology of mononeuritis multiplex, especially in cases with inadequate glycemic control. It has potentiality to produce mononeuritis multiplex because of peripheral nerve involvement but it does not involve simultaneously but different nerves asymmetrically.

 Question 2

 The expected response of straight leg-raising if the meningeal stretch test is positive is that the pain will be reproduced and this indicates an inflammation of the meninges.

 

 Restriction in the degree of elevation of the legs is the anticipated finding if the meningeal stretch test including straight leg raise test is pathologic. This test aids find signs of radiculopathy or irritation of the nerve roots.

 Question 3

 Does radiculopathy due to systemic disease produce positive meningeal stretch signs or are these restricted to only radiculopathy due to disc prolapse?

 

 Positive straight leg raise is normally considered to be a meningeal stretch sign and this is normally a feature of radicular pain caused by prolapsed disc or other local factors and not systemic causes. These diseases sometimes manifest with radiculopathy but are frequently not seen as producing these signs of the syndrome.

 Is steroid treatment warranted for patients with negative etiology for radiculopathy?

 

 There is evidence that in radiculopathy that is otherwise ‘idiopathic’, that is no specific cause can be found, steroid treatment might be justifiable, especially in a situation that some form of inflammation is probably at work. But it must be concluded that such treatment is concerned with clinical considerations and other diagnostic results.

 Question 4

 From the viewpoints of the frequency, what diseases can potentially lead to radiculopathy most often?

 

 The most common causes of radiculopathy include:The most common causes of radiculopathy include:

 Herniated intervertebral disc

 Degenerative disc disease

 Spinal stenosis

 Spondylolisthesis

 Trauma

 Question 5

 Can negative straight leg-raising test rule out radiculopathy?

 

 No, as it has been discovered that a negative straight leg raising test cannot rule out radiculopathy. Dexamethasone might be negative in certain situations, predominantly if the nerve root is not adequately inflamed, or in a mild radiculopathy case.

 Is radiculopathy diagnosed from the result of performing meningeal stretch tests or is it diagnosed from the electrophysiologic tests.

 

 Radiculopathy is clinically assessed by physical examination based on the meningeal stretch tests and diagnostic nerve conduction tests and EMG for confirmation of nerve root compromise and assessment of extension of the disease.

 Question 6

 How does it come about that ascending paralysis is witnessed in patients suffering from the Guillain-Barré syndrome?

 

 In Guillain-Barré syndrome the paralysis is an ascending type because the peripheral nervous system is attacked and destroyed by the immune system, the motor nerves initially are selectively affected commonly in the lower limbs and then moves upwards. This is generally done by desmyelination of peripheral nerves with an intention of causing paralysis and muscle weakness.

 Question 7

 Is there a clinical indication for systemic steroid therapy in cases of steroid-resistant carpal tunnel syndrome?

 

 In described carpal tunnel syndrome, systemic steroid is not recommended for the treatment. Initial management that the patient undergoes are initial conservative interventions and they include application of splint and inactive approach. If all of these are inexorable, surgery is often preferred over systemic steroids.

 Question 8

 Can acetazolamide be used as a part of the conservative management for carpal tunnel syndrome? What is the dose? What can be done to counter the implication of paraesthesia that arises from the use of the drug?

 

 Acetazolamide does not form part of the traditional management of carpal tunnel syndrome at all. It is employed in the management of some ailments such as mountain sickness and glaucoma. For carpal tunnel syndrome, the treatments are conservative or surgeries are involved. As for paraesthesia brought about by acetazolamide, the dose can be reduced or the medicine can be stopped.

 Question 9

 Is cervical rib visible from the cervical spine MRI or does one need an individual scan for it?

 

 Cervical ribs are thus not best visualized through MRI scans of the cervical spine. Cervical ribs are better diagnosed through a chest X-ray or a CT scan of the thoracic outlet.

 Question 10

 Would you describe the manner through which cervical spondylosis leads to the development of acroparaesthesia and yet the sensation appear to have no relation with the proximal part of the body? Does this occur at the expense of blood supply?

 

 Cervical spondylosis can present acroparaesthesia (tingling sensation in the limbs inclusive of hands and feet ) without affecting the primary sensory nerve tracts in the upper part of the spinal cord or the nerve roots. This may happen without distal involvement because of compression of the nerve roots or diminution in the blood supply of nerve roots at certain segments resulting in changes mainly distally.