To the Editor.
—Barron and Heffner1 recently reported an interesting case of gross enlargement of a single lower extremity in a young woman. They described the presence of electrical activity in this hypertrophic muscle at rest, and postulated that the hypertrophy was due to spontaneous electrical activity, together with "pulling," in a partially denervated muscle.On the other hand, atrophy of a partially denervated muscle is much more common than hypertrophy. The presence of spontaneous activity does not, of course, prove that involvement is due to neuropathy, since many myopathies also show similar spontaneous activity.The "proof" in this case that the involvement was, indeed, neuropathic rests on the somewhat slowed motor nerve conduction observed. (Sensory nerve conduction does not appear to have been measured in the right lower extremity.) Histologic examination of the right sural nerve showing loss of fibers was more convincing than any other test.
Rogoff JB. Neuropathy in Gross Enlargement of Muscle. Arch Neurol. 1984;41(2):138. doi:10.1001/archneur.1984.04050140036018