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To the Editor.
—The following case illustrates an unusual, hitherto-undescribed clinical feature of McArdle's disease in a patient with posttraumatic nuchal muscle spasms.
Report of a Case.
—A 32-year-old woman presented in 1980 with muscle fatigability and weakness as well as exercise-induced cramps in the calves and thighs. Her sister suffers from a similar illness. Results of general and neurologic examination and electromyography were normal. An ischemic forearm exercise test showed no rise in the serum lactic acid level when compared with a normal control. A muscle biopsy specimen showed prominent subsarcolemmal periodic acid-Schiff-positive masses and absent cytochemical activity of glycogen phosphorylase. The diagnosis of myophosphorylase deficiency (McArdle's disease) was made. In 1987, she sustained a hyperextension-flexion injury of the neck (whiplash), following which she developed intermittent painful "lumps" in the nuchal muscles in addition to diffuse muscle contraction headaches. The "lumps" were clearly different from the so-called fibromyositic
Yamut BI, Karpati G. McArdle's Disease Aggravates Nuchal and Cranial Muscle Contraction Pains. Arch Neurol. 1989;46(4):361–362. doi:10.1001/archneur.1989.00520400015010
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