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April 1989

McArdle's Disease Aggravates Nuchal and Cranial Muscle Contraction Pains

Author Affiliations

Montreal Neurological Institute 3801 University St Montreal, Quebec, Canada H3A 2B4

Arch Neurol. 1989;46(4):361-362. doi:10.1001/archneur.1989.00520400015010

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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

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