Eosinophilic fasciitis (EF), also known as Shulman syndrome, is an inflammatory disorder of unknown etiology. It usually presents with pain, swelling, and tenderness of the proximal aspect of the limbs, chest, or neck, with subsequent induration of the skin and subcutaneous tissues, in association with peripheral eosinophilia. EF is differentiated from scleroderma by the pattern of skin involvement and non-involvement of muscle. We report a case of progressive EF presented with tightness and stiffness in all limbs.

Background
and Objectives: The proximal and distal nerve segments are preferentially involved in acquireddemyelinating polyneuropathies (ADP). This study was undertaken in order to assess the usefulness of motor evokedpotential (MEP) and somatosensory evoked potential (SSEP) in the detection of the proximal nerve lesion in ADP.Methods: MEP, SSEP and conventional NCS were performed in 6 consecutive patients with ADP (3 AIDP, 3 CIDP).MEP was recorded from abductor pollicis brevis and abductor hallucis using magnetic stimulation of the cortex and thecervical/lumbar spinal roots. SSEP were elicited by stimulating the median and posterior tibial nerves. Latency fromcortex and cervical/lumbar roots, central motor conduction time (CMCT), EN1-CN2 interpeak latency were measuredfor comparison.Results: MEP was recorded in 24 limbs (12 upper and 12 lower limbs) and SSEP in 24 limbs (12 median nerve, 12posterior tibial nerve). F-wave latency was prolonged in 25 motor nerves (25/34, 73.5%). Prolonged CML and PMLwere found in 41.7% (10/24) and 45.8% (11/24), respectively. Interside difference (ISD) of CMCT was abnormallyincreased in the upper extremity, 66.7% (4/6 pairs) in case of CML-PML. EN1-CN2 interpeak latency was abnormallyprolonged in one median nerve (1/10) and LN1-P1 interpeak latency was normal in all posterior tibial nerves.Conclusions: MEP and SSEP may provide useful information for the proximal nerve and root lesion in ADP. MEPand SSEP is supplemental examination as well as complementary to conventional NCS.

B a c k g r o u n d: Somatosensory evoked potential (SSEP) is valuable for the evaluation of the central pathway.However, peripheral neuropathy sometimes renders the test useless by preventing the conduction from reaching theCNS. We postulated that the peripheral conduction problems could be overcome by proximal stimulation in SSEP andwanted to verify this in the study.Methods: Twenty patients with diabetic sensorimotor polyneuropathy were included. SSEP was elicited by stimulatingthe median and posterior tibial nerves. We compared the effect of distal and proximal stimulations in each SSEP inthe aspect of presence/absence and various latencies of resultant waves.Results: Among the 40 cases, proximal stimulation caused reappearance of subsided waves in 10 cases (25%). In themedian nerve SSEP, proximal stimulation made EN1 and CN2 visible which were not evident when distally stimulated.In the posterior tibial nerve SSEP, there was also improvement of forming waves when proximally stimulated.Conclusions: In the diabetic polyneuropathy, proximal stimulation of SSEP is more effective than the conventionaldistal stimulation in evaluating central pathway.