[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-406407-105":3,"detail-sidebar-cat-0-en-105":81,"doc-detail-406407-en":130},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","selective-loss-of-ulnar-somatosensory-evoked-potentials-revealing-a-focal-cervical-cord-plaque-in-multiple-sclerosis","Selective loss of ulnar somatosensory evoked potentials revealing a focal cervical cord plaque in multiple sclerosis","","A 40-year-old woman with relapsing-remitting multiple sclerosis developed isolated numbness in the fifth digit of the right hand while remaining stable on interferon β-1a. Neurological examination showed mild ulnar-distribution sensory disturbance without weakness and reflex changes; nerve conduction and electromyography were normal. Median SSEPs were preserved, but ulnar SSEPs were selectively absent at cervical, primary cortical, and associative cortical responses despite adequate stimulation, prompting MRI localization of a discrete C6 dorsal column T2-hyperintense plaque. Systematic consideration of ulnar SSEPs helped detect a lower cervical dorsal column lesion and guided earlier therapeutic reassessment.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/selective-loss-of-ulnar-somatosensory-evoked-potentials-revealing-a-focal-cervical-cord-plaque-in-multiple-sclerosis/406407/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/selective-loss-of-ulnar-somatosensory-evoked-potentials-revealing-a-focal-cervical-cord-plaque-in-multiple-sclerosis/406407.png","ImageObject",300,407,{"name":42,"@type":43},"Cipher","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-30","2026-09-28",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",8,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"Why were ulnar SSEPs recorded after normal median SSEPs?","Question",{"text":63,"@type":64},"Median SSEPs showed preserved conduction, so the report proceeded to ulnar SSEPs to further evaluate possible discordant localization. Ulnar SSEPs revealed selective absence of cervical and cortical responses.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What neurophysiological findings localize the lesion in this case?",{"text":68,"@type":64},"Median SSEPs remained normal, whereas ulnar SSEPs failed to elicit N13, N20, and N35 despite adequate peripheral stimulation. This pattern pointed to a selective dorsal column involvement in the lower cervical cord.",{"name":70,"@type":61,"acceptedAnswer":71},"How did MRI findings change clinical management?",{"text":72,"@type":64},"Cervical spine MRI demonstrated a discrete T2-hyperintense plaque at C6 in the dorsal columns, involving the ulnar sensory fasciculus. The early SSEP abnormalities guided MRI localization and allowed earlier therapeutic reassessment.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},406407,1790773967,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,114,119,122,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":107,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":108,"slug":109},7,40,"healthcare",{"id":55,"doc_module":4,"doc_module_name":25,"category_name":111,"show_sort_weight":112,"slug":113},"Research & Report",30,"research-report",{"id":115,"doc_module":4,"doc_module_name":25,"category_name":116,"show_sort_weight":117,"slug":118},9,"Religion & Spirituality",20,"religion-spirituality",{"id":117,"doc_module":4,"doc_module_name":25,"category_name":120,"show_sort_weight":117,"slug":121},"World Cup","world-cup",{"id":123,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":123,"slug":125},10,"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":97,"slug":129},19,"General","general",{"code":4,"msg":82,"data":131},{"doc_id":79,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":107,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":26,"language":139,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":12,"update_tm":143,"read_time":97,"preview_page_count":4},687208528416,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","Clinical Neurophysiology Practice 11 (2026) 3–4  \nContents lists available at ScienceDirect  \nClinical Neurophysiology Practice  \njournal [homepage:](homepage: www.elsevier.com/locate/cnp)[ www.elsevier.com/locate/cnp](homepage: www.elsevier.com/locate/cnp)  \nLetter to the Editor  \nSelective loss of ulnar somatosensory evoked potentials revealing a focal cervical cord plaque in multiple sclerosis  \nA 40-year-old woman with relapsing-remitting multiple sclerosis, stable on interferon β-1a, developed isolated numbness in the fifth digit of her right hand. Neurological examination revealed mild sensory disturbance in the ulnar distribution without weakness or reflex changes. Nerve conduction studies and electromyography were normal, excluding a peripheral ulnar neuropathy. Somatosensory evoked potentials (SSEPs) by stimulation of the median nerve were then recorded.(Fig. 1A)  \nMedian somatosensory evoked potentials (SSEPs) showed preserved N9, N13, and N20 latencies, consistent with intact median pathway conduction (Fig. 1A). This normal result prompted additional recording of ulnar SSEPs, which, in contrast, failed to elicit cervical (N13), primary cortical (N20), or associative cortical (N35) responses despite adequate peripheral stimulation (Fig. 1B). Cervical spine MRI disclosed a discrete T2-hyperintense lesion in the dorsal columns at the C6 level (Fig. 1C), located just beneath the median afferent entry zone and selectively  \ninvolving the ulnar sensory fasciculus.  \nThis pattern aligns with previous reports demonstrating that ulnar SSEPs, although not routinely recorded, are more sensitive than median SSEPs for detecting lower cervical dorsal column lesions (Restuccia et al., 1994; St¨ohr et al., 1982) and remain useful in localizing demyelinating plaques in multiple sclerosis (Dziadkowiak et al., 2021; Hamannet al., 2022). Thus, in this patient, early ulnar SSEP abnormalities revealed a lower cervical dorsal column lesion and guided subsequent MRI localization, allowing earlier therapeutic reassessment.  \nThis case highlights the diagnostic value of systematically considering ulnar SSEPs when sensory symptoms are discordant with median SSEP findings, particularly in suspected lower cervical dorsal column involvement.  \nFig. 1. Panel A: Median SSEP tracing with normal peripheral (N9), spinal (N13), and cortical (N20, N35) components. Panel B: Ulnar SSEP tracing showing absent N13, N20, and N35 despite adequate stimulation at the elbow. Calibration bars: horizontal = 6 ms; vertical = 2 µV (Panels B, C). Panel C: Sagittal T2-weighted cervical MRI demonstrating a focal hyperintense plaque involving the dorsal columns at the C6 level (arrow).  \n[https://doi.org/10.1016/j.cnp.2025.12.002](https://doi.org/10.1016/j.cnp.2025.12.002)  \nReceived 12 November 2025; Accepted 4 December 2025  \nAvailable online 8 December 2025  \n2467-981X/© 2025 The Author(s). Published by Elsevier B.V. on behalf of International Federation of Clinical Neurophysiology. This is an open access article under the CC BY-NC-ND license ([http://creativecommons.org/licenses/by-nc-nd/4.0/](http://creativecommons.org/licenses/by-nc-nd/4.0/)).  \nLetter to the Editor Clinical Neurophysiology Practice 11 (2026) 3–4  \nReferences  \nDziadkowiak, E., Wieczorek, M., Zagrajek, M., Chojdak-Łukasiewicz, J., Gruszka, E., Budrewicz, S., Pokryszko-Dragan, A., 2021. Multimodal evoked potentials as potential biomarkers of disease activity in patients with clinically isolated syndrome. Front. Neurol. 12, 678035. [https://doi.org/10.3389/fneur.2021.678035](https://doi.org/10.3389/fneur.2021.678035).  \nHamann, J., Ettrich, B., Hoffman, K.T., Then Bergh, F., Lobsien, D., 2022. Somatosensory evoked potentials and their relation to microstructural damage in patients with multiple sclerosis-A whole brain DTI study. Front. Neurol. 13, 890841. [https://doi](https://doi). org/10.3389/fneur.2022.890841.  \nRestuccia, D., Valeriani, M., Di Lazzaro, V., Tonali, P., Maugui`ere, F., 1994. Soma","cbCaip6kbgRy34Ov","https://ap.wps.com/l/cbCaip6kbgRy34Ov","pdf",3113685,"English","# Letter to the Editor\n## Selective ulnar SSEP loss and MRI-confirmed C6 dorsal column plaque","[{\"question\":\"Why were ulnar SSEPs recorded after normal median SSEPs?\",\"answer\":\"Median SSEPs showed preserved conduction, so the report proceeded to ulnar SSEPs to further evaluate possible discordant localization. Ulnar SSEPs revealed selective absence of cervical and cortical responses.\"},{\"question\":\"What neurophysiological findings localize the lesion in this case?\",\"answer\":\"Median SSEPs remained normal, whereas ulnar SSEPs failed to elicit N13, N20, and N35 despite adequate peripheral stimulation. This pattern pointed to a selective dorsal column involvement in the lower cervical cord.\"},{\"question\":\"How did MRI findings change clinical management?\",\"answer\":\"Cervical spine MRI demonstrated a discrete T2-hyperintense plaque at C6 in the dorsal columns, involving the ulnar sensory fasciculus. The early SSEP abnormalities guided MRI localization and allowed earlier therapeutic reassessment.\"}]","Selective loss of ulnar somatosensory evoked potentials revealing a focal cervical cord plaque in multiple sclerosis | PDF",1790565507]