#NeuroNotes
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arkanalabs.bsky.social
What enzyme is deficient in this patient’s disease?

A. Acid alpha-glucosidase
B. Glycogen phosphorylase
C. Glucose-6-phosphate translocase
D. Myophosphorylase

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September 9, 2026 at 7:50 PM
arkanalabs.bsky.social
(see prior Arkana Neuronotes: www.arkanalabs.com/collagen-poc...)
Collagen Pockets in Nerve Biopsy
When small unmyelinated axons are lost to damage, collagen pockets in nerve biopsies are one morphologic sign of axonal loss.
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September 3, 2026 at 5:39 PM
arkanalabs.bsky.social
In the supplied medium and high magnification images from electron microscopy, which of the labeled structures represents an intact unmyelinated small diameter axon?

A.
B.
C.
D.

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September 2, 2026 at 1:20 PM
timholt2024.bsky.social
What if an alien wrote a review of #AncientAliens? See what that looks like in Part IV of my #Novella: The Critic
#scifi #writing #sciencefiction #writer #speculativefiction holtwrites2026.tumblr.com/post/8265604...
The Critic Part IV: The Review Tim Holt
The Review He absorbed all the seasons with the glee of a youngling who had just discovered his father’s secret stash of Vlorn holoviews. He took neuronotes on his thought recorder like he had never.....
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September 1, 2026 at 1:34 PM
arkanalabs.bsky.social
(2/2) What term would you use to describe the changes in this patient’s nerve biopsy?
A. Demyelinating
B. Perineuritis
C. Perineurioma
D. Traumatic neuroma

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July 1, 2026 at 1:03 PM
arkanalabs.bsky.social
The answer is: Necrotizing Myopathy

To learn more, head to our blog: www.arkanalabs.com/needle-core-...

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Needle Core Biopsy Muscle
Clinical History:This 50-year-old patient presented with progressively worsening muscle weakness of one month duration. Their past medical history was significant…
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March 3, 2026 at 4:23 PM
arkanalabs.bsky.social
We have launched four neuropathology quizzes on our website! If you're interested in testing your neuropathology wisdom, head to our site. #neuropathology #neuromuscular #pathology #neuropath #neuronotes

Education
At Arkana Laboratories, we put the education of the next generation first! We offer quizzes, a pathology fellowship, and resident rotations.
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March 2, 2026 at 1:55 PM
arkanalabs.bsky.social
1/ What is the best pathologic diagnosis? Clinical history in thread.

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March 2, 2026 at 1:50 PM
arkanalabs.bsky.social
The answer is: Denervation (neurogenic atrophy) and incidental vascular amyloid deposition

To learn more, head to our blog: www.arkanalabs.com/denervation-...

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Denervation with Incidental Vascular Amyloid
Clinical History:This 76-year-old male presented with complaints of muscle pain. Their past medical history is significant for Sjogren’s syndrome, fibromyalgia,…
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January 22, 2026 at 4:00 PM
arkanalabs.bsky.social
The answer is: Vacuolar myopathy due to hydroxychloroquine toxicity

To learn more, head to our blog: www.arkanalabs.com/toxic-vacuol...

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Toxic Vacuolar Myopathy Due to Hydroxychloroquine
Clinical History:This 50-year-old patient presented with a one year history of of persistent muscle weakness. They also had shortness of…
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January 8, 2026 at 3:11 PM
arkanalabs.bsky.social
1/ This 50-year-old patient presented with a one yearhistory of of persistent muscle weakness. They also had shortness of breath with exertion.

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January 7, 2026 at 2:01 PM
arkanalabs.bsky.social
The answer is: D.) Duchenne muscular dystrophy

To learn more, head to our blog: www.arkanalabs.com/sporadic-lat...

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Sporadic Late-Onset Nemaline Myopathy
Clinical History:The patient is a 69-year-old male who presented with complaints of proximal lower extremity muscle weakness and BMI of…
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December 30, 2025 at 2:12 PM
arkanalabs.bsky.social
(1/2) The patient is a 69-year-old male who presented with complaints of proximal lower extremity muscle weakness and BMI of 37. His home medication list includes atorvastatin. Bilateral thigh biopsies were performed to evaluate for myopathy.

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December 29, 2025 at 3:30 PM
arkanalabs.bsky.social
The answer is: Collagen pockets

To learn more, head to our blog: www.arkanalabs.com/collagen-poc...

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Collagen Pockets in Nerve Biopsy
When small unmyelinated axons are lost to damage, collagen pockets in nerve biopsies are one morphologic sign of axonal loss.
www.arkanalabs.com
November 4, 2025 at 2:53 PM
arkanalabs.bsky.social
(1/3) This 40-year-old patient underwent sural nerve biopsy to evaluate for a painful mixed large fiber and small fiber axonal neuropathy. The biopsy showed light microscopic features of a chronic active axonopathic process.

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November 3, 2025 at 2:30 PM
arkanalabs.bsky.social
The answer is: The terminal boutons of the motor axons are missing from the neuromuscular junction (NMJ).

To learn more, head to our blog: www.arkanalabs.com/denervated-n...

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Denervated Neuromuscular Junctions
Images of a muscle biopsy from this 40-year-old patient showed morphologic and enzyme histochemical features of denervation.
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October 29, 2025 at 1:45 PM
arkanalabs.bsky.social
(1/2) Muscle biopsy from this 40-year-old patient showed morphologic and enzyme histochemical features of denervation.

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October 28, 2025 at 12:50 PM
arkanalabs.bsky.social
The answer is: C.) PCR fragment analysis of DPMK

To learn more, head to our blog: www.arkanalabs.com/ring-fibers/

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Ring Fibers
The images demonstrate ring fibers with fluorescence with congo red staining under polarized light. Distal muscle weakness, mild myotonia, ring fibers, and mild CK elevation are consistent with myoton...
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September 30, 2025 at 1:35 PM
arkanalabs.bsky.social
Answer choices:
A.) PCR fragment analysis of CNBP
B.) Muscular dystrophy gene panel
C.) PCR fragment analysis of DPMK
D.) Myositis specific antibody panel

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September 29, 2025 at 1:15 PM
arkanalabs.bsky.social
Which genetic test is required to establish the diagnosis in this 59-year-old with distal muscle weakness, mild myotonia, and persistently elevated CPK values (200-300 U/L)?

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September 29, 2025 at 1:15 PM
arkanalabs.bsky.social
The answer is: Denervation, reinnervation, and myofibrillar myopathy

To learn more, head to our blog: www.arkanalabs.com/vacuolar-myo...

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Vacuolar myopathy in 92-year-old male
Clinical History:The patient is a 92-year-old-male and presented progressive muscle weakness that began in the left upper extremity and spread…
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September 25, 2025 at 1:37 PM
arkanalabs.bsky.social
The patient is a 92-year-old-male and presented progressive muscle weakness that began in the left upper extremity and spread to the BLEs and bulbar muscles. CK WNL. EMG/NCS: widespread denervation and reinnervation.

Based on the images below what is the most likely etiology? #NeuroNotes #pathsky
September 24, 2025 at 1:03 PM
arkanalabs.bsky.social
The answer is hybrid myofibers.
To learn more, head to our blog: www.arkanalabs.com/hybrid-myofi...

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Hybrid myofibers
Clinical History: This previously healthy 35-year-old patient presented with proximal upper and lower extremity weakness and myalgias. Laboratory studies showed…
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August 27, 2025 at 6:25 PM
arkanalabs.bsky.social
This previously healthy 35-year-old patient presented with proximal upper and lower extremity weakness and myalgias. Laboratory studies showed normal CPK. The patient's home medication is negative for myotoxic medications.

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August 26, 2025 at 12:55 PM
arkanalabs.bsky.social
Correct Answer: Amyloidosis

Head to our blog for a more detailed explanation and additional reading: www.arkanalabs.com/76-year-old-...

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76-year-old with weakness
Clinical History:The patient has numerous complaints including weakness, myalgia, arthralgia, back pain radiating down bilateral legs, cramps and twitching, imbalance,…
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July 24, 2025 at 2:06 PM