Sensory Loss in a Limb Flashcards
A 65-year-old female presents with saddle anesthesia accompanied by urinary retention. She has a history of breast cancer. On examination, there is an absent right ankle jerk. CT scan shows a large intrathecal mass in the lumbar canal.
Cauda equina syndrome
A 31-year-old female complains that her left hand goes to sleep every time she sleeps with her hand under her head. On examination, she has downward sloping shoulders. Both Roos and Adson’s tests are positive. Cervical and chest x-rays were normal. No cervical rib present.
TOS
A 23-year-old male prisoner complains of numbness along the back of his thumb and the first to third fingers following being held in handcuffs for a prolonged period. On examination, there is loss of sensation along the lateral and dorsal aspects of his thumb, index and middle fingers. NVC study shows a delay along the superficial radial nerve.
Cheiralgia paresthetica
An overweight 45-year-old female presents with paresthesia in her fingers and toes. She also has been suffering from polyuria, polydypsia and polyphagia. On examination, there is a glove and stocking pattern of anesthesia. Fasting blood sugar is 415 mg/dL. There is glucose and ketones in her urine. HbA1c is 9.
Diabetic neuropathy
A 56-year-old overweight male presents with burning pain followed by partial numbness along the anterior and lateral aspects of his right thigh. On examination, there is decreased sensation over the anterior and lateral aspect of the thigh. No tests were done.
Meralgia paresthetica
A 34-year-old male presents with loss of sensation in his fingers. There is no previous history of injury. On examination, there is a cape-like distribution of loss of pain. However, vibration and proprioception are intact. MRI of the spine shows a cystic lesion in the center of his spinal cord in the lower cervical region.
Syringomyelia (could be Central Cord syndrome if there was trauma involved)
A 32-year-old strict vegetarian complains of tingling and numbness in her fingers and toes. On examination, there is decreased sensation in the finger tips and toes. She has a sore, beef red tongue. She has no ankle jerk reflexes and loss of both vibration and proprioception. CBC shows a macrocytic normochromic anemia and numerous hypersegmented neutrophils. Serum methylmalonic acid levels are also increased.
B12 deficiency
A 67-year-old female presents with nocturnal pain followed by tingling in her left hand. The pain is felt in the thumb, index and middle fingers. She also suffers from hypothyroidism. Tinel, Phalen and wrist compression tests reproduce the pain. NCV study shows a delay along the median nerve.
Carpal Tunnel syndrome
9-year-old boy is constantly tired and frequently constipated. On examination, his mucosa is pale and there is a blue gum line present. Peripheral blood smear shows numerous RBCs with basophilic stippling.
Lead poisoning
A 73-year-old retired accountant complains of loss of sensation in the fingers of both hands following a hyperextension injury from a car accident a day ago. On examination, there is a cape-like loss of pain and temperature in both limbs. However, vibration and proprioception are intact. Spinal MRI shows hyperintense signals in the parechyma of the cervical spinal cord.
Central Cord syndrome (Could be syringomyelia if there was no trauma)
