11/3/2023 0 Comments Dr jing xiang![]() Other serum tests including liver/kidney functions, electrolytes, hemoglobin A1c level, thyroid function, and vitamin B12 were normal. ![]() He had increased erythrocyte sedimentation rate (40 mm/hour) and C-reactive protein (98.5 mg/L). Cranial nerves were intact.īlood tests at admission were remarkable for leukocytosis of 23.7 × 10 9/L (neutrophils: 20.22 × 10 9/L, 85.5% lymphocytes: 0.55 × 10 9/L, 2.3% eosinophils: 1.92 × 10 9/L, 8.1%). He had bilateral flexor plantar responses. Deep tendon reflexes were absent in all 4 limbs. The sensory examination revealed loss of pinprick in distal extremities. Asymmetric weakness was noted (right/left Medical Research Council grades): abductor pollicis brevis (0/2), first dorsal interosseous (0/2), abductor digiti minimi (0/2), finger extensors (1/2), biceps (3/4), deltoids (3/4), knee flexors (3/3), knee extensors (3/2), tibialis anterior (4/3), and gastrocnemius (5/5). On examination, the patient was febrile (38☌) with age appropriate mental status. ![]() Surgical history included resection of pulmonary nodules found on routine examination 4 years ago. Medical history was remarkable for well-controlled diabetes mellitus. The patient denied recent illness or travel, toxin exposure, insect bites, tobacco/alcohol addiction, or family history with similar presentations. He also reported 2 days of distal numbness but denied any pain. Weakness progressed so rapidly that the patient was unable to walk independently on presentation. He sequentially developed weakness in the left leg, the left hand, and then the right leg. Days later, he was unable to lift his right arm above the shoulder. A 60-year-old right-handed man presented in a wheelchair with a 5-day history of progressive weakness.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |