descending weakness, help in the diagnosis.

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50 years old man with numbness in both upper limb - 5 days, weakness in right upper limb and both lower limb for 1 day. power in both lower limb 3, and right upper limb is 4. power in left upper limb is normal. numbness in both lower limb- 1 day. no urine/stool incontinence. mental status normal. cranial nerve examinations normal. reflexes are normal. no pathological signs. CT head: normal. History of diabetes. no other disease history. NO trauma. lab parameters are normal. patient is admitted for further investigations and management.

what diagnosis are you thinking of?

 

[95439]

50 years old man with numbness in both upper limb - 5 days, weakness in right upper limb and both lower limb for 1 day. power in both lower limb 3, and right upper limb is 4. power in left upper limb is normal. numbness in both lower limb- 1 day. no urine/stool incontinence. mental status normal. cranial nerve examinations normal. reflexes are normal. no pathological signs. CT head: normal. History of diabetes. no other disease history. NO trauma. lab parameters are normal. patient is admitted for further investigations and management.

what diagnosis are you thinking of?

May want to check out the spinal cord ;o). The asymmetric nature of the weakness/numbness isn't characteristic of Diabetic neuropathy (and DM usually affects longer, sensory nerves first). If you can't see anything in the spinal cord, I'd get an LP.

 

[hikehub]

yea, we are waiting for the mri report. thanks.

 

[95439]

yea, we are waiting for the mri report. thanks.

You can't use a 'real patient' on here..but just for the record CT's are usually negative in the 1st 24 hours after a stroke anyway.

 

[Mattchiavelli]

Don't forget PNS if CNS isn't giving a lot
Some things to get more info on-
-Leg weakness- is it proximal, distal, favoring flexors, extensors, or throughout?
-Numbness- to pain/temp, vibration/position, or both? Dermatomal demarcations or not?
-pt ambulatory or not?
-Diabetes well or poorly contolled? And what with?
-patient with no other illnesses because they get screened regularly and have been negative or no other illnesses because they haven't felt sick and therefore haven't gone in for anything?

 

[hikehub]

cervical mri report is cervical vertebral disc herniation C4－5、C5-6 and C6-7.

patient limb weakness and numbness is recovered now. power gradings are 5 in all limbs. He is being treated with 20% mannitol, thiamine , methylcobalamin. 🙂

 

[95439]

cervical mri report is cervical vertebral disc herniation C4－5、C5-6 and C6-7.

patient limb weakness and numbness is recovered now. power gradings are 5 in all limbs. He is being treated with 20% mannitol, thiamine , methylcobalamin. 🙂

That'll be $250 please. 😀