Hey so I'm a student but i dont know wherelse to post this,,we've been given this first case and i'll like your feedback on it,,please,,and what do you think would be the potential diagnosis? would really appreciate it
Case 1
Part 1
A 72 year-old male fell backwards from a height of ~ 4 feet. He is a known diabetic for 20 years
on metformin but he is noncompliant. There is no history of stroke, MI, nephropathy or
retinopathy. He denies intoxication. He felt unwell as if he would faint. He sat on a low wall
and then found himself on the ground. He does not remember the fall or hitting the ground.
Once he revived he had severe pain in the neck and shoulders associated with numbness to the
fingers of the left hand. There was no vomiting, seizure activity, ENT bleed, urinary or faecal
incontinence.
He has a 3-month history of numbness to the digits of both hands, left greater than right but
the numbness in the left hand was abnormally persistent since the fall. He also gives a history
of lower back pain radiating down both legs for 3 months associated with intermittent
numbness to both soles.
On examination he had makeshift neck immobilization. Vital signs : T 36.8C, BP 126/89, P 82,
R20, SpO2, 99%. Other systems were normal. In the CNS, GCS was 15/15. The cranial nerves
were intact. Muscle bulk was normal but tone was decreased in the left upper limb. There was
no fasciculations. Power was grade 5/5 except in all myotomes of left upper limb where there
was grade 4/5 power. Deep tendon reflexes were not elicited. For sensation, light touch and
pin prick were decreased in C6/C7. Proprioception was normal. There was patchy decrease in
light touch and pin prick in lower limbs with normal proprioception.
Case 1
Part 1
A 72 year-old male fell backwards from a height of ~ 4 feet. He is a known diabetic for 20 years
on metformin but he is noncompliant. There is no history of stroke, MI, nephropathy or
retinopathy. He denies intoxication. He felt unwell as if he would faint. He sat on a low wall
and then found himself on the ground. He does not remember the fall or hitting the ground.
Once he revived he had severe pain in the neck and shoulders associated with numbness to the
fingers of the left hand. There was no vomiting, seizure activity, ENT bleed, urinary or faecal
incontinence.
He has a 3-month history of numbness to the digits of both hands, left greater than right but
the numbness in the left hand was abnormally persistent since the fall. He also gives a history
of lower back pain radiating down both legs for 3 months associated with intermittent
numbness to both soles.
On examination he had makeshift neck immobilization. Vital signs : T 36.8C, BP 126/89, P 82,
R20, SpO2, 99%. Other systems were normal. In the CNS, GCS was 15/15. The cranial nerves
were intact. Muscle bulk was normal but tone was decreased in the left upper limb. There was
no fasciculations. Power was grade 5/5 except in all myotomes of left upper limb where there
was grade 4/5 power. Deep tendon reflexes were not elicited. For sensation, light touch and
pin prick were decreased in C6/C7. Proprioception was normal. There was patchy decrease in
light touch and pin prick in lower limbs with normal proprioception.
