Peripheral Neuropathy
Here is an Indian gentleman who complaints of feeling shaky on walking for the past 3 years. The onset is insidious and his condition gradually worsen for the period mentioned.
There is trophic changes noted over the lower limbs i.e. the skin is shinny, smooth and loss of hair. There is hyperpigmented skin lesions suggestive of diabetic dermopathy. There is no muscle wasting and the power is normal.
There is impairment of sensation to vibration sense, joint position and pinprick over a stocking distribution ( from foot up to knee level). The reflexes are absent.
There is sensory ataxia as evidenced by positive Romberg's sign and stamping gait (broad based gait, foot stamping on the floor)
In conclusion, he has a peripheral neuropathy predominantly involving the sensory component. Functionally, he has sensory ataxia due to impaired joint position sense. The likely cause would be diabetes mellitus in view of the diabetic dermopathy.
I would like to complete my examination by:
1. Checking the upper limbs (sensory loss over a glove distribution)
2. Palpating the peripheral pulses (peripheral arterial disease due to the trophic skin changes)
3. Examine the fundus for diabetic retinopathy.
4. Checking the urine for sugar.
What are the other causes for sensory peripheral neuropathy?
Labels: Neurology
posted by Dr. David Teoh @ 8/02/2006 10:43:00 PM
7 Comments:
A nice article, though:
1-the shin is prominant suggesting wasting of the anterolateral compartment, yet the "candidate" told us that therte is no wasting!.
2- nothing was mantioned about any trophic ulcers, or Charcot's joint(s),as the pictures is one of a severe sensory loss in both lower limbs for 3 years.
3- i would add "doing fundoscopy".
4- this was written:"In conclusion, he has a peripheral neuropathy predominantly involving the sensory component". the examiner may understand that this is a sensori-motor one with a predomiant sensory component; yet, the "candidate" told us that there are no wasting or weakness!
5- which reflexes were absent? (ankles, kness,cremasteric...etc!) besides, where was no comment about the planters!
Thank you eMRCPian for your kind work, and please continue.
Dr. O Amin
Neurologist
A nice article, though:
1-the shin is prominant suggesting wasting of the anterolateral compartment, yet the "candidate" told us that therte is no wasting!.
2- nothing was mantioned about any trophic ulcers, or Charcot's joint(s),as the pictures is one of a severe sensory loss in both lower limbs for 3 years.
3- i would add "doing fundoscopy".
4- this was written:"In conclusion, he has a peripheral neuropathy predominantly involving the sensory component". the examiner may understand that this is a sensori-motor one with a predomiant sensory component; yet, the "candidate" told us that there are no wasting or weakness!
5- which reflexes were absent? (ankles, kness,cremasteric...etc!) besides, where was no comment about the planters!
Thank you eMRCPian for your kind work, and please continue.
Dr. O Amin
Neurologist
Thx for your comments. Ya, a fundoscopy is mandatory in this case!
Noticed u hv Wuchereria Bancrofti as one of your interests,u do tropical med-one of my interest hehe
Nope...I practice western medicine :)
I didnt know Wuchereria Bancroft is a traditional med :)
I agree with saramin,there appears to be wasting of muscles more onleft than right and i thinkthere is pescavus. wecanthink of charcot marie tooth disesae inthis case.
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