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Tingling & Weakness

UnFiNiShEd CaSe CoMe BaCk LaTeR

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History of Present Illness:

Is a 32-year-old male who presents with approximate 1 week of paresthesias in both hands and feet that he describes as tingling more than numbness. He states when he washes his hands they feel particular cold. He is also had a little bit less time of progressive weakness in both arms and legs. He denies any pain fever injury recent viral illness sensory level trouble controlling urine or other complaints.

Vital Signs & Physical Exam:

T: 36.6 °C    RR: 18    BP: 147/79   SpO2: 99%

Neuro: Normal speech. No focal weakness. No clonus.  Unable to elicit any deep tendon reflexes. 5/5 strength throughout to resistance, but difficulty raising from a one-leg 90 degrees knee bend.  Normal pin prick and position sense

Initial Differential Diagnosis:

  • Electrolyte abnormality
  • Anxiety
  • GBS
  • Cervical cord lesion

Initial Diagnostic Testing:

  • Labs: CBC WNL, BMP normal except sodium of 132
  • Imaging: MR cervical spine shown below

QUESTIONS:

  1. What does the case image show?  
  2. What should you do next?  
  3. Want a 1-minute consult/tutorial on this case? 
  4. Want to know what happened with this patient?

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ANSWERS:

  1. What does the case image show?  The MR is normal.
  2. What should you do next?  LP for GBS.  This may be false negative early on.  Plasma exchange.
  3. Want a 1-minute consult/tutorial on this case?  See yellow area from sample page below.
  4. Want to know what happened with this patient?  See case conclusion below tutorial page.

1-Minute EM Consult on the topic for this case from the Emergency Medicine 1-minute Consult Pocketbook

CLICK HERE TO LEAR MORE ABOUT THIS BOOK

CASE CONCLUSION: LP showed 1 RBC, 2 WBC and protein of 125

CASE LESSONS:

  1. Know how to tailor your physical exam.  Always check for clonus and DTR’s in a patient with any  complaint of lower extremity weakness.  If strength seems normal always have them do single leg partial squats.
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