Chief Complaint Numbness in feet. History This is a 62-year-old right-handed white male who states that in November of last year he started noticing some numbness in the soles of his feet. It has progressed to the point where the numbness in the soles of his feet is constant. He also may have some constant numbness and tingling on the dorsum of his feet. He also notes that his legs will fall asleep more easily now, at which point he will have the numbness and tingling up to his knees. This largely resolves when he moves around. He is also having some numbness and tingling in his hands, which is intermittent and positional. He also more recently has been noticing a sense of weakness in his legs and arms. There is no dermatomal pattern
Patient is a 50-year-old-year-old left-handed white male who presents with his wife for evaluation of multiple symptoms that have been present since an MVA in 02/2013. At that time, he was T. boned and his car was totaled. He has amnesia for the event and is unaware whether or not he hit his head. The airbag did deploy. Afterwards, he was confused and noted significant pain in his neck and upper back. Since then, he has had multiple symptoms. He does have involuntary twitching on the right, more than left, both hands, legs, and sometimes feet. He demonstrates one of these twitches and it looks like a focal myoclonic jerk of a limb. These occur on a daily basis. He also has problems with his left thumb and index finger locking up. When he is fatigued, especially when his neck gets tight, he has some problems with word finding, paraphasic errors, and syntax errors. He did see Anthony P. Knox,
She converses appropriately. Blood pressure 92/60 supine. Blood pressure decreased to 72/50 standing. Pulse is 90 and regular. Weight 113 pounds. She has a normal appearance of her face and does not have a masked appearance of her face. She has good strength throughout her face. She has good strength of her extremities. She has only minimal cogwheel rigidity at the left wrist, but no cogwheel rigidity at the right wrist. She has no tremor of her hands. She moves her extremities freely and with normal speed. She is able to rise on her own from a sitting to a standing position, only minimal bradykinesia of standing. She walks fairly freely and there is a normal cadence of her gait. She did not have dyskinetic movements of her extremities. She is able to walk, including turning without losing her balance. She does not shuffle her feet when walking. She does not have en bloc turning. She has good posture stability
SKIN: She has some mild ecchymosis on her skin, and some erythema. She has patches but no obvious skin breakdown. She has some fissuring in the buttocks crease. PULMONARY: Clear to percussion and auscultation bilaterally. CARDIOVASCULAR: No murmurs or gallops noted. ABDOMEN: Soft, nontender, protuberant, no orgonomegaly, and positive bowel sounds. NEUROLOGIC EXAM: Cranial nerves II through XII are grossly intact. Diffuse hyporeflexia. MUSCULOSKELETAL: Erosive, destructive changes in the elbows, wrists, and hands consistent with rheumatoid arthritis. Has bilateral total knee replacements with stovepipe legs, and perimalleolar pitting edema 1 +. I feel no pulses distally in either leg. PSYCHIATRIC: Patient is a little anxious about these new symptoms and their significance. We discussed her situation and I offered her psychologic services. She refused for now.
-Contacted Desert Springs facility and follow-up on the patient. Spoke to medtech Muriel and stated that another caregiver has been going to patient’s room and no complaint or concern was raised from the patient. Instructed Muriel to see the patient and she stated that patient is the same and “normal” sitting up in her recliner’s chair. Speech is clear and no facial droop per Muriel. Per Muriel, patient did complaint about a week ago with right foot
On examination, cervical and lumbar spine is restricted in all planes with increased pain. Muscle guarding is also noted. The patient is not able to heel and toe walk. He is obese and deconditioned. Straight leg raise (SLR) is positive bilaterally. Muscle guarding is noted along cervical paraspinal and trapezius muscle groups bilaterally. Sensation is normal to light touch, pinprick, and temperature along all dermatomes of the bilateral upper extremities, except right C6-8, decreased to
Kathy, a 20-year-old woman, awakens one morning to a tingling, numb sensation covering both of her feet. This has happened to her a number of times throughout the year. In the past, when experiencing this sensation, within a couple of days to a week the numbness would subside, and so she is not too concerned. About a week later, she
The patient is an 80-year-old right-handed white female, who presents with her male partner for evaluation of left lower extremity symptoms. She did present for an EMG nerve conduction study in May. At that time, she gave a history of intermittent numbness into the anterior lateral thigh. The numbness rarely extended below the knee at that time, and it rarely occurred on the right. There was no clear radicular component. Her exam was normal. Her EMG of the left lower extremity was limited because she is on Pradaxa, but it was normal and CBs were consistent with a mild motor neuropathy. The diagnosis was possible meralgia paresthetica. The patient now states that the numbness is intermittent. It is on the anterior thigh, but now it goes down into the calf anteriorly and
I did receive a significant amount of records from this patient's PCP, as well as neurology consult in followup and infectious disease notes. In short, he is a 67-year-old right-handed white male who while living in Alaska developed some hip pain, as well as medial right hand numbness. He did have an EMG on 10/2000 that showed ulnar neuropathy with cubital tunnel syndrome on the right. Ulnar nerve transposition was considered, but the patient deferred this. He did have an MRI of the cervical spine, which revealed most significantly C3-4, moderate bilateral neuroforaminal narrowing, C4-5 severe left and moderate right neuroforaminal narrowing, C5-6 severe bilateral neuroforaminal narrowing. He did
Per medical report dated 10/26/15 by Dr. Parsioon, the patient was initially seen on 9/14/15 for evaluation and treatment of cervical pain. At that time, he had neck pain without radiculopathy and bilateral hand tingling. IW stated that physical therapy made his neck pain increase and he wanted to make sure that it is okay to continue this. His chief complaint is pain in his neck radiating to the right shoulder and arm. He states the only time he gets the tingling sensation in the hand is
Weakness or numbness on one side of the body or in an arm or leg.
Blood pressure -138/88, HR 71, Lung sounds –clear, temperature 98.8 F, radial pulse and pedal pulses +1 bi-laterally, normoactive bowel sounds. No history of smoking, drugs, alcohol use or diabetes; takes no daily medications. Surgical history: Hernia surgery September 2016 and cataract surgery September 2013. Moderately active, walks every day, sometime incorporating hand weights. Patient presents with minimal trembling unilaterally, (left side) when fingers stretched out, reports movements have been slower than normal. Patient’s wife reports “He’s been eating more slowly and it has been taking longer for him to get dressed in the morning.”. Upon examination it was determined that patient has reduced arm swing, slight stiffness in neck, difficulty rising from sitting position in the chair, masked facial features and deteriorated balance. No signs or symptoms of stroke.
Per medical report dated 11/24/15 by Dr. Cano, the patient is complaining of severe numbness in the right hand, tightness around the right worse than left hand. She also associates this with dropping items. She is unable to button her shirts or raise her arms up to her elbows. This is continuous all day long. Also, associated is severe low back pain with numbness, radiation, and muscle spasm in the thoracic area, and numbness and radiation down the right sciatic nerve with severe low back pain. She continued to work, sixteen-hour shifts, seven days a week. At this time, she is unable to function. She states that she has had 24 sessions of physical therapy that has definitely helped her.
The patient is a 72 year old female. She has been experiencing progressively worse pain and stiffness in her joints. She is reports that she is having decreased range of motion, redness, and swelling in her joints. She is reports symptoms occur in the same joints on both sides of her body. She is also reporting the symptoms are worse when she first wakes up in the morning.
Case Study: A thirty six year old male has developed severe muscle weakness throughout the body. The condition began fifteen months ago with a left foot drop and within a year, he described difficulty with speech and swallowing, muscle twitching and cramping, and muscular atrophy throughout the upper and lower limbs. Within the last two months, his breathing has become more difficult, and there has been a noticeable difference in his voice. Prior to the fifteen months, he presented little to no symptoms. The patient, a medical doctor, has a wife and two young children.
Numbness and tingling of the limbs are also common symptoms. Since Multiple Sclerosis targets the central nervous system, no signals are dispatched down the spine creating numbness is multiple parts of the body. Healthline Editorial Team, George Krucik, MD, MBA Early Signs of Multiple Sclerosis, January 25, 2013, states that “the spinal column (the body’s message center), it can send conflicting signals around the body. Sometimes, no signals are sent, which results in the most common symptom, numbness.”