Intermittent Numbness Case Summary

groups of her lower extremities bilaterally. Sensory exam is normal to pin prick and light touch

Visual fields full to confrontation. Extraocular muscles intact. Pupils are slightly enlarged on the left compared to the right, which she states is old since her eye injury. They do respond directly and consensually. Normal facial symmetry, sensation, and movement. Tongue and uvula are midline. Normal shoulder shrug. Normal auditory acuity.

On Exam:  BP today was 140/86. Head and neck exam was all clear. She had no oral or nasal ulcers. She had no lymphadenopathy or bruits. Heart sounds were normal and the chest seemed clear, as did the abdominal exam. Musculoskeletal exam disclosed widespread Heberden's and Bouchard's nodes. She had no swelling or stress pain at the MCPs. She was not tender at the CMC joints. She had no swelling in the wrist, elbows or shoulders. She had no soft tissue tender points. She has bilateral knee crepitus but only slight instability and no effusions. She had actually good range of movement of both hips. She was tender in the lumber spine and has a scar at the lower lumbar spine from her previous operations. Her feet are somewhat flat with tenderness across the

Patient is an 86-year-old right-handed white female who is a poor historian. She states she saw me several years ago, but cannot recall for what. She did see Geoffrey Starr, MD in 2011 for episodes of numbness and tingling in the right side of her cheek. He did a workup, which included the EEG, EMG, and carotid studies. She was complaining of some right upper extremity and left lower extremity numbness and tingling as well. These were all negative. Her PCP switched her from aspirin 81 mg to Plavix 75 mg. Dr. Starr added Trental to that. The patient states that over the years, she continued to have the numbness and tingling episodes of the right side of her face. The last several seconds at times, rarely

Example: She says wap instead of lap. She likes to listen to stories and responds with “what’s that?” and “Why”. She uses syntax. She understands the meaning of most words. Example: Her mother said “do you love mommy” and Haper replied “yes” the mother asked “how much” and Harper replied “sixty dollars”.

Madelynn’s language Art skills are phenomenal, she is able to recognize the alphabet when doing activities (letter of the day), and she is able to recognize and count past the number 10. Madelynn would always talk about her family, mainly her mom, dad,pet dog, and her brother Logan. Madelynn loves to point out animals and what type of animal they are. She is able to make all the animals noises, and loves to tell me about her pet dog at home. Madelynn is able to speak in full sentences and carry on a full conversation she would always want to talk about her dad and would always ask a lot of questions like, “what is that?” and “how do you do this?”. She is also a very good listener and great a following instructions.

Her grooming and hygiene are fair. Her attitude and behavior is calm and cooperative. She is engaged in the conversation, and maintains good eye contact. The following are my observations from our meeting: Psychomotor - no abnormal movements noted, Mood - “ok”, Speech - coherent normal rate and rhythm, Thought process - linear, logical and goal directed, Thought content - no fixed delusions elicited, Perceptual disturbance - endorses visual hallucinations, Insight/judgment and impulse control - fair.

O: mild grimace on her face; sitting strait up on the exam able without the support; tender over the left side of the lumbar spine, Full lower lumbar ROM with some pain; able to perform heel and toe walks; negative straight leg raise; no impairment of NVS; DTR 2+to bilateral lower extremities

PHYSICAL EXAM: Cast is intact. She is walking on it. Neurovascularly intact. Calves are soft and nontender.

There are mild limitations with her heel bilaterally (Yamamoto, 2007). She demonstrates spasticity in all lower extremities and her trunk (Yamamoto, 2007). Her movement reflects significant spasticity in her legs (Yamamoto, 2007). Although she can sit independently, she has difficulty sitting on the floor without her legs extended in front of her for support (Yamamoto, 2007). She requires assistance when moving in and out of sitting in a chair, undressing skills such as removing shoes and socks (Yamamoto, 2007). She can push up in prone to hands and is able to crawl for short distances (Yamamoto, 2007). She supports her weight in a supported standing position with knees in a small degree of flexion, hips adducted and feet plantar flexed and pronated (Yamamoto, 2007). She ambulates with a walker for short distances (Yamamoto, 2007). There is incoordination with her upper extremities caused by mild increased muscle tone (Yamamoto,

plantar reflex. She has sensory loss over her left hemibody and left side ataxia as well in fingerto-

History of Present Illness (Use OLDCARTS format). T.R. is a 50 year old white female that present in the office today as an established patient who is concerns about numbness and tingling in her right wrist and hand. She reports that the numbness and tingling started about 5 days ago. She denies pain, but described the numbness and tingling as intermittent in nature which radiates to fingers (thumb, the scound, third, and partially of the fourth digits). She noticed that her right hand grip is weak, and she is not able to hold a cup of coffee tightly. The numbness and tingling are aggravated by movement and relieved with rest. The numbness and tingling seems to feel worst when typing and less severe at rest. Denies having these symptoms

Select individuals may suffer from neurological symptoms resulting in the inability to work and participate in leisure activities

The patient woke up early this morning and presents with chief complaints of numbness and tingling on the right side of the face, preceding a headache. No known history of trauma to the area. Has had pain in his teeth prior to the facial numbness, but has no knowledge of recent tooth infections. The patient thought the numbness and tingling on his face this morning might have been related to sleeping in an improper position. He has no recollection of this happening to him previously. He has had associated twitching in the nose for approximately one week and felt as if the tip of the nose were numb. Patient reports generalized muscle weakness in the face and describes it as exhausting and he has been tense and twitchy.

While watching her, it was clear to see that she is withdrawn from people around her. She would rather sit by herself on a tablet or phone that play with her sisters. Also, does not share well or at all. When asked to play with others she wants to be in charge, if she is not then she is very quick to start acting out or becomes very angry. She has very little control of herself and does not think things through before she acts. The child also shows a strong