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| A 54-year old male alcoholic presents with weakness in both of his legs. On examination, there is a glove and stocking loss of sensation in both upper and lower limbs. CBC shows macrocytosis of the red blood cells. |
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| A 58-year old male presents with the sudden onset of one-sided facial weakness. He also has ipsilateral hyperacusis. On examination, there is a lower motor lesion of his left CN VII. Muscle strength and deep tendon reflexes in the extremities are normal. |
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| A 65-year old male presents with recent difficulty walking and pain radiating into the back of his right leg. He also complains of urinary retention and has a history of prostate cancer. On examination, there is saddle anesthesia and an absent right ankle jerk. CT scan shows a large intrathecal mass in the lumbar canal. |
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| An overweight 76-year old male hypertensive smoker presents with sudden paralysis of his entire right side. There is also aphasia. On examination, there is areflexia on the right side. He cannot smile on the same side. However he could wrinkle his forehead on the both sides. Babinski and Hoffman signs are present on the right side. CT scan shows a large intraparietal cerebral hemorrhage. |
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| A 48-year old female presents with decreased grip in her left hand. She also has some difficulty in buttoning up her blouse with her left hand. On examination, there is a grade 3/5 pincher grip between her thumb and index finger on the left side. The right side is graded at 5/5. There is no sensory loss. Tinel and Phalen tests are negative. MRI shows a posterolateral disc bulge compressing the spinal cord at C5/6. |
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| A 14-year old teen presents with a foot drop. There is no antecedent trauma. On examination, there is atrophy of his peroneal muscles and loss of sensation over the dorsum of the affected foot. |
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Definition
| Charcot-Marie-Tooth Disease |
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| A 35-year old overweight female presents with muscle weakness. On examination, she is mildly hirsute. There is a moon-face and a buffalo hump. Her BP is raised. There are purple striae on her abdomen. CMP shows hypernatremia and hypokalemia. ACTH levels are elevated. CT scan of her brain shows a 10 mm tumor in the pituitary fossa. |
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| An overweight 43-year old male presents with progressive muscle weakness. He has been diabetic for the past 10 years. On examination, there is a glove and stocking loss of sensation in the hands and feet. His HbA1C is 9. |
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| A 2-month old infant presents with paralysis of the left upper limb. The mother had a difficult labor because of shoulder dystocia. On examination, the left upper limb is held with the arm internally rotation, the elbow extended and the forearm pronated. |
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| A 45-year old male presents with progressive ascending weakness of both lower limbs. This followed a bout of gastroenteritis the previous week. On examination, there is complete flaccid paralysis of the muscles in the lower limbs. There is no sensory loss. CSF shows elevated protein and very few white blood cells. |
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| A 65-year old male presents with sudden onset of drooping eyelid on the left side. On examination, there is left-sided ptosis, miosis and anhydrosis. |
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| A 63-year old female presents with fatigue. There is a recent change in her voice and she has put on weight. She is also constipated and does not like the cold. On examination, there is loss of the outer third of the eyebrows. Her ankle reflexes are slow to relax and her hair is coarse and brittle. TFTs show a decrease in T3 and T4 with an elevated TSH. |
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| A 3-month old child presents with a right-sided claw hand. She was a breech baby. On examination, the distal and proximal joint in the left hand are flexed while the metacarpophalangeal joints are extended. |
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A 9-year old child presents with a strange gait affecting his right foot. The teacher complains that the child has been having behavioral problems at school. On examination, there is a blue gum line.
There is a right foot drop. CBC shows a microcytic hypochromic anemia and the peripheral blood smear show basophilic stippling of the red blood cells. |
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| A 73-year old female presents with weakness in her legs and dysphagia. On examination, there is spasticity, hyperreflexia and a positive Babinski sign in her lower limbs. There is muscle atrophy with areflexia in her upper limbs. |
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| A 23-year old female presents with insidious onset of weakness in her left arm. She had diplopia in the past which has resolved. On examination, there is scanning speech, nystagmus and an intention tremor. MRI of her brain and spinal cord shows patchy periventricular plaques. The CSF is positive for oligoclonal bands. |
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| A 38-year old female presents with weakness in her arms especially after exertion. On examination, there is bilateral diplopia. The edrophonium [Tensilon] test is positive. Chest x-ray shows a mass in the anterior mediastinum. |
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| A 10-year old unimmunized Mennonite child presents with sudden onset of weakness in the left leg two weeks after returning from a mission trip to Haiti with her parents. She had a mild sore throat and runny nose last week. On examination, there is a flaccid paralysis of all of the muscles in her left leg. The left ankle reflex is absent. There is no loss of sensation in the leg. CSF shows normal glucose, mildly elevated protein and many lymphocytes. |
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| A 51-year old female vegan presents with numbness and muscle weakness. She had gastric bypass surgery 6 years ago. On examination, there is loss of proprioception and vibration sense. Pain and temperature sensation is intact but touch is decreased. There is muscle weakness and hyporeflexia. CBC shows a macrocytic anemia. There is decrease in the level of methylmalonic acid. |
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Definition
| Subacute Combined Degeneration of the Cord |
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