Paresthesia

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of ‍numbnesstinglingparesthesia

Location is on ‍rightleftbilateral ‍fingerstoeshandsfeetlimbs

Type of sensation is ‍numbnesstinglingpins and needles

Onset is ‍gradualsudden and is ‍persistentintermittent

Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍weakness

‍difficulty moving

‍difficulty gripping

‍difficulty walking

‍difficulty speaking

‍loss of coordination

‍pain

‍changes in skin color

‍tremors

‍confusion

‍seizures

‍blurred vision

‍dizziness

‍loss of consciousness

‍fatigue



Contributing factors:

‍alcohol abuse

‍repetitive movements at work

no history of: ‍peripheral neuropathy, ‍diabetes, ‍spinal injury, ‍multiple sclerosis, ‍stroke, ‍vitamin B12 deficiency, ‍carpal tunnel syndrome

no use of: ‍chemotherapy, ‍antiretrovirals, ‍new medication





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Cervical spine: ‍tenderness on ‍, range of motion ‍fulllimited

Lumbar spine: ‍tenderness on ‍, range of motion ‍fulllimited

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍

Neurologic: cranial nerves ‍intact, strength ‍intact 5/5, sensation ‍intact, reflexes ‍intact 2+, cerebellar function ‍intact, gait ‍steady





ASSESSMENT:

‍Peripheral neuropathy ‍likelysuspectedpossible

DDx: peripheral neuropathy, carpal tunnel syndrome, cervical radiculopathy, peripheral polyneuropathy, diabetic neuropathy, multiple sclerosis, vitamin B12 deficiency, alcohol use disorder, stroke, transient ischemic attack, complex regional pain syndrome, Guillain-Barré syndrome, HIV-associated neuropathy, chemotherapy-induced peripheral neuropathy, spinal cord compression, syringomyelia, amyotrophic lateral sclerosis, Charcot-Marie-Tooth disease, hereditary neuropathies, vasculitis, hypothyroidism, Lyme disease, sarcoidosis, heavy metal poisoning, entrapment neuropathies, Raynaud's phenomenon





PLAN:

Investigations:

- Blood work: ‍CBC, ‍creatinine, ‍lytes, ‍glucose, ‍TSH, ‍LFTs, ‍CRP, ‍B12

- Nerve conduction study

- EMG

- ‍CervicalLumbar X-ray

- MRI of the ‍cervicallumbar spine

Treatments:

- ‍NSAIDs

- ‍Neuropathic pain medications

- Physical therapy

- Occupational therapy

- Splinting

Further care:

- Referral to neurologist

- Referral to orthopedic surgeon

- Referral to plastic surgeon

- Follow-up in ‍ ‍weeksmonths