An elusive cause for a progressive neuropathy.
An elusive cause for a progressive neuropathy.
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进行性神经病的难以捉摸的原因。
DOI：
10.1136/practneurol-2013-000587
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发表时间：
2014
影响因子：
2.8
通讯作者：
Aurangzeb S
中科院分区：
文献类型：
--
作者：
Aurangzeb S
一名68岁女性，因6个月进行性不稳和灵活性丧失病史来到神经病学快速通道诊所。她最初的症状是左腿麻木和灼痛，随后几周右腿、右臂和左臂感觉受损，最后是左臂。她以前是独立的，但现在无法独立行走或站立。她还报告间歇性恶心和明显的体重减轻。就在症状出现之前，她的全科医生在为她治疗胸部感染时发现了低钠血症。四年前，例行的乳房x光检查显示了一个可疑的病变，活检后报告为良性。三年后，她拒绝了召回乳房x光检查的邀请。她是一个长期吸烟者（每周约75克烟草）。她的女儿患有甲状腺功能减退症和白癜风，孙子患有自身免疫性肝病。她的母亲患有心脏瓣膜病和2型糖尿病，她的父亲死于盆腔肉瘤。检查时，有全身肌肉萎缩，特别是腿部肌肉萎缩，以及闭眼伸出的手的假性手足动症。她的整个左腿，从右腿的脚趾到膝盖，以及上肢的手指到肘部都有针刺和轻触感受损。双侧膝盖以下关节位置受损。她的双侧力量因髋关节屈曲而轻度减弱，但出人意料地保存完好。反射都没有，足底反应也没有。脑神经检查正常。静息性心动过速，收缩压在85 ~ 170 mm Hg之间波动
A 68-year-old woman presented to the neurology rapid access clinic with a 6-month history of progressive unsteadiness and loss of dexterity. Her initial symptoms had been numbness and burning pain in the left leg, followed over several weeks by impaired sensation in the right leg, right arm and finally the left arm. She had been previously independent, but was now unable to walk or stand unaided. She also reported intermittent nausea and significant weight loss.Just before the symptoms began, her general practitioner identified hyponatraemia while treating her for a chest infection. Four years before, a routine mammogram had shown a suspicious lesion, which was biopsied and reported as benign. Three years later, she declined the invitation for a recall mammogram. She was a longstanding smoker (∼ 75 g of tobacco per week). Her daughter had hypothyroidism and vitiligo and a grandson had autoimmune liver disease. Her mother had valvular heart disease and type 2 diabetes mellitus, and her father had died of pelvic sarcoma. On examination, there was generalised muscle wasting, particularly of the legs, and pseudoathetosis of the outstretched hands with eyes closed. She had impaired pinprick and light touch sensation throughout the left leg, from toe to knee on the right, and fingers to elbows in the upper limbs. Joint position was impaired up to the knees bilaterally. Her strength was mildly reduced bilaterally for hip flexion but otherwise surprisingly well preserved. Reflexes were all absent and the plantar responses were mute. Cranial nerve examination was normal. She had a resting tachycardia and her systolic blood pressure fluctuated between 85 and 170 mm Hg. There were