Neuro Case

[hammodi]

a 66 year-old man complains of difficulty in walking, 1st noticed a week ago. he describes it as a feeling that he frequently trips, he has no difficult rising from a chair but has tripped once when climbing the stairs. he has diabetes, most recent Hg A1c is 6.8% and he's on metformin 500 mg twice daily. OE patient has no tenderness or deformity of the back. left patellar reflex is decreased compared with the right, and there is loss of dorsiflexion in the left foot. when walking patient has been noticed to swing the left leg higher than the right.

so 1st, what term describes the patient's gait?
2nd, what is the most likely cause of patient's abnormality?

[Aljubouri83]

Nice & Tough one Dr. Hammodi

What term describes the patient's gait ?
- It is called " High Step Gait " ..

What is the most likely cause of patient's abnormality ?
- It is due Mono-Neuritis Multiplex, which is cosidered as a complication of DM ..


Thanx Dr. Hammodi ..
Waiting for more ..


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Ahmed A. Al-Jubouri

[hammodi]

glad u liked it Ahmed

u answered the 1st question right, it's also called steppage gait.

it's good u didn't say it's a diabetic neuropathy coz these r usually bilateral and sensory and this patient had unilateral foot drop. however, this patient has controlled diabetes, his Hg A1c is 6.8% which is pretty good and it means that diabetes is unlikely to be the cause of his problem. so this patient most probably has L5 radiculopathy (herniated L5 disc)

p.s. i copied this case from harrison's mcq book.