Clinical Reasoning: Burning hands and feet
| Autor: | Einar Wilder-Smith, Amanda C. Chan |
|---|---|
| Rok vydání: | 2015 |
| Předmět: |
Adult
Male medicine.medical_specialty Shoulders Diagnostic Techniques Neurological Pain Diagnosis Differential Polyneuropathies Ptosis medicine Humans Medical history Pain Measurement Diplopia Proprioception Foot business.industry Cranial nerves Hand Surgery Allodynia Autonomic Nervous System Diseases Hyperalgesia Neurology (clinical) medicine.symptom business |
| Zdroj: | Neurology. 84:e146-e152 |
| ISSN: | 1526-632X 0028-3878 |
| DOI: | 10.1212/wnl.0000000000001559 |
| Popis: | A 25-year-old banker, a nonsmoker and nondrinker, presented with pain in the hands and feet for 4 weeks that progressed to involve shoulders and hips. Pain was associated with constipation, followed by diarrhea. He had no prior trauma, vaccinations, or infectious symptoms. Medical history was noncontributory; he was on no medication. He had consulted numerous doctors for the pain, who noted transient urinary hesitancy, tachycardia, and hypertension that required short duration treatment with antihypertensives. All symptoms except the pain resolved spontaneously. On examination, he was afebrile, alert, and oriented. Cranial nerves were intact; there was no ptosis, diplopia, or facial plegia. Four-limb power was Medical Research Council 5/5 proximally and 4/5 distally, limited by pain. Reflexes were just elicitable (1+); anal tone was intact. Cerebellar signs were absent. Gait was slow from bilateral sole pain. No joint deformities or skin abnormalities were seen. He often adopted a posture with both arms abducted and fingers extended, which alleviated pain. Sensory testing revealed hyperalgesia and brush allodynia over the hands and feet. Temperature, vibration, and proprioception were preserved. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|