tailieunhanh - Neurology Study Guide - part 7

Một người đàn ông 75 tuổi bắt đầu phàn nàn của tê và ngứa ran ở chi dưới và đốt cháy đau liên quan đến dưới cùng của bàn chân, đặc biệt là vào ban đêm. Ông cũng bắt đầu trải qua chóng mặt và lightheadness khi đột nhiên đứng từ một vị trí nằm, bất lực, và đổ mồ hôi sau khi ăn dồi dào | 146 14. Neurological Complications of Systemic Disorders mine levels are decreased in the serum but it is important to obtain serum or urine levels of methylmalonic acid and total homocysteine that increase in patients with cobalamine deficiency. Treatment The treatment consists of intramusclular injections of cyanocobalamin. Neurological Complications of Diabetes Vignette A 75-year-old man started complaining of numbness and tingling in the lower extremities and burning pain involving the bottom of the feet particularly at night. He also started experiencing dizziness and lightheadness when suddenly standing from a lying position impotence and profuse sweating after eating. His medical history included hypertension and diabetes for over 10 years. He was recently diagnosed with lung cancer treated with chemotherapy. Neurological examination shows mild weakness of foot dorsiflexion and absent reflexes in the legs. Sensation was decreased to pain temperature and vibration more than proprioception below the knees. Summary A 75-year-old man experiencing paresthesias and pain in the lower extremities together with autonomic symptoms. The neurological examination shows evidence of mild distal weakness sensory loss and absent reflexes in the lower extremities. Medical history is significant for diabetes hypertension and lung cancer treated with chemotherapy. Localization and Differential Diagnosis and Diagnosis The localization is the motor unit in particular the peripheral nerve with suggestion of a distal symmetrical sensorimotor neuropathy with autonomic symptoms. Several neuropathies are associated with painful paresthesias. These include in particular idiopathic sensory polyneuropathy and neuropathy secondary to diabetes mellitus. In both conditions the pain is symmetrical and worse in the feet. Idiopathic sensory neuropathy is a chronic disorder of unknown cause that affects individuals in the sixth or seventh decade of life and is characterized by painful dis tal .