Monday, March 10, 2008

Students of Hookers

This was done in Dr. Josephson's BMB Case of the Day, but deserves a rerun for USMLE review.

A 60 year old man presents with sudden, brief, severe stabs of pain affecting the limbs lasting for minutes. He also has an ataxic gait. His pupils are small, do not respond to light, but contract normally to accommodation and convergence.

Challenge: What's the diagnosis?


Alex said...

tert syph with argyl robertson pupils. could also have aneurysm of the ascending aorta

Craig said...

Students of Hookers

According to Wikipedia, the eye finding (Argyll-Robertson pupils) is also known as prostitute’s pupils because, “like a prostitute, they accommodate but do not react.” This is neurosyphilis, also known as tabes dorsalis. It is a disease of the posterior columns of the spinal cord and of the dorsal roots. It has a long latency between primary infection and onset of symptoms.

Sources: UpToDate; Wikipedia; Dr. Josephson’s COTD.