Thursday, January 23, 2014

Nerves?

Your neurology practice gets two referrals from a rheumatologist. The first is a 30 year old woman with Churg-Strauss syndrome who presents with the following physical exam finding:


Note the wrist drop in the left hand and dorsiflexion weakness in the right hand. You also notice as she enters the exam room that she has an unusual gait. She lifts one knee higher than the other as she walks, a sort of "foot-slapping" step.

Another patient, a 50 year old woman with microscopic polyangiitis has this finding on exam:


She also has a foot drop.

Challenge: What's this constellation of neurologic symptoms called?

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1 comment:

Craig Chen said...

Nerves?

Vasculitic diseases can cause a peripheral neuropathy from ischemia; here, mononeuritis multiplex is described. Mononeuritis multiplex involves nerve damage to two or more nerves in separate parts of the body. The first patient's gait shows tibilias anterior weakness. The second image shows atrophy in the webspace between the thumb and second finger.

Source: UpToDate.