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School of Medicine >
Department of Neurology >
Medical Student Cases and Questions >
The Woman Who Had Trouble Going Down Stairs
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A 65 y.o. college professor came to the neurology clinic referred by her
family physician because of frequent falling. She had a history of non-insulin
dependent diabetes mellitus for 20 years. Her chief complaint was trouble
descending stairs, but not climbing them. She also noted that she caught
her foot frequently on things like rugs, curbs and steps. On examination,
the positive findings were mild distal weakness in her wrists and hands
and moderate weakness of her legs. Her right ankle was weaker than her other
extremities, especially plantar extension. There was mild atrophy of the
anterior tibialis bilaterally, worse on the right. She had diminished appreciation
of all sensory modalities in a stocking-glove distribution.
wa normal.
Questions:
- Where is the anatomic site of her problem, muscle, nerve, spinal cord,
brainstem, or cerebral hemispheres? What is the most likely diagnosis.
- Name three types of peripheral neuropathies caused by diabetes.
- Predict the following EMG findings in this patient:
a) conduction velocities
b) amplitude of motor unit potentials
c) presence of fibrillations and fasiculations
- What treatment would you recommend for this patient?
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Last Modified on 04/30/2008
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