DIAG 2740 Chapter 8 Case Studies

DIAG 2740 Chapter 8 Case Studies - Chapter 8 Cases Case#1...

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Chapter 8 Cases Case #1 Unilateral Neck Pain and Tingling Numbness in the Thumb and Index Finger Chief Complaint A 30 year old man came to his physician’s office because of 4 weeks of left sided neck pain and arm pain and tingling History Previous history was unremarkable except for minor sports injuries. These included a skiing accident 2 years ago in which he struck the left side of his neck and had local pain, lasting about 3 weeks, and a backward fall in a softball game 1 year ago in which he struck his occiput without loss of consciousness but had confusion for about 30 minutes. Four weeks ago he awoke with severe left neck and shoulder pain with tingling radiating down into the first and second fingers of the left hand. The symptoms improved slightly after a few days but then recurred 4 days ago, making sleep difficult . Over the counter medications helped but did not eliminate the pain. He did not notice any change in bowel or bladder function, or L' Hermitte’s sign. Physical examination Vital signs: Temperature = 98º Pulse = 72 BP = 140/80 Neck: supple, no tenderness Lungs: clear Heart: regular rate Abdomen: soft Extremities: normal Neurologic exam: Mental status : alert and oriented x3. Normal language. Gave detailed history Cranial nerves : Intact Motor : Normal tone. Muscle strength 5/5 throughout except 4/5 left biceps, brachioradialis, and wrist extensors. Reflexes : left arm biceps and brachioradialis absent Coordination : normal finger nose and heel shin testing Gait : normal. Tandem gait. Romberg’s normal. Sensory : mildly decreased pinprick sensation in the left first and second fingers. Two point discrimination 4-5 mm in the left index finger, compared to 3 mm in the right index finger. Localization and differential diagnosis On the basis of the signs and symptoms presented in bold above, which nerve root shows lesion? Case #2 Unilateral Occipital and Neck Pain Minicase A 74 year old man with a past history of bladder carcinoma developed left sided occipital and neck pain over the course of 2 weeks. Exam was normal except for questionable altered sensation over the left occipital area. Head CT and cervical x-ray were normal. A bone scan and MRI of the cervical spine were therefore done. Localization and differential diagnosis On the basis of the signs and symptoms shown in bold above, which nerve root shows lesion?
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Case #3 Unilateral Shoulder Pain and Weakness Minicase a 50 year old man with a history of multiple high school and college football injuries, was in a motor vehicle accident and developed left shoulder pain and numbness that occasionally radiated down the left arm into the thumb and was increased by neck extension. Exam was normal except for 4/5 left deltoid power strength and decreased pain sensation in the left shoulder.
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