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28 year-old
woman is evaluated for development of painless burns on both hands and
arms. She has had neck pain since she had whiplash following neck injury
one year ago.
NE
wasting of intrinsic hand
muscles
spastic legs
absent biceps and triceps reflex
pendular knee jerks
clonus (sustained) at ankles
bilateral plantar extensor response
loss of temperature and pinprick over posterior neck, and shoulders
and extending to arms in shawl distribution.
normal vibration and position sense
normal cranial nerves
Images
Questions:
- Explain sensory findings.
- Explain wasting in hands
and spasticity in legs.
- Why did patient burns hands?
- With dissemination of findings
in space, could patient have MS?
- What does MRI show?
- What treatment is indicated?
- What is relation of MRI
shown lesion to motor vehicle accident?
- Following whiplash injury,
patient develops left thumb numbness, absent triceps reflex and weakness
of elbow extension, what is likely mechanism?
- Following slip and fall
injury on wet floor, patient develops "lumbago" and "sciatica".
What does this mean and what finding might you expect on examination?
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CT17 (2) - Revised 7/5/2005
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