Muscle Weakness, Fever, Thia Prynne discussed on NEJM This Week - Audio Summaries
Our images in clinical medicine features in eighty four year old man who presented to the primary care clinic with fever Malays and discoloration and pain in the fingers and toes that had progressed over a two week period. The patient had a body temperature of thirty seven point eight degrees celsius a physical examination was notable. For blue black discoloration of the distant second through fifth fingers of the left hand dusky discoloration of several fingers of the right hand per perk. Lesions on both hands and similar discoloration on the toes of both feet. There was associated Dima, but no scleroderma actally or to lend Jack Tegas radio post, earier tibial, and or Saleh's pitas pulses were palpable on both sides laboratory tests revealed normal renal and liver function and an elevated c reactive protein level of twelve point two. Nine milligrams per deciliter necrosis of the fingers and toes has abroad differential diagnosis, including vascular disease, infection arterial, embolism, and thrown affiliate given the clinical concern about vascular litis treatment with glucocorticoid was initiated and a biopsy of the lesions on a finger and toe was performed the biopsy specimens showed fibrin, OI, necrosis, inflammation and medial thickening in a medium sized artery findings that are consistent with a diagnosis of Polly arteritis. No dosa, a medium vessel, vascular litis, the symptoms of fever and melas diminished with treatment which included the addition of as Thia prynne and the level of c reactive protein normalized, the new chronic areas of the fingers were amputated and the remaining fingers and toes recovered completely. A twenty four year old man presented to the neurology clinic with a one year history of progressive dysphasia, disarm three and weakness in his arms and legs three months before the onset of these symptoms. He had received an electric shock while repairing an electric fan. The contact point was the right hand, which had touched an uninstigated wire. The physical examination was notable for cloudiness of the jaw brisk deep, tendon reflexes in the arms and legs and facilitations of the tongue and of the muscles in the arms and legs. See the video at any J M dot org. Nerve conduction. Studies of the median owner tibial and common perennial nerves on both sides of the body showed diminished. Amplitude of compound muscle action. Potentials electromyograms easy revealed. Neuro genyk motor unit action potentials with the situation potentials in the tongue and in all limbs. These findings were consistent with chronic motor Diener Vatian and re innovation M R I of the brain and spinal cord revealed. No abnormalities given the presence of both upper and lower motor neuron signs with sparing of the sensory pathways a diagnosis of Amaya trophy lateral sclerosis was made jaw clone is typically indicates damage to the upper motor neurons in the court Akot Ponting tracks at follow up six months after the diagnosis was made the patient had worsening limb and ballboy, muscle weakness and actor. Raffi? This concludes our summary. Let us know what you think about our audio summaries. Any comments or suggestions may be sent to audio at any AM dot org. Thank you for listening.