Back Pain Cases

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Task 1.
In men 32 years after lifting weights appeared severe pain in the lumbar spine. The pain increases
sharply when driving in the lumbar spine. In a study of the expressed tension of the back
muscles, scoliosis convex to the right in the lumbar, flattening the lumbar spine. Movement in
the lumbar sharply limited trunk bent forward is not possible due to a sharp increase in pain.
Paresis, sensitivity disorders and other neurological disorders were not found.
1. Clinical diagnosis? Lumbalgia
2. Additional tests?
3. Treatment?
Task 2.
Male 45 years old at the time of the physical work in the country felt a pain in the lumbar spine,
radiating surface posteroexternal on the right foot. The pain persisted for the next three days,
which was the reason for seeking medical attention. Upon questioning, the patient stated that the
pain increases with movement in the lumbar spine, coughing or sneezing. In a study of the
expressed tension of the back muscles, scoliosis convex to the right in the lumbar, flattening the
lumbar spine. Movement in the lumbar sharply limited trunk bent forward, bending to the right is
not possible due to a sharp increase in pain. Marked pain hypoesthesia on the outer surface of the
right leg and the outer edge of the foot, ankle reflex was absent on the right, positive symptom
Lasegue right angle of 30 .
1. Neurological syndromes? Segmental-radicular type sensitivity disorder
2. Location of the lesion? L5-S1
3. Clinical diagnosis? Radiculopathy
4. Additional tests? CT MRI
5. Treatment?
Problem 3.
Male 46 years old, the driver went to a doctor complaining of acute pain arose in the lumbosacral
spine. Pain in the lumbar region periodically disturbed for 15 years, usually after exercise, lifting
weights. Currently exacerbation during the week. The pain is worse when moving, coughing. In a
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study of the expressed tension of the back muscles, scoliosis convex to the left in the lumbar spine.
Movement in the lumbar spine are sharply limited, positive symptom "landing." Marked tenderness
of the intervertebral joints in the lower lumbar spine. Paresis, sensitivity disorders and other
neurological disorders not.
1. Clinical diagnosis? Lumbalgia
3. Treatment?
Task 4.
Woman 57 years old, accountant, complains of pain in the cervical spine, extending along the
outer surface of the right hand. Pain disturbed during the last 3 months, gradually increasing. On
examination detected tension in your neck, increased kyphosis in the cervical spine and limited
mobility of the cervical spine due to pain. Defined stress and pain trapezius muscle, supraspinatus
muscle, middle scalene muscle on the right. On palpation scalene muscle, turning the head to the
left having pain on the outer surface of the right hand. Marked hypoesthesia on the medial surface
of the forearm and wrist, and reduced reflexes with m.biceps right, no other neurological
disorders.
1. Neurological syndromes? Mononeuropathy of sensory disorder of the right hand.
2. Location of the lesion? Musculocutaneous nerve(??)
3. Clinical diagnosis? Cervicobrachialgia
5. Treatment?
Task 5.
A woman aged 42, an accountant, complaining of severe pain in the lumbar region, extending along
the outer surface of the right foot to the toes. The pain intensified when moving, coughing. Pain in
the lumbar region periodically disturbed for 5 years, usually after exercise, work in the country.
Currently aggravation arose last week after an awkward motion. In a study of the expressed tension
of the back muscles, scoliosis convex to the right in the lumbar kyphosis in the lumbar spine.
Movement in the lumbar sharply limited trunk bent forward is not possible due to a sharp increase
in pain. Marked pain hypoesthesia on the outer surface of the right leg and the outer edge of the
foot, ankle reflex was absent on the right, positive symptom Lasegue right angle of 30 . For
percussion on the lumbar spine occur shooting pain, extending along the outer surface of the right
foot to the heel.
1. Neurological syndromes? Location of the lesion? High muscle tone syndrome (musculoskeletal
pain)
2. Clinical diagnosis?
4. Treatment?
Task 6.
Female 27 years old, pianist, complains of intense pain in the neck, inability to turn the head,
especially the right, because of the pain. Neck pain periodically disturbed in the past 5 years, this
aggravation for two days amid intense musical exercises. In a study of marked restriction of
movement in the cervical region, the protective voltage long muscles, more on the right, flattening
of the cervical lordosis. Paresis, sensitivity disorders and other neurological disorders not.
1. Clinical diagnosis? Cervicalgia
3. Treatment?
Task 7.
2
Male 24 years old, computer programmer, complaining of severe pain in the thoracic spine, which
extends to the left side of the chest. The pain came two days ago against the long-term operation of
a personal computer. The pain is worse when breathing, rotary motion in the spine. Nitroglycerin
did not reduce the severity of pain, electrocardiogram revealed no changes. On examination
revealed S-shaped scoliosis of the spine, pain paravertebral points at the thoracic level (Th5-Th6)
left tenderness intercostal space Th5-Th6 left protective voltage long back muscles at the thoracic
level on the left. Paresis, sensitivity disorders and other neurological disorders not.
3. Treatment?
Task 8.
Male 57 years old complained of intense pain in the lower thoracic spine, extending into the chest to
the right. Concerned in pain for 2 months. Pain intensity demanded appointment of drugs. During
the last week said the weakness in the legs, numbness in the feet. In the past six months, she lost 10
pounds. Marked tenderness to percussion of the spinous processes of the thoracic vertebrae Th10Th 11, hypersensitivity to intercostal spaces Th10-Th11 right, weakness in the legs up to 4 points,
the recovery of tendon reflexes and foot, double-sided Babinski sign, decreased joint and muscle
sense in the toes right legs, easing pain sensitivity at the level of the left groin.
1. Neurological syndromes?
2. Location of the lesion?
3. Preliminary clinical diagnosis?
Target 9.
A man aged 47, a porter, periodically for 5 years, had pain in the neck and shoulders on both sides.
In the past two months, appeared narosla weakness in the legs. In the neurological status: mild
malnutrition, muscle weakness of the right shoulder and arm, absent tendon reflexes with biceps
and pain hypesthesia in areas C5-C6 on both sides, loss of strength in his legs to 4 points, the
recovery of tendon reflexes and legs, a symptom Babinski on both sides.
1. Neurological syndromes? Mixed paresis, cervicobrachialgia
2. Location of the lesion? C5-C6
5. Treatment, if confirmed the preliminary diagnosis?
Task 10.
Man, 48 years old, driver, complains of pain in the lumbosacral and right gluteal region, extending
along the outer surface of the right leg, tingling and numbness in the right foot. Pain came back
after six months of exercise and gradually increase. Neurological examination revealed flattening of
the lumbar lordosis, pain on palpation of the paravertebral points L5-S1 and the piriformis muscle
on the right, positive symptom Lasegue to 50 right desensitization sparava as a band on the
outside of the leg and dorsum of the foot, thumb extensor muscle weakness big toe of right foot.
5. Treatment, if confirmed the preliminary diagnosis?
Target 11.
Female 35 years after lifting weights felt a sharp pain in the lumbar region, radiating to the left leg
by posteroexternal thigh and lower leg. First pain arose two years ago after physical activity and
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have been for a few days. Now worsening in two days. On examination: lumbar lordosis flattened,
scoliosis of the lumbar left back muscle strain, lumbar motion severely restricted, marked
tenderness paravertebral points. Symptom Lasegue left - 40 . Revealed reduction of all kinds of
sensitivity as a band on the surface posteroexternal left thigh, lower leg and the outer edge of the
foot, the absence of Achilles reflex.
5. Treatment?
Task 12.
A woman of 62 years complained of pain in the lumbosacral area radiating to the back of the right
thigh to the knee. Pain appeared two months ago and gradually increase. They are aggravated by
prolonged sitting and diminish after walking. In a study of observed flattening of the lumbar
lordosis, S-shaped deformation of the spine and limited mobility in the lumbar spine due to
increased pain, muscle tension back. Marked tenderness of the intervertebral joints in the lower
lumbar spine. Paresis, sensitivity disorders and other neurological disorders not.
3. Treatment?
Task 13.
Female 50 years, engineer, complains of pain in the lumbar region radiating to both legs and
numbness in the feet, worse walking. These complaints concerned for two years and gradually
increase. At the age of 25 years old patient during skiing fell, hit his back and suffered back pain for
a few months after the fall. On examination there is a growing lordosis of the lumbar spine, with
pressure on the spinous process of the fifth lumbar vertebra is noted his "drowning". Revealed
bilateral symptom Lasegue an angle of 50 , reduced Achilles reflexes on both sides. On
radiographs of the lumbar marked displacement of the body of the fourth lumbar vertebra relative to
fifth on 20 mm.
3. Treatment?
Target 14.
Male 65 years old complains of aching pain in the lumbar region radiating to the anterior surface of
the right thigh. Pain concerned about three months and gradually increase. 5 years ago revealed
prostate adenoma. The clinic at the pain in the lumbar region received nonsteroidal antiinflammatory drugs and vitamins without significant effect. On examination: lumbar lordosis are
smoother motion in the lumbar spine is limited because of the pain in the back and sides, tenderness
to percussion on spinous processes of the second and third lumbar vertebrae. Reveals painful
hypoesthesia on the inner surface of the right thigh, no knee-jerk right, positive symptoms
Wasserman and Matskevich right.
Target 15.
Male 55 years old complains of severe pain in the lumbar region radiating to the anterior abdominal
wall, worse at night, as well as coughing and sneezing, muscle weakness right leg, numbness in my
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left leg. He considers himself a patient about two years. Illness began with pain in the lumbar region
on the right, the intensity gradually increased. Eighteen months later joined the weakness in his
right leg and numbness in the left foot, which later rose to the groin. In a study of loss of strength in
his right leg up to 3 points with the recovery of tendon reflexes and Babinski symptom, decreased
pain sensitivity at the level of Th11 dermatome on the left, a sharp pain effleurage on spinous
processes of the seventh and eighth thoracic vertebrae.
Task 16.
Female 44 years old, waitress, complained of pain in the lumbar region, radiating to the left leg,
numbness in the fingers of his left leg. Back pain periodically disturbed for 3 years. Last
aggravation that has occurred two weeks ago, the patient connects with hypothermia and physical
activity. OBJECTIVE: lumbar lordosis flattened, scoliosis of the lumbar convexity to the left,
marked limitation of motion in the spine due to pain, stress the long back muscles. Revealed
reduced sensitivity as a band on posteroexternal surface of the left thigh, the outer surface of the
tibia, the inner edge of the foot and big toe, positive symptom Lasegue at 30 .
5. Treatment?
Target 17.
Male 37 years of lifting weights felt a sharp pain in the lumbar region radiating to the right leg on
posteroexternal thigh and lower leg. Back pain concerned for ten years, most often after exercise,
they last for a few days to a month. Currently exacerbation within three months. A study in the
neurology department treatment with non-steroidal anti-inflammatory drugs, muscle relaxants,
physical therapy did not improve the condition. On examination: lumbar lordosis flattened, scoliosis
of the lumbar right back muscle strain, lumbar motion severely limited, symptom Lasegue right - 20
. Revealed reduction of all kinds of sensitivity as a band on the surface posteroexternal right
thigh, lower leg and the outer edge of the foot, the absence of the Achilles reflex. Magnetic
resonance imaging revealed intervertebral hernia about 10 mm in diameters between the fifth
lumbar vertebra and the sacrum.
5. Did the surgery?
Target 18
Female 18 years old complains of dull aching, sometimes burning pain in the anogenital region
during defecation acquire sharp, shooting character. The above symptoms appeared last week after
the start of sexual activity. Anamnesis: 3 years ago, slipped and fell on the tram tracks, hitting the
coccyx, pain in that period lasted about a week and regressed independently. On examination, the
gynecologist and proctologist pathology detected. In status: no focal neurological symptoms, tense
muscles of the pelvic floor, the coccyx is offset to the right of the midline, palpation sharply painful.
3. Treatment?
5
Task 19
In men 39 years after landing with a parachute appeared severe pain in the lumbar spine. The intake
of non-steroidal anti-inflammatory drugs back pain regressed, however, the patient noted the
appearance of pain and numbness in the legs when walking. At first, the pain appeared when
walking distance of over 500 meters, but the distance was reduced during the year to 100 meters. To
reduce the intensity of pain and the patient is forced to sit down and lean forward. In neurological
paresis, sensitivity disorders and other neurological disorders were found. Movement in the lumbar
moderately limited due to voltage paravertebral muscles.
3. Treatment?
Task 20
Male 20 years old, a forester, loading logs in tractor trailer was injured spine. Did not lose
consciousness, but the pain could not get up on their own, and was taken home. After injury
appeared narosla leg weakness, concerned about pain achingly-burning character in the
interscapular region. In the neurological status: attenuation of pain and temperature sensation below
the level Th7 on both sides, loss of strength in his legs to 4 points, the recovery of knee and Achilles
reflexes, increased tone in the legs with the phenomenon of "jackknife" Babinski sign on both sides,
compelling urge to urinate.
5. Treatment?
6.Disease of peripheral nervous system
Task 1.(77)
Male 43 years old, a plumber, said the morning after sleep weakness in the right
hand. On the eve of drinking alcohol in large quantities and at once fell asleep at the
end of a feast. On examination, marked weakness of the extensor muscles of hand
and fingers ("hanging brush"), brachioradialis muscle (inn. by radial nerve),
weakness extension and abduction of the thumb, reduction of all types of sensitivity
in the anatomical snuffbox (radial nerve), decreased reflex with triceps brachii (C7C8, radial nerve).
1. Neurological syndromes? Right peripheral of the extensor of hand, hypoesthesia
with mononeuropathy type of I finger.
2. Preliminary clinical diagnosis? Mononeuropathy of the radial nerve
3. Additional tests? ENMG EMG
4. Treatment? Massage, surgical
Task 2.(78)
Male 52 years after sweeping floor noted weakness and numbness in the foot. In a
study marked weakness of the muscles that provide dorsiflexion of the foot, reducing
all kinds of sensitivity on the outside of the leg, the back of the foot. The patient
cannot stand on the heel of right foot (n. fibularis), knee and Achilles reflexes
saved.
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1. Neurological syndromes? Right Peripheral paresis of extensor m. of foor,

hypoesthesia of lateral side of leg.
2. Preliminary clinical diagnosis? Mononeuropathy of right peroneal nerve
4. Treatment?
Problem 3.(79)
Female 32 years complains of facial asymmetry, tearing from the left eye, pain in the
left side of BTE. Ill the day before admission, the day before a long time was on the
street without a hat with an air temperature -5 . On examination revealed facial
asymmetry: left lagophthalmos (inability to close the eyelids completely), flattened
left nasolabial fold, and lowered the angle of the mouth. When the mimic samples
marked weakness of facial muscles of the left side of the face, a symptom of Bell's
left (peripheral facial paresis- ipsilateral). Reduced taste sensitivity to the anterior
two thirds of tongue (dysgeusia- facial nerve responsible) left, no other neurological
disorders.
1. Neurological syndrome?
2. Location of the lesion? Facial nerve until chorda tympani
3. Clinical diagnosis? Bells palsy // Mononeuropathy of facial nerve
4. Additional tests? MRI to exclude tumor
5. Treatment? Prednisolone,acyclovir, relaxotherapy
Task 4.(80)
Girl, 16 years old was admitted to hospital with complaints of weakness in the legs
and arms, numbness in the feet (the "feel of foam under the feet"). She became ill
four days before admission, when he noted numbness and pain in the legs, which is
gradually joined by the weakness in the legs first, then the arms and facial muscles.
Two weeks before admission were manifestations of acute respiratory viral
infections. On admission revealed the weakness of facial muscles on the left side,
weakness in the legs to two points in the hands of three points, muscle hypotonia,
absence of tendon reflexes to the ground and with it, the positive symptoms of nerve
root tension (peripheral paresis), reducing all kinds of sensitivity in the feet of type "
socks " (polyneuropathy).
1. Neurological syndromes? Hemiparesis peripheral left,
2. Location of the lesion? Myelin of peripheral nerve
3. Clinical diagnosis? Guillain barre syndrome
4. Additional tests? Lumbar puncture, enmg
5. Treatment? Plamaphoresis, ivig,
Task 5.(81)
A woman aged 52 complained of numbness, tingling and pain in the hands, especially
on the palmar surface of the first three fingers, swollen hands. Pain disturbed for 5
years and gradually increases. They are amplified during sleep and work hands
(ironing, knitting). In the last year they were joined by weakness and loss of weight
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of the hands. When viewed from both sides of malnutrition identified in the muscles
of thumb, weakness in his abduction and opposition, the weakness of the flexors of
the first three fingers (carpal tunnel- compression of median nerve), positive
symptom Tunnel in the wrist, reducing all kinds of sensitivity on the palmar surface
of the first three fingers. The pain intensified when lifting the arms and hands flexed
wrist joint.
5. Treatment?
Task 6. (Dejerine-Klumpke syndrome)(82)
Male 55 years old complained of intense shooting pain in the right forearm and hand,
numbness in the inner surface of the right hand, the restriction of movements of the
right hand, swelling and cyanosis of the hand. The above complaint arose after the
dislocation of the right shoulder joint with significant displacement. When viewed in
the right hand revealed a weakness in the proximal and distal parts, the absence of
tendon reflexes, hypotension and muscle atrophy shoulder, forearm and hand,
reduced sensitivity to all kinds of "mosaic type."
2. Location of the lesion? Lower divison of Brachial plexus
3. Clinical diagnosis? plexopathy
5. Treatment?
Task 7. (Sensory ataxia due to alcoholic polyneuropathy, peripheral paresis- lesion at
peripheral nerve)(83)
Male 32 years old complains of numbness, burning, tingling in the feet, fingers, leg
weakness, unsteadiness when walking, especially in the dark. The above complaints
concern for 3-4 months. Long time abuse alcohol. OBJECTIVE: weakness to 4
points in the distal arm and up to 3 points in the distal parts of the legs,
malnutrition limb muscles with a predominance in the distal regions, the absence of
Achilles and karporadialnyh reflexes, reduction of all kinds of sensitivity
according to the "glove" and "socks "positivity Romberg promahivanie when the
paltsenosovoy pyatochnokolennoy samples and with eyes closed. When
electromyographic lower extremities revealed a significant decrease in the amplitude
of muscle response with a relatively small deceleration rate of the excitation of
motor fibers of the peroneal and tibial nerves.
4. Treatment?
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Task 8.(84)
A woman aged 52 complained of pain, numbness, burning, tingling sensation in
the feet. These complaints concerned a period of 4 months. Suffers from insulindependent diabetes mellitus for 3 years, taking maninil level of fasting blood sugar in
the range of 8-10 mmol / l. In the neurological status: reduction of pain and
temperature sensitivity of the type of "socks", giperpatiya in the feet, the absence
of Achilles reflexes, trophic changes in the skin of both feet.
1. Neurological syndromes? Polyneuropathy type of sensory disturbance
2. Location of the lesion? Peripheral nerve
3. Clinical diagnosis? Diabetic polyneuropathy
5. Treatment? Control blood glucose,
Target 9.(85)
Male 38 years old complained of numbness on the medial surface of the forearm,
hand and thumb on the left. These feelings arose in anesthesia recovery after
undergoing abdominal surgery two months ago. Neurological examination revealed
left hand: reducing all kinds of sensitivity on the inner surface of the forearm, hand,
little finger and ring finger, little finger muscle hypotrophy, intercostals muscles, loss
of strength in the flexors of the little finger, ring finger and muscle abductor pinky (4th
and 5th finger- ulnar nerve compression at elbow level, cubital tunnel syndrome).
5. Treatment?
Task 10.(86)
Male 22 years old complains of pain in the right gluteal region radiating
posteroexternal on the thigh, lower leg, as well as numbness, tingling and weakness
in his foot in it. On the eve of intoxicated patient fell asleep, sitting on a chair, and
then having the above complaints. On examination: tenderness of the right piriformis
muscle, positive symptom Lasegue (straight leg raise to detect back pain) right,
reducing all kinds of sensitivity on the outside of the leg and the right foot, muscle
weakness of right foot, providing a rear, and plantar flexion, the absence of the right
ankle reflex (schiatic nerve).
5. Treatment?
Target 11.(87)
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Male 47 years old complained of muscle weakness left hand, numbness on the back
of the hand. Two days ago, the patient underwent surgery, which took place under
general anesthesia. During the operation assigned to the left hand side in the
measurement of blood pressure, intravenous fluids, and other manipulations. In a
study of the left hand revealed a weakness in the wrist and fingers extensors, no
reflex with triceps brachii (radial nerve), reduction of all types of the sensitivity of
the outer surface of the bottom of the forearm, the dorsum of the hand and thumb.
5. Treatment?
Task 12. (Guillain-Barre syndrome)(88)
Female 33 years old 12 days after giving birth felt numbness in the feet, staggering
when walking, feeling "insoles" under the feet, difficulty climbing stairs, getting up
from his chair. After 3 days, these complaints have joined numbness in the fingers,
difficulty in lifting the arms. After another 2 days narosla weakness in the arms and
legs, the patient was unable to walk, and she was admitted to the neurological
department. On examination: moderately severe weakness of facial muscles on both
sides, weakness of limbs to one point in the legs and three points in the hands, with a
predominance in the proximal, muscular hypotonia, absent tendon reflexes, positive
symptoms Lasegue and Wasserman, reduction of all types of sensitivity type "socks"
and "gloves" (polyneuropathy). During electromyography, lower extremities revealed
a significant decrease in the rate of excitation of motor fibers of the peroneal and
tibial nerves at a relatively small decrease in the amplitude of muscle responses.
5. Treatment?
Task 13.(89)
Female 23 years in the one and a half hours in the electric train at the open window to
the right of it. The next morning, she found that bad right eye closed, it implies a tear
dropped right corner of the mouth, the liquid food poured from the right corner of his
mouth. On examination: on the right side of the face lowered brow, lagophthalmos,
flattened nasolabial fold, the angle of the mouth is omitted, the right eye does not
close completely, and the tears in the face grin skewed to the left. Other neurological
disorders have been identified.
3. Clinical diagnosis?facial nerve mononeuropathy
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5. Treatment?
Target 14. (Charkott-Marie-Tooth- hereditary motor and sensory neuropathy (HMSN)
and peroneal muscular atrophy (PMA))(90)
Female 36 years old complained of weakness in the legs, difficulty walking, "weight
loss" leg muscles, and weakness in the hands. Considers herself a patient in 16 years,
when he first noted weakness in the legs. Further weakness gradually increased, it
was joined a weight loss of muscle weakness in the legs and hands. Similar violations
were observed in mothers and grandmothers sick. On examination revealed the
hollow of the foot with the deformation of fingers, severe malnutrition leg
muscles, light brushes malnutrition, weak dorsiflexion of the foot and toes to two
points, weakness of plantar flexion of the foot to four points, the absence of Achilles
reflexes, and reduction of all kinds of sensitivity of the type "socks." During
electromyography, lower extremities revealed a significant decrease in the rate of
excitation of motor fibers of the peroneal and tibial nerves at a relatively small
decrease in the amplitude of muscle responses.
5. Treatment?
Target 15.
Female 47 years old complained of weakness in the legs, numbness in the toes. These
complaints appeared six months ago and gradually narosli to the extent that the
patient has become difficult to move independently. A year ago, the patient was
established cervical cancer, she was operated on and is currently under medical
observation. On examination: hypotonia and hypotrophy of muscles legs and feet,
muscle strength decreased in the distal leg up to 2 points in the proximal parts - up to
4 points, not caused knee and Achilles reflexes, pain hypesthesia to the level of the
knee.
5. Treatment and prognosis of the disease?
Task 16.
Female 64 years old complains of pain in the legs and feet, numbness and tingling in
those areas that are of concern during the year. Suffer long-term hypertension, normal
blood pressure values 150-160/90-100 mmHg, regular treatment was given, the last
three years, said dry mouth, increased thirst, to doctors in connection with these
disorders are not addressed. In a study of easing pain and temperature sensitivity of
the type "socks", reduction of knee-jerk reaction and the absence of Achilles reflexes,
11
vibration sensitivity in the upper spine - 12 "hips - 8", knee joints - 5 "at the ankle
joints is absent; instability in the sample Romberg on closing the eyes.
5. Treatment and prognosis of the disease?
Target 17.
Male 52 years, right-handed, were gradually growing in six months weakness of right
hand in the form of insufficient force to compression of the fingers into a fist. Six
months later there was a weight loss of muscle right hand. Examination revealed loss
of strength and muscle atrophy of the thenar eminence and the muscles, causing the
thumb, no reflexes in his right hand. No other neurological disorders. When
electromyographic amplitude decrease M-response during stimulation of the median
and ulnar nerve blocks of the excitation on the forearm and at Erb with stimulation of
the median nerve.
3. Additional examination?
4. Treatment?
Target 18.
A woman 60 years of age, within four months increasing weakness in the legs, it
was difficult to walk on his toes and heels, climbing stairs, getting up from his
chair. The patient was concerned about the feelings of numbness, tingling in the legs
and feet. Recently, she notes the appearance of weakness in the muscles of the
arms, is more in the hands. On examination: cranial nerves without pathology,
atrophy and weakness of the proximal and distal muscles in the legs and distal
muscles in the hands, the absence of tendon reflexes in the hands and feet,
reducing pain and temperature sensitivity of the type "socks" and "gloves". When
electromyographic: reduced rate of excitation of motor and sensory nerves in the feet
to 34 m / sec, in the hands of up to 45 m / sec.
4. Treatment?
Task 19.
A woman 26 years old, suffering from diabetes at age 14 and receiving
insulin therapy in the past six months are marked fainting when standing up sharply,
and constipation alternating with diarrhea, no abdominal pain, numbness in the feet.
Blood pressure in the supine position - 130/70 mm Hg, in a standing position - 85/50
mm Hg, a constant tachycardia at rest - 100-110 beats per minute. On examination:
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the weakening of pain and temperature sensation from the level of the lower
third of the leg, decreased vibration sense in the end phalanx of the great toe to 4
points, the absence of Achilles reflexes .. Stop dry skin, there is hyperkeratosis of the
skin and cracks on the sole of the foot.
4. Treatment?
Task 20.
Woman 58 years old was operated on for cancer of the left breast, she held radiation
therapy and started treatment with vincristine. After 1.5 months, the patient appeared
weakness in the feet, his gait, a sense of numbness and burning pain in the feet,
cramps in the calves at night. On examination: no dorsiflexion and plantar flexion
moderately relaxed feet, reduced knee and Achilles reflexes are absent, reduced
sensitivity to all kinds of type "socks", unstable walking, and in the sample Romberg
with eyes closed.
1. Neurological syndromes? Sensory ataxia, polyneuropathy sensory disturbance,
peripheral paresis of leg
4. Treatment?
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1. Neurological syndromes? Right Peripheral paresis of extensor m. of foor,

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