Hello, I was wondering anyone could help me with a patient I saw today.
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He is a 49 year old male, presenting with unilateral drop foot (left side). He has no noted health problems. His only medication is Ibuprofen taken when required. Strength test 1/5 on dorsiflexion. He also demonstrated weakness when asked to invert and evert the foot against resistance (3/5). The foot was cold to the touch and was significantly colder than the right foot. Appearance was cyanotic. Muscle tone was lacking when compared to the right foot, foot appeared 'floppy'. Pulses were present although the dorsalis pedis was weak. There was presence of hair on his feet and his nails appeared healthy. I tested his light touch (10g monofilament) and vibration sensation (tuning fork), all of which he could feel perfectly. He walks with a steppage gait, using his quads to lift his left foot. He had some slight lower back problems 5 years ago, he did not see the GP and this does not cause him problems any more. Around 7 years ago whilst paint balling, he was hit in the calf with a paint ball which caused significant bruising at the time but again has had no problems since. My patients wife came in with him and noted that "he bruises like a peach". There is a family history of high blood pressure. Also of note, his uncle had a "massive stroke" at the age of 52. My patient was noted to have high cholesterol during an examination for a medical research project 4 years ago but I understand this is now under control.
Something which is very interesting is that at the exact time the foot drop occurred, my patient also began experiencing problems with his vocal chords. His wife explained that they have been told that his "vocal chords don't meet". I suspect these symptoms have been caused by a CVA or TIA. Do you think this is correct?
I wonder if anyone has experience of similar presentations? I work privately in a small area so would appreciate some input from colleagues further afield. I hope the information I have provided is helpful. Thank you.
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