Diagnostic Approach Clinical Vignette A 65-year-old man developed a tingling sensation in the toes, which quickly gave way to painful numbness. Over the next few months, paresthesias ascended to involve his distal thighs and fingertips. Within 6 months, he required…
Clinical Vignette A 13-year-old boy presents with frequent tripping. He enjoys playing baseball but has had several falls this season, one resulting in a fractured ankle. Born at term, his early developmental milestones were normal and he walked at 13…
Peripheral nerve hyperexcitability (PNH) syndromes present with involuntary, continuous muscle overactivity due to hyperexcitability of the motor axon. PNH syndromes are a heterogeneous group of disorders with distinct clinical and electrodiagnostic features. Muscle cramps are the hallmark of these conditions,…
Clinical Vignette A 48-year-old hospital administrator began having difficulties during meetings when her back would stiffen up every time she was asked to get up to speak. Subsequently, she developed episodes of anxiety accompanied by her left leg tightening up.…
Clinical Vignette A 35-year-old man sought medical attention for leg weakness. He noticed difficulty getting up from low chairs and ascending stairs. Looking back, he reported that 10 years previously he had noticed some difficulty when trying to stand after…
Clinical Vignette A 54-year-old man reported painless left arm weakness for 6 months. While exercising at the gym, he noticed difficulty lifting weights with his left arm. Progressively he had difficulty cutting food and opening jars with his left hand.…
Sciatic Neuropathies Clinical Vignette An 82-year-old frail woman fell in her home. She sustained a hip fracture, which necessitated surgical repair. Postoperatively, she received anticoagulation. Two days later, she had discomfort in her right buttock and foot weakness. Within 24…
Mononeuropathies of the Shoulder Girdle Mononeuropathies of the shoulder girdle are relatively uncommon and can be challenging to diagnose. Unlike other mononeuropathies, pain is often the cardinal symptom. Shoulder pain and weakness can originate not only from mononeuropathies, but also…
Clinical Vignette A 54-year-old man developed acute-onset right thigh, hip, and buttock pain. He reported right knee “buckling” when he stepped off a curb, resulting in a fall. He also noted right foot drop. Paresthesias developed over the right thigh,…
Epidemiology Low back pain is an extremely common condition; according to the World Health Organization's Global Burden of Disease Study, of 291 studied conditions, it is the greatest contributor to global disability. As the leading cause of activity limitation and…