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.…
Cranial Nerve XI: the Spinal Accessory Nerve Cranial nerve (CN) XI, or the spinal accessory nerve (SAN), serves primarily as the motor nerve for the sternocleidomastoid (SCM) and trapezius muscles in the neck and shoulder. It has an intriguing functional…
Clinical Vignette A 62-year-old judge became aware of subtle weakness of his left lower face that he first noted while shaving. Two months later, he noted that he could no longer close his left eyelid fully and was having increasing…
Clinical Vignette A 58-year-old retired town clerk presented with a 2-week history of numbness over her left chin and adjacent lower lip as well as vague pain in the left jaw. She explained that the area feels “Novacaine-like,” exactly like…
Clinical Vignette A 64-year-old woman, a retired music teacher and a food and wine connoisseur, was driving to the airport to catch a flight to Spain when she noted she could not smell the characteristic skunk odor her friend was…