1/
A 21 yo woman presents with numbness in her hands and difficulty walking due to numbness in her left foot. She also reports numbness over the right thigh.
On exam, she has patchy sensory loss and give way weakness.
It feels like a #ContinuumCase of Tactile Anarchy!
A 21 yo woman presents with numbness in her hands and difficulty walking due to numbness in her left foot. She also reports numbness over the right thigh.
On exam, she has patchy sensory loss and give way weakness.
It feels like a #ContinuumCase of Tactile Anarchy!
2/
I could never do sensory ganglionopathy justice after this incredible thread posted by @zach_london. So, you need to check this out, if you havenāt already and then come back:
I could never do sensory ganglionopathy justice after this incredible thread posted by @zach_london. So, you need to check this out, if you havenāt already and then come back:
3/
Youāve concluded the weakness is more a symptom of proprioceptive loss.
NCS/EMG demonstrated absent sensory nerve action potentials, normal motor conduction and a normal needle exam ā findings that are consistent with a sensory ganglionopathy
But why?
Youāve concluded the weakness is more a symptom of proprioceptive loss.
NCS/EMG demonstrated absent sensory nerve action potentials, normal motor conduction and a normal needle exam ā findings that are consistent with a sensory ganglionopathy
But why?
4/
You run to your fridge where this excellent diagnostic schema is obscuring your 8 year oldās finger paint.
You now agreeā¦ this *was* worth it!!
pubmed.ncbi.nlm.nih.gov
You run to your fridge where this excellent diagnostic schema is obscuring your 8 year oldās finger paint.
You now agreeā¦ this *was* worth it!!
pubmed.ncbi.nlm.nih.gov
5/
She has no symptoms to suggest malignancy and no chemotherapy exposure. You ask her about over the counter vitamins. No B6. No HIV risk factors.
She then notes that she canāt wear contacts because her eyes feel so dry. Is this part of the sensory neuronopathy?
She has no symptoms to suggest malignancy and no chemotherapy exposure. You ask her about over the counter vitamins. No B6. No HIV risk factors.
She then notes that she canāt wear contacts because her eyes feel so dry. Is this part of the sensory neuronopathy?
6/
What do you want now?
What do you want now?
7/
Oh, and yes, sheās so thirsty! Really just a terrible dry mouth all the time.
Oh, and yes, sheās so thirsty! Really just a terrible dry mouth all the time.
8/
We werenāt led astray! ANA, Anti-SSA/SSB are all found in high titers, and she is diagnosed with Sjogren Syndrome.
Patients with Sjogrens often have PNS involvement. Of which sensory neuronopathy is one of the most severe forms as it often causes a sensory ataxia.
We werenāt led astray! ANA, Anti-SSA/SSB are all found in high titers, and she is diagnosed with Sjogren Syndrome.
Patients with Sjogrens often have PNS involvement. Of which sensory neuronopathy is one of the most severe forms as it often causes a sensory ataxia.
9/
Tx in these patients is generally geared to severity & progression. In this case because the patient was quickly progressing and had severe sensory ataxia, immunotherapy was initiated with IVIG. While this stabilized the disease, unfortunately it did not reverse the symptoms
Tx in these patients is generally geared to severity & progression. In this case because the patient was quickly progressing and had severe sensory ataxia, immunotherapy was initiated with IVIG. While this stabilized the disease, unfortunately it did not reverse the symptoms
10/
Rituximab may have some role in treatment however it tends to work best in patients that have associated cryoglobulins or vasculitis.
Rituximab may have some role in treatment however it tends to work best in patients that have associated cryoglobulins or vasculitis.
11/
This issue of @continuumAAN is really making me enjoy the peripheral nervous system (this was not really my experience prior to this lol), and the Autoimmune Axonal Neuropathies chapter was super high yield!
journals.lww.com
This issue of @continuumAAN is really making me enjoy the peripheral nervous system (this was not really my experience prior to this lol), and the Autoimmune Axonal Neuropathies chapter was super high yield!
journals.lww.com
12/
Also, @LyellJ , what do you think about a new metric?
The āLondon Factorā, which is when you write such a blockbuster tweetorial that it is referenced in other tweetorials?āŗļø
Thank you @zach_london for the great FOAM teaching on this topic at such a relevant time!
Also, @LyellJ , what do you think about a new metric?
The āLondon Factorā, which is when you write such a blockbuster tweetorial that it is referenced in other tweetorials?āŗļø
Thank you @zach_london for the great FOAM teaching on this topic at such a relevant time!
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