Aljohin
Mjek. Psikiater.
Regjistruar: 08/07/2003
Vendbanimi: Padova
Mesazhe: 576
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A 49-year-old left-handed woman was evaluated in the neurology clinic because of
painful asymmetric neuropathy.
The patient had been well until several years earlier, when numbness developed in
the right hand. A right carpal-tunnel–release operation had been performed eight
months before the current evaluation, but without benefit. During the four months before
the evaluation, she experienced increasing burning pain in the same hand, and
similar symptoms developed in the left hand. She frequently observed blisters on the
first, second, and third digits of the right hand, without any recollection of injury. She
had decreased sensation in the legs, particularly a decreased sensation of temperature,
and feelings of “pins and needles.” There were intermittent, lancinating pains in the
distal portion of the left leg and pain over the left side of the face after it was touched.
She also had hearing loss, which was more prominent in the left ear than in the right.
She recalled two episodes of pruritic rash on the back. More recently, she had observed
swelling of the feet and ankles, especially on the left side.
The patient had immigrated to the United States from India 13 years earlier. She had
worked in an office until the hand pain forced her to retire. She had a long history of
low back pain but no history of arthralgia or articular swelling, although the fingers became
swollen and stiff at times and the right hand sometimes became “purple and
cold.” She experienced frequent constipation, seasonal allergies, and “chronic anemia.”
There were no other gastrointestinal symptoms or changes in bladder function,
changes in weight, fevers, chills, chest pain, palpitations, respiratory symptoms, or
night sweats. Her medications were vitamin B, oxycodone–acetaminophen, and a calcium
supplement; in the past, she had also received vitamin B
12
injections. She had had
three uneventful pregnancies. A sister and a brother were well, as were her children; no
one in her family had neurologic problems.
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"I believe there are more instances of the abridgement of the freedom of the people by gradual and silent encroachments of those in power than by violent and sudden usurpations." James Madison
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