Areflexia and Loss of Vibration and Position Sense in the feet - USMLE Forums
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  #1  
Old 10-21-2011
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Hammer and Otoscope Areflexia and Loss of Vibration and Position Sense in the feet

Over the course of the last year, a 69-year-old Russian immigrant develops problems with urinary incontinence, a very unsteady gait, and a sharp stabbing pain in his legs. He has not been previously sick or had any recent sick contacts. On physical exam, it is noted that he has absent deep tendon reflexes, no vibratory or position sense in his feet, and a positive Romberg sign. He has no problems with rapid alternating movement and no tremors. His serum glucose and hemoglobin A1C is normal. What is the most likely diagnosis?

A. Friedreich's ataxia
B. Cerebellar ischemia
C. Guillain-Bare syndrome
D. Tabes dorsalis
E. Vitamin B12 deficiency
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  #2  
Old 10-21-2011
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i m with tabes dorsalis
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  #3  
Old 10-21-2011
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it could be E ?
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  #4  
Old 10-21-2011
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D. Tabes dorsalis
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  #5  
Old 10-21-2011
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parasthesian,pain and poyuria--Tabes dorsalis
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Old 10-22-2011
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Quote:
Originally Posted by dr.muhamad View Post
it could be E ?
I think then it could be easy to find out with lab tests and he would have anemia symptoms as well
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  #7  
Old 10-22-2011
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Default E

the fact is it could be any of the given options but since the question mentions a russian immigrant .., Assuming some sort of giardia malabsorption syndrome ., i would go with option "E" . I stand to be corrected . And explain how else could you exclude the other options . Thanks .
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Old 10-24-2011
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What is the answer ricko335? thanks
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Old 10-24-2011
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D would be correct.
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Old 10-24-2011
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D. Tabes dorsalis
typical for it lose position and vibratory sense
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  #11  
Old 10-24-2011
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C. Guillain-Bare syndrome

***has absent deep tendon reflexes
*urinary incontinence, a very unsteady gait, and a sharp stabbing pain in his legs.
*no vibratory or position sense in his feet, and a positive Romberg sign.

Seems like a classic presentation.

Last edited by slowpoke; 10-24-2011 at 05:40 PM.
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Old 10-24-2011
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I would go with Tabes Dorsalis...

As there is no H/O either respiratory or GIT infection, that excludes "Guillain-Bare syndrome".

Hyporeflexia or Areflexia is common in this age group.
Vit B 12 Deficiency does not explain "urine incontinence" plus there is no clue about Anemia. (Of course Russian like Vodka.. ).

Interesting queston..would be looking forward its answer.
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  #13  
Old 10-24-2011
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I am pretty sure these funny Step people want to talk about vodka in here...
Like just because of that i'd go with B12...

But G.-Barre actually fits better. After campylobacter infection for example.


...why do they always put us Russians into stereotypes...
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Old 10-24-2011
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What's the answer?
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Old 10-24-2011
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Urinary incontinence, unsteady gait, sharp standing pain in legs (paresthesias and pain --> dorsal root irritation), absent deep tendon reflexes (areflexia --> dorsal root irritation), no vibratory or position sense in his feet and a positive Romberg sign (the most important) all indicate dorsal column syndrome seen in tabes dorsalis.

So i'll go with D.

E --> entails UMN lesion signs (e.g. spastic paresis) due to demyelination of corticospinal tracts.
C --> postinfectious polyneuritis, follows infectious illness (''He has not been previously sick or had any recent sick contacts'')
A --> similar to E
B --> actually i don't know but i assume his reflexes would be fine.
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Old 10-24-2011
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it is tabes dorsalis
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  #17  
Old 10-25-2011
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Tabes dorsalis ..
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Old 10-26-2011
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Default D

B12 Neuropathy damages dorsal columns, spinocerebellar tracts and lateral corticospinal tracts. So the patient should have some UMN signs as well
On the other hand tabes dorsalis affects only the sensory pathways in the dorsal column which also causes dorsal column ataxia and a romberg sign. So I think D is a better option.
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Clinical-Signs, Nervous-System-, Neuroanatomy-, Pathology-, Step-1-Questions

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