is a 37 year-old male who complains of pain and right leg weakness. It began
two months ago. He was bending down to lift a chair and developed acute
pain in the right back and buttocks. Painful sensations radiated into his
lateral calf and top of the foot. It was associated with numbness that started
in his right big toe, 2nd and 3rd toes. The patient reports the pain is
worse with sitting, but standing and walking are also bad. He denies bowel
or bladder problems, left leg symptoms, and the arms are fine.
PMH: Intermittent low back pain.
Allergies: PCN causes rash.
Family History: Noncontributory
Social History: He is currently unemployed. He has been
a one pack a day smoker
for 19 years. Drinks occasionally.
BP 112/60 HR 72
T 36.7°C Wt __
General: Thin. No acute distress.
Mental Status: Alert and oriented x 3. Speech fluent
HEENT: Head was normocephalic and atraumatic. Neck was
supple, with full range of motion.
CN: The pupils were equal, round and reactive to light
and there was no relative afferent pupillary defect. Extraocular movements
were intact without nystagmus. Visual field testing was full to confrontation.
Optic discs were sharp bilaterally with venous pulsations present. There
was no facial weakness. Facial sensation was intact. The palate elevated
symmetrically. Full sternocleidomastoid strength. The tongue was midline
Motor (Power/Tone/Bulk): 5/5 left lower extremity. Right:
5/5 hip flexion, 5/5 knee flexion and extension, 4-/5 dorsiflexion, 5/5
plantar flexion, and 4-/5 EHL. No atrophy. Right straight leg raise caused
pain down the lateral leg.
Sensory: Sensation was intact to light touch, pin prick
and proprioception bilaterally in the upper and lower extremities, except
in the dorsum of the right foot and great toe.
Reflexes: 2/4 bilateral biceps, brachioradialis, triceps,
patellar and Achilles.
Coordination: Finger-to-nose and rapid alternating movements
were intact bilaterally.
Gait: Antalgic, without ataxia. Patient unwilling to
try toe or heel walking due to pain.
Abnormal Movements: None.
Other Organs: Noncontributory.