This is a 62-year-old male with 6 months of right arm symptoms. While
lifting his bags into the overhead compartment of an airplane, he experienced
right neck and shoulder pain. Shortly thereafter, he had weakness in the
right upper extremity which has persisted. He also has tingling of the
right forearm and thumb which has improved. He underwent plain films of
the neck, and he was told he had arthritis.
ROS negative for symptoms in the left arm, legs, bladder, speech, swallow
1. Diabetes since 1995.
3. Prostate cancer.
Allergies: Sulfa causing a rash.
Family History: Negative for neurological disorders.
Social History: The patient is a hotel manager. He is
in the "hospitality industry." He smokes half-a-pack per day
and drinks about fifteen ounces per week.
BP 148/72 HR
108 T 37.60C
General: Well appearing.
Mental Status: Normal.
HEENT: II: Visual acuity was 20/20 bilaterally. Visual
fields were full to confrontation. Funduscopic examination revealed flat
discs with venous pulsations seen bilaterally. III, IV, VI: The pupils
are equal, round and reactive to light and accommodation. Extraocular
movements were full, without nystagmus. V: There was normal motor and
sensory function. VII: There was a symmetrical nasolabial fold without
volitional weakness. VIII: Hearing was intact to finger rubbing bilaterally.
IX, X: Palate elevation is symmetrical in the midline. XI: Sternocleidomastoid
was strong bilaterally. XII: Tongue with normal bulk, strength and movement.
Motor (Power/Tone/Bulk): Normal bulk, tone and strength
throughout except the following. Muscle strength 3/5 in the right deltoid,
biceps, brachioradialis. Supraspinatus and infraspinatus 4/5. Atrophy
present in the same muscles.
Sensory: Vibratory sense was diminished to ten seconds
bilaterally at the toes. Joint position sense was intact at the toes.
Romberg was minimally unsteady. Pinprick and light touch were abnormal
to the distal few centimeters of either foot with some abnormal sensation
at the ball of the feet bilaterally. Pinprick and light touch reduced
in the right lateral forearm and thumb.
Reflexes: Biceps 0/4 on the right, 2/4 on the left; triceps
2/4; brachioradialis 0/4 on the right, 2/4 on the left; knee jerk 2/4;
ankle jerk 1/4. Both toes downgoing.
Coordination: Finger-to-nose testing could not be done
on the right. HKS normal bilaterally.
Gait: Tandem was unsteady. Heel walking and toe walking
Abnormal Movements: None.
Other Organs: Noncontributory.