Numb : Part 1

Nervous System & Special Senses


Step 1: View Clinicals

A 60 year old man presents with numbness of both feet for 2 months.


He was diagnosed with type 2 diabetes mellitus 6 years ago, which is well controlled on Metformin alone. His medical history is otherwise unremarkable.


He consumes a mixed diet and only drinks socially.


His HbA1c is 6.0%, while a recent full blood count and serum creatinine were normal.


Step 2: Order Relevant Investigations

1. Electrodiagnostic studies

check

There is a length dependent sensory and motor polyneuropathy.

2. ESR + S. Electrophoresis

check

ESR: 10 mm/1h

The serum plasma electrophoresis shows a normal pattern.

3. Serum Vitamin B12 and Folate

check

Serum Vitamin B12: 95 pg/ml (200 - 900)

Serum Folate: 10 ng/ml (5 - 16)

4. Serum TSH

check

Serum TSH: 1.0 mIU/L (0.4 - 4)

Step 3: Select Appropriate Management

1. Vit-B12 supplementation

check

2. Folate supplementation

clear

3. Gabapentin

clear

4. Protective footwear

check