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.
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
There is a length dependent sensory and motor polyneuropathy.
2. ESR + S. Electrophoresis
ESR: 10 mm/1h
The serum plasma electrophoresis shows a normal pattern.
3. Serum Vitamin B12 and Folate
Serum Vitamin B12: 95 pg/ml (200 - 900)
Serum Folate: 10 ng/ml (5 - 16)
4. Serum TSH
Serum TSH: 1.0 mIU/L (0.4 - 4)
1. Electrodiagnostic studies
There is a length dependent sensory and motor polyneuropathy.
2. ESR + S. Electrophoresis
ESR: 10 mm/1h
The serum plasma electrophoresis shows a normal pattern.
3. Serum Vitamin B12 and Folate
Serum Vitamin B12: 95 pg/ml (200 - 900)
Serum Folate: 10 ng/ml (5 - 16)
4. Serum TSH
Serum TSH: 1.0 mIU/L (0.4 - 4)
Step 3: Select Appropriate Management
1. Vit-B12 supplementation
2. Folate supplementation
3. Gabapentin
4. Protective footwear
1. Vit-B12 supplementation
2. Folate supplementation
3. Gabapentin
4. Protective footwear