Blood & Lymphoreticular System

{"ops":[{"insert":"Diagnosis and reasoning"},{"insert":"\n","attributes":{"header":1}},{"insert":"This lady has presented with a concerning constellation of neurological findings:\n\n- Abnormal sensation (i.e. numbness and tingling), in a bilateral glove-and-stocking pattern\n- Impaired vibration and proprioception, in the same distribution\n- Brisk reflexes in both upper and lower limbs\n- A positive Romberg sign\n\nNote that the above could be due to a neuropathy, myelopathy, or a neuromyelopathy; further localization should be attempted by performing nerve conduction studies, along with magnetic resonance imaging (MRI) of the spine.\n\nElectrodiagnostic studies turn out to be normal, essentially excluding a neuropathy; however, the spinal MRI reveals symmetric hyperintensity of the posterior columns (i.e. an \u0027inverted V sign\u0027); this can be ca"}]}

Want to continue playing?

Open your Clinical Odyssey account today.

Enjoy unlimited access to 600+ simulations.
Safely improve your skills, anytime and anywhere.
Get answers to your follow-up questions from practicing physicians.