Lab Studies:
Emergency Department:
Chemistry: CMP within normal limits, CPK 252, TSH 0.2
Hematology: WBC 15.6, otherwise CBC within normal limits
Other Studies:
X-ray lumbosacral spine (ED): Mild multilevel degenerative changes of the lumbar spine most pronounced at L3-L4. Case Photo #1 Case Photo #2
MRI lumbar spine: Mild degenerative changes including mild L3-L4 disc bulge. No spinal canal stenosis or nerve root compression. Case Photo #3
MRI lumbosacral plexus: Peripheral neuropathy of L3-L4 nerve roots extending into the femoral nerve. Subacute denervation changes with mild atrophy in quadriceps, sartorius and pectineus muscles. Case Photo #4 Case Photo #5 Case Photo #6 Case Photo #7
EMG/NCS: Abnormalities in distribution of femoral nerve proximal to the branch to the iliopsoas with ongoing active denervation and evidence of early re-innervation.
Consultations:
Neurology was consulted and the following labs were obtained:
Chemistry: CMP, T4/T3, B12 and ESR within normal limits. CPK 90, RBC folate slightly high.
Hematology: CBC within normal limits with WBC 8.2.
Infectious: HIV, Syphilis, Hepatitis B and C, B. burgdorferi, cryptococcus, and tuberculosis all negative.
Autoimmune: Positive ANA (1:160). dsDNA, ANCA, C3, C4, RF, RNP, Smith, SSA, and SSB all negative.
CSF: Cell counts, protein, glucose within normal limits. Normal MS profile.
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