Not Just Another Case Of Sciatica

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Not Just Another Case Of Sciatica - Page #3

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. Click here to continue. Challenge yourself by writing down a revised, working diagnosis before moving to the next slide.		Back
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