Patient: male, 66 years old
Diagnosis: Axonal and Demyelinative Sensorimotor Neuropathy
Born in Iraq, immigrated to Israel when was 10.
Married +2, accountant.
Works out in a Gym 3-4 times weekly.
Does not take drugs regularly.
No neurological disease in the family.
During the last 6 years has a cold sensation and stinging of feet at night.
Feels numbness in hands at night.
During walking feels difficulty and also has difficulty in writing. After 20 minutes of walking has pain in gastrocnemius and thighs and has to stop. After a rest, pain disappears.
The cold sensation and the stinging of feet and hands ,only at night.
Nerve conduction and EMG preformed 2 years ago have demonstrated axonal and demyelinative sensorimotor neuropathy with neurogenic changes in muscles.
Was hospitalized for work-up including LP which found protein 76.
Laboratory work-up in the direction of collagen disease, multiple myeloma, B12 defienncy, hypothyroidism , VDRL, were all normal.
Following, tests for HgA1c, protein electrophoresis, urine proteins, Cryoglobulins, anti SSA-SSB, anti Hu, Chest CT – all normal.
An expert’s opinion 2 years ago concluded that the diagnosis is:
Axonal sensor neuropathy of unknown reason, without paraesthesias.
It was concluded that there was no need for nerve biopsy because of the very small chance of finding a treatable disease and only follow-up was recommended.
In the last 2 years complaints have not changed much.
New nerve conduction studies were preformed on October 2008. It was concluded that:
“Nerve conduction testing done today showed evidence for predominantly axonal sensorimotor neuropathy with mild demyelinating features in the legs. EMG study revealed mild chronic neurogenic changes in the distal muscles of the right lower extremity. There were not significant changes as compared with the previous study from 12/2006.”