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Distinguishing Motor Weakness From Impaired Spatial Awareness: A Helping Hand!
Suneil A Raju1, Charles R Swift2, Karna Dev Bardhan2
1Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, UK.
Clinical Medicine Insights. Case Reports
|June 6, 2017
Summary
A 73-year-old man with peripheral neuropathy experienced sudden gait instability and limb weakness. A subdural hematoma was diagnosed and surgically evacuated, leading to rapid symptom resolution.
Area of Science:
- Neurology
- Neurosurgery
Background:
- A 73-year-old male with a history of peripheral neuropathy presented with new-onset gait disturbance and right arm weakness.
- The patient's symptoms mimicked parietal lobe dysfunction, complicating the initial assessment of motor weakness versus spatial awareness deficits.
Observation:
- Clinical examination confirmed motor weakness in the right arm using a specific testing maneuver.
- Urgent computed tomographic (CT) scan revealed a left subdural hematoma.
Findings:
- Surgical evacuation of the subdural hematoma resulted in rapid and complete resolution of the patient's neurological deficits.
- The case highlights the potential for subdural hematomas to present with subtle neurological signs.
Implications:
- This case underscores the importance of considering intracranial pathology in patients with acute neurological changes, even with pre-existing conditions.
- It prompts a re-evaluation of the mechanisms underlying limb position awareness in rehabilitation medicine, suggesting they may be more complex than solely joint position sense.
