Here is an Indian gentleman who complaints of feeling shaky on walking for the past 3 years. The onset is insidious and his condition gradually worsen for the period mentioned.
There is trophic changes noted over the lower limbs i.e. the skin is shinny, smooth and loss of hair. There is hyperpigmented skin lesions suggestive of diabetic dermopathy. There is no muscle wasting and the power is normal.There is impairment of sensation to vibration sense, joint position and pinprick over a stocking distribution ( from foot up to knee level). The reflexes are absent.
There is sensory ataxia as evidenced by positive Romberg's sign and stamping gait (broad based gait, foot stamping on the floor)In conclusion, he has a peripheral neuropathy predominantly involving the sensory component. Functionally, he has sensory ataxia due to impaired joint position sense. The likely cause would be diabetes mellitus in view of the diabetic dermopathy.I would like to complete my examination by:1. Checking the upper limbs (sensory loss over a glove distribution)2. Palpating the peripheral pulses (peripheral arterial disease due to the trophic skin changes)3. Examine the fundus for diabetic retinopathy.4. Checking the urine for sugar.What are the other causes for sensory peripheral neuropathy?
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