Tingling and Numbness
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Tingling andNumbness
Group 12:
CORPUS, KRIZZELLE
ODIGILI, PHILIP
REPATO, ALDRIN A.
REYES, SARAH M.
ROSARIO, WINSTONE
RUDANI, KAUSHAL
SANTILLAN, KENNETH S.
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OUTLINEI. Tingling and NumbnessS#$op%&%
T'r(&$o)o*#Ep&+'(&o)o*#A$-o(# $+ P-/#%
D'r(-o('%Clinical Practice Guidelines:R&%0 -or%H&%-or# T0&$*
7!1" 2
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OUTLINED&*$o%&%C)&$&) E3(&$-&o$
L4. T'%-A)*or&-(
R'+ )*%
II. Hypotetical CaseIII. E!idence "ased #edicine
7!1" !
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$%NOP$I$
umbness$+ tinglingr' 4$or() %'$%-&o$%-- $ our $#/'r' &$ #our 4o+#, 4u- r'o5-'$ 5')- &$ #our 6$*'r%, $+%, 5''-, r(%, or )'*%.
Tingling
8pins and needles
9$ 4$or() po%&-&' %#(p-o( o5 +&%or+'r'+%'$%-&o$.
umbness8 o$%&+'r'+ % $'*-&' %#(p-o(+u' -o )o%% o5 %'$%or# 5u$-&o$ $+ +&(&$&%'+ or4%'$- 5'')&$*
7!1"Harrison&s Principles o' Internal#edicine( )*t Edition ;
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SYNOPSIST/o C-'*or&'% o5 4$or() S#(p-o(%:
Positive $+ egative Symptoms
Pro-o-#p&) Po%&-&' S#(p-o(:
Tingling ( pins and needles)
I-, pr&0&$*, )&*-$&$* )&0' %oo-&$* 5'')&$*%
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SYNOPSISPositive Phenomena
-r&$% o5 &(pu)%'% *'$'r-'+ - %&-'% o5 )o/'r'+
-r'%o)+ or '&*-'$'+ '3&-4&)&-# )o$* p'r&p'r) or '$-r) %'$%or# p-/#.
egative Phenomena
)o%% o5 %'$%or# 5u$-&o$.+&(&$&%'+ or 4%'$- 5'')&$*.
umbness
7!1"Harrison&s Principles o' Internal#edicine( )*t Edition "
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TE+#INOLOG%Paresthesias8 r'5'r% -o -&$*)&$* or p&$%9$+9$''+)'%%'$%-&o$% 4u- (# &$)u+' /&+' r&'-# o5 o-'r4$or() %'$%-&o$%, '3'p- p&$? &- &% %o('-&('% &(p)&'%
-- -' 4$or() %'$%-&o$% r' p'r'&'+ %po$-$'ou%)#.
Dysthesias
8 (or' *'$'r) -'r(
9D'$o-'% )) -#p' o5 4$or() %'$%-&o$%, &$)u+&$* p&$5u)o$'%, r'*r+)'%% o5 /'-'r %-&(u)u% &% '&+'$-.
Hypesthesia or hypoesthesia8 r'5'r% -o r'+u-&o$ o5u-$'ou% %'$%-&o$ -o %p'&6 -#p' o5 -'%-&$* %u %pr'%%ur', )&*- -ou, $+ /r( or o)+ %-&(u)&
7!1"Harrison&s Principles o' Internal#edicine( )*t Edition 7
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TE+#INOLOG%Anesthesia8 o(p)'-' 4%'$' o5 %0&$ %'$%-&o$ -o -'%(' %-&(u)& p)u% p&$pr&0
Hypalgesia or analgesia8 -o r'+u' or 4%'$- p&$
p'r'p-&o$
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EPIDEMIOLOGYA% *' pro*r'%%'%, o$' ou- o5 -r'' p'op)'
%u'r 5ro( $'urop-# or $'r' +(*'.
I- &% )%o '%-&(-'+ -- rou$+ 1B -o 1>(&))&o$ &)&p&$o% ' $'urop-#.
N'urop-# '-% p'op)' /o ' $u$4)$'+ +&'- $+ u$')-# )&5'%-#)', /&
&$)u+'% %(o0&$*, )oo) +r&$0&$*, or -o%'/o + &$ur&'% or ' +&4'-'%.
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ANATOMY
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Spinothalamic Pathway
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DERMATOMES
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,E+#-TO#E$ $ r' o5 %0&$ -- &% %'r'+ 4# %&$*)' %p&$)
$'r'.
+'r&'+ 5ro( -' '))% o5 %o(&-'.
(&)&r&-# /&- -' +'r(-o('% &% )&$&))# u%'5u)
&$ )o)&&$* -' )'%&o$ -o $'r' roo- or %p&$)or+ pr-&u)r)# &$ r+&u)op-#.
T' ) spine segments o$ ' %&+' *&' r&%' -o!1 %p&$) $'r'%, /& r' o(po%'+ o' /cer!ical( )0 toracic( 1 lumbar( 1 sacral( and )coccygeal spinal ner!e. ,ermatomes '3&%- 5or
' o5 -'%' %p&$) $'r'%, '3'p- -' 6r%- 'r&)%p&$) $'r'. S'$%or# &$5or(-&o$ 5ro( %p'&6+'r(-o(' &% -r$%(&--'+ 4# -' %'$%or# $'r'64'r% -o -' %p&$) $'r' o5 %p'&6 %'*('$- o5-' %p&$) or+.
tora2 and abdomen, -' +'r(-o('% r' ''$)#
%p'+ %'*('$-% %-0'+ up o$ -op o5 ' o-'r,$+ ' &% %upp)&'+ 4# +&'r'$- %p&$) $'r'.
arms and legs3 +&'r 5ro( -' p--'r$ o5 -' -ru$0+'r(-o('%, 4'u%' -'# ru$ )o$*&-u+&$))# )o$*-' )&(4%. T' *'$'r) p--'r$ &% %&(&)r &$ ))p'op)', 4u- %&*$&6$- r&-&o$% '3&%- &$ +'r(-o('
(p% 5ro( p'r%o$ -o p'r%o$
REFERENCE:http://emedicine.medscape.com/article/188!88"o#er#ie$
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LOC-LI4-TION
7!1"Harrison&s Principles o' Internal#edicine( )*t Edition 1;
NE+5E -N, +OOTNer!e trun6 lesion7 u%' %'$%or#4$or()&-&'%
+oot radicular lesion 8 +''p &$* p&$ )o$*-' our%' o5 -' r')-'+ $'r' -ru$0Upper Cer!ical cord lesion 8 '-% 4o- $+%$+ 5''-Upper motor lesion7 %p&$-'r &$o)'('$-Central8"rainstem Lesion7 S'$%or#+&%-ur4$', '-% )) '3-r'(&-&'%, u%'%%#$*o(#')&$pinal cord Lesion7 S'$%or# +&%%o&-&o$,
$u(4$'%% or pr'%-'%&% &$ 4o- 5''-.
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LOC-LI4-TION"+-IN$TE# $mall lesion in te brainstem7 +(*' 4o- &p%&)-'r)
+'%'$+&$* -&*'(&$0 -r- $+ %'$+&$* %p&$o-)(& 64'r%
Lesion in te tegmentum o' Pons and #idbrain9 u%'%p$%'$%or# )o%% o$-r)-'r))#
Lesion in te Talamus7 )$u)r &$5r-&o$, /& '-% PL$u)'u%, u%'% T)(& p&$ r'5'rr'+ -o %, D''$$'9Rpu%%#%#$+ro('.
CO+TE9
Parietal lobe lesion7 o$-r)-'r) '(&$'*)'-, '(&&$--'$-&o$, -'$+'$# $o- -o u%' -' '-'+ $+ or r(
-nterior Parietal in'arction7 p%'u+o-)(& %#$+ro(' /&-o$-r)-'r))o%% o5 pr&(r# %'$%-&o$5ro( '+ -o -o',
7!1"Harrison&s Principles o' Internal#edicine( )*t Edition 1>
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+I$ ;-CTO+$ Extra weight.Being overweight or obese may
increase the pressure on your lateral femoral
cutaneous nerve
Pregnancy.A growing belly puts a!!e! pressure
on your groin" through which the lateral femoralcutaneous nerve passes
Diabetes.#iabetes$relate! nerve in%ury can lea!
to meralgia paresthetica
Age.People between the ages of &' an! (' are
at a higher ris)
Lifestyle habits A se!entary lifestyle an! poor
nutrition*+itamin B comple,- are ma%or ris) factors
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HI$TO+% T-ING W- pr- or pr-% o5 #our 4o+# ' $u(4$'%%
or -&$*)&$*F T' -ru$0F Your )'*% or 5''-F Yourr(%, $+%, or 6$*'r%F
W& %&+' o5 #our 4o+# &% &$o)'+F W& r' o5 -- 4o+# pr-F or '3(p)', &%
#our &$$'r -&*, )5, or 5oo- '-'+F Your p)(,6$*'r%, -u(4, /r&%-, or 5or'r(F
Do'% -' $u(4$'%% or -&$*)&$* '- #our 5'FArou$+ #our '#'%F Your ''0%F Arou$+ #our(ou-F I% o$' or 4o- %&+'% o5 #our 5'&$o)'+F
7!1" Pennstateersey.adam 17
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HI$TO+% T-ING Do'% -' pr- o5 #our 4o+# /&- $u(4$'%% or
-&$*)&$* $*' o)or%F Do'% &- 5'') o)+ or/r(F
Do #ou ' o-'r 4$or() %'$%-&o$%F
Do #ou &*$or' ''r#-&$* o$ -' '-'+%&+'F
Ho/ )o$* ' #ou + -' $u(4$'%% or-&$*)&$*F
W'$ +&+ &- %-r-F
Do'% $#-&$* (0' &- /or%', %u %
'3'r&%' or %-$+&$* 5or )o$* p'r&o+% o5 -&('F7!1" Pennstateersey.adam 1@
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+E5IE< O; $%$TE#General
W'&*- )o%% or *&$
-&*u' ''r or &))%
W'0$'%%
Trou4)' %)''p&$*
Neurologic
D&&$'%%
&$-&$*
S'&ur'%
W'0$'%%
Nu(4$'%% T&$*)&$*
Tr'(or
7!1"
"-TE$=$ Guide to Pysical
E2amination and History Ta6ing( ))tedition 1
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,I;;E+ENTI-L ,I-GNO$I$Common:
DM 1 $+ 2A)oo)&%(Upp'r $+ Lo/'r E3-r'(&-# N'urop-&'%Au-' S-r'%% D&%or+'r
H#p'r'$-&)-&o$
S-ro0' S#$+ro('R'$) &)ur'
H'rp'% o%-'r
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,i>erential ,iagnosisOccasional
Dru*%Nu-r&-&o$) D'6&'$#
R'%-)'%% L'*% S#$+ro('Gu&))&$9rrJ %#$+ro('Cr$&) N'r' N'urop-&'%H#po-#ro&+&%(
L'pro%#Sro&+o%&%L#(' D&%'%'M'-4o)&
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-pproac in Internal #edicine.( C$#adgaon6ar 21
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,i>erential ,iagnosis+are
%u)&-&% S#$+ro('Mu)-&p)' M#')o(
Ho+*0&$% +&%'%'Pr$'op)%-& %#$+ro('M)&*$$#D&p-'r&Porp#r&To3&$%D''r&$'9Rou%%# %#$+ro('CIDPH'r'+&-r#
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Clinical E2amination o'
$ensationPrimary $ensation
Pain9 P&$%Temperature9 /r( or o)+Touc9 /&%p?oint Position Testing7 propr&o'p-&o$5ibration7 -u$&$* 5or0
@uantitati!e $ensory Testing%'r&) ')u-&o$ o5 u-$'ou% %'$%-&o$% &$
)&$&) -r&)%
7!1"Hrr&%o$% Pr&$&p)'% o5 I$-'r$) M'+&&$',1- E+&-&o$ 2!
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CLINIC-L E9-#
Cro$& &$((-or# +'(#')&$-&$*
po)#r+&u)o$'urop-#
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E9-#IN-TION O;
$EN$-TIONCortical $ensationTAo7point ,iscrimination9 %p'&) )&p'rTouc LocaliBation9 )&*- pr'%%ur'? /&%p o5
o--o$ /oo)&)-'r) S&(u)-$'ou% S-&(u)-&o$%Grapestesia9 )'--'r%, $u(4'r% p)( o5
$+$tereognosis9 0'#%, pp'r )&p%, o&$%.
7!1"Hrr&%o$% Pr&$&p)'% o5 I$-'r$) M'+&&$',1- E+&-&o$ !"
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L-"O+-TO+% TE$T$General Lab testsC"C7iron deciency anemia( macrocytic
anemia and Leu6ocytosis
E$+7 systemic and inDammatory processes
"lood( Glucose( Urea( Creatinine(Electrolytes
C9+7rule out lung cancer and sarcoidosis
97ray
7!1" Hrr&%o$% Pr&$&p)'% o5 I$-'r$) M'+&&$',1- E+&-&o$ !7
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L-"O+-TO+% TE$T$Sp'&6 L4 -'%-%T$H7 #po-#ro&+&%(.Ner!e Conduction $tudy NC$F7-#p' o5 PN,
3o$) 5ro( +'(#')&$-&$* $'urop-&'%.CT8#+I7 %-ro0'? 'r&), -or&, %p&$)
o(pr'%%&' %#$+ro('%? -or& ou-)'-%#$+ro('? (u)-&p)' %)'ro%&%? 4r&)
p)'3u%'&+'$' o5 &$6)-r-&$* P$o%- )'%&o$.
7!1" Hrr&%o$% Pr&$&p)'% o5 I$-'r$) M'+&&$',1- E+&-&o$ !@
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L-"O+-TO+% TE$T$$pecic Lab tests
Ner!e "iopsy7 &$((-or#, &$5'-&ou%, $+('-4o)& PN%.
Lyme Titer7 L#(' +&%'%' ($&5'%--&o$%.C$; -nalysis7 &$((-or#, &$5'-&ou%, r&'-#
o5 &((u$'('+&-'+ PN%
$erum Protein Electroporesis and
Immuno2ation7 (u)-&p)' (#')o( oro%-'o%)'ro-& (#')o(
To2ic $creen
Genetic Test
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-LGO+ITH# O; TINGLING-N, NU#"NE$$ +EL-TE,
NEU+OP-THIE$
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7!1" Hrr&%o$% Pr&$&p)'% o5 I$-'r$) M'+&&$',1- E+&-&o$ ;1
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7!1" Hrr&%o$% Pr&$&p)'% o5 I$-'r$) M'+&&$',1- E+&-&o$ ;2
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RED LAGS
Su++'$ o$%'- o5 $u(4$'%% Su++'$ or rp&+ o$%'- o5 /'0$'%% D#%p$' S&*$% o5 u+ 'u&$ or o$u% ('+u))r&%
%#$+ro(' N'uro)o*& +'6&-% 4')o/ %p&$) %'*('$-
7!1" #$, #anualttp:88AAA.gponline.com ;!
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RED LAGS
Lo%% o5 %'$%-&o$ o$4o- -' 5' $+ 4o+#
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+E, ;L-G$ O; NU#"NE$$8TINGLING
Su++'$ o$%'- o5 $u(4$'%% Su++'$ or rp&+ o$%'- o5
/'0$'%% D#%p$' S&*$% o5 u+ 'u&$ or o$u%
('+u))r&% %#$+ro(' N'uro)o*& +'6&-% 4')o/ %p&$)
%'*('$- Lo%% o5 %'$%-&o$ o$ 4o- -'
5' $+ 4o+#
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H%POTHETIC-LC-$E
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H#po-'-&) C%'A >"9#'r9o)+ ($, pr'&ou%)# /')), pr'%'$-% -o &%pr&(r# r' p#%&&$ /&- ;9(o$- &%-or# o5 4ur$9&$* p&$ &$ -' %o)'% o5 &% 5''-. T' p&$ &% +'%r&4'+
% 4'&$* /or%' - $&*-5r'u'$-)# % pr''$-'+ &(5ro( 5))&$* %)''p, $+ % r''$-)# 4''$ /0'$&$*&( 5ro( %)''p. H' 5ou$+ -- '-(&$op'$ -4)'-%+&+ $o- r')&'' -' p&$. H' + $o-&'+ %o(' +#-&('$u(4$'%% $+ -&$*)&$* %'$%-&o$% %-r-&$* - 4ou- -'
%(' -&(', $+ &$ -' %(' +&%-r&4u-&o$ % -' p&$. H'+&+ $o- ' /'0$'%%, )o/ 40 p&$, 4o/') or4)++'r +&%-ur4$'%, 4u- % '3p'r&'$'+ 'r'-&)'+#%5u$-&o$ &$ -' )%- 1 -o 2 (o$-%.
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CHIE COMPLAINur$&$* P&$ &$ -' %o)'% o5 &% 5''-D#-&(' -&$*)&$* $+ $u(4$'%% %'$%-&o$%
Er'-&)' D#%5u$-&o$ 5or -' )%- 192 (o$-%
7!1" Hrr&%o$% Pr&$&p)'% o5 I$-'r$) M'+&&$',1- E+&-&o$ ;@
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#E,IC-L HI$TO+%T' p-&'$-% ('+&) &%-or# /% %&*$&6$-5or $ pp'$+'-o(# 2B #'r% *o
H#p'r-'$%&o$ 5or 1 #'r, $+ $ 'p&%o+' o5u-' *ou- &$ -' )'5- 6r%- -o' > #'r% *o
S'%o$) ))'r*&'% -o *r%% $+ r*/''+. H'-0'% ('-opro)o) 2> (* o$' +&)#.
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+E5IE< O; $%$TE#$5'')% /')) $+ &% /'&*- &% %-4)'.% *oo+ pp'-&-'.
'3p'r&'$'% )&*-9'+'+$'%% o$ %-$+&$* u&0)#,
4u- +o'% $o- ' %#$op) 'p&%o+'%.+o'% $o- ' '+'%, $or +o'% ' '
$*'% &$ &%&o$ or 4u)4r 5u$-&o$%.
H' +'$&'% %or-$'%% o5 4r'-, '%- p&$, or
p)p&--&o$%?5ur-'r(or', -'r' &% $o &%-or# o5 $u%',
o(&-&$*, or 4+o(&$) p&$, 4u- ' % $o-'+ro$& o$%-&p-&o$
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;-#IL% HI$TO+%T' p-&'$-% 5-'r +&'+ - *' "> o5 (#or +&) &$5r-&o$.
H&% (o-'r + -#p' 2 +&4'-'% ('))&-u%, $++&'+ - *' 7B o5 %-ro0'.
H' % 2 4ro-'r%, *'+ "B $+ >;-' 6r%-% +&4'-'%, #p'r-'$%&o$, $+ o4'%&-#, $+-' %'o$+ % &%-or# o5 (#or+&)&$5r-&o$.
T' p-&'$- % ! &)+r'$, 2 o5 /o( r'o'r/'&*-.
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$OCI-L HI$TO+%T' p-&'$- /% 4or$ $+ r&%'+ &$ O%/, O$-r&o,C$+, $+ /or0% - G'$'r) Mo-or% % )&$'&$%p'-or.
'$o#% /-&$* %por-% o$ -')'&%&o$.H' )oo0% 5-'r -' #r+, 4u- +o'% $o- p)# $# %por-% or
4')o$* -o *#(.
+r&$0% 2 -o ! 4''r% +&)# $+ +ou4)' -&% (ou$- o$/''0'$+ +#%.
%(o0'% 2 p0% o5 &*r'--'% +&)#, $+ % +o$' %o 5or!B #'r%.
% $o- u%'+ r'r'-&o$) +ru*% %u % (r&u$,o&$', or 'ro&$
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PH%$IC-L E9-#IN-TIONpp'r% -o 4' $ )'r-, oop'r-&', $+ o4'%' ($/o pp'r% o)+'r -$ &% %--'+ *'
(&)+ +&%-r'%% +u' -o +&%o(5or- &$ &% 5''-
W'&*-: 2!B )4%,
P 1>B> (( H* HR:1B; 4p( $+ r'*u)r
RR&% 1" 4r'-% p'r (&$u-'
o+# T'(p: !7QC.
T' r$&) $'r'% r' $or().H&% $'0 &% %upp)'.
T'r' &% %o5- )'5- ro-&+ 4ru&- 'r+ +ur&$* %#%-o)'.
T'r' &% $o u*u)r '$ou% +&%-'$%&o$.
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PH%$IC-L
E9-#IN-TIONT' -#ro&+ &% $or() &$ %&'.T' '%- &% $or() $+ 4r'- %ou$+% $or().
T' %'o$+ 'r- %ou$+ &% '$-u-'+, $+ -'r'
r' $o (ur(ur% or -r&))%.T' 4+o('$ &% +&%-'$+'+, 4u- $o$-'$+'r -o
p)p-&o$ /&- $or() 4o/') %ou$+% $+ $o'p-o%p)'$o('*)#.
T' *'$&-)& r' $or(), % &% r'-) -o$'.T' p-&'$- % +r# %0&$ o$ -' )o/'r '3-r'(&-&'%.
T' %0&$ &% (o--)'+ $+ oo) /'$ +'p'$+'$-
P & ) ) ) + + -
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P'r&p'r) pu)%'% r' $or(), $+ ' +o'% $o-' '#(o%'%, p'-'&', or r%'%.
H' +o'% $o- ' p'+) '+'(.
T' p-&'$- pp'r% -o ' $or() %-r'$*-.
H&% $0)' r''3'% r' 4%'$-.
S'$%or# )o%% &$ -' 5''- &% %%u('+ -o 4'
pr'%'$- o$ p)p-&o$, 4u- $o o4'-&' -'%-%r' p'r5or('+.
H&% *&- &% $or().
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NEU+OLOG% CON$ULT-TION
-' p-&'$- + -' %(' %#(p-o(% %pr'&ou%)# +'%r&4'+
T' p-&'$- % $o-'+ '3'%%&' -&r%- $+ur&$-&o$ 5or -' )%- @ (o$-%. H&% /'&*- %
4''$ %-4)'. H' &% 4'o(&$* +'pr'%%'+ 4ou--' p&$.
T'r' &% $o 5(&)# &%-or# o5 $'uro(u%u)r+&%or+'r%. T' p-&'$- r'por-% ' % $''r
+ $# o44&'% %u % /oo+9/or0&$* orr'6$&%&$* 5ur$&-ur' /&- po-'$-&) '3po%ur' -o-o3& *'$-%.
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Nor() ('$-) %--u% $+ %p''u$+o%op& '3(&$-&o$ %o/% (&)+ A9
$&0&$* o5 -' '%%')%, 4u- -' r$&) $'r'%r' o-'r/&%' $or().
M&)+)# r'+u'+ (u%)' 4u)0 &% &$ -' %()) 5oo-(u%)'% $+ -'r' &% (&)+ )/&$* o5 -' -o'%.
To$' $+ oor+&$-&o$ -'%-&$* r' $or().
T' +''p -'$+o$ r''3'% r' $or() &$ -'
upp'r )&(4% $+ - -' 0$''%, 4u- 4%'$- --' $0)'%.
T' p)$-r r'%po$%'% r' '3or.
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S'$%or# -'%-&$* %o/% %-o0&$* )o%% o5 )&*--ou, p&$pr&0, $+ -'(p'r-ur' %'$%-&o$%-o -' $0)'%, $+ )o%% o5 &4r-&o$ %'$%-&o$
- -' -o'%, 4u- propr&o'p-&o$ &% $or().T' po%-ur', *&-, -$+'( *&-, $+ Ro(4'r*
-'%-% r' $or(). T' p-&'$- &% 4)' -o /)0o$ '')% $+ -o'% /&-ou- +&u)-&'%.
-
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,I;;E+ENTI-L
,I-GNO$I$D&4'-& N'urop-#Cu+ Eu&$ S#$+ro('
P'r$&&ou% $'(& $+ 12 D'6&'$#
7!1" >
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D&4'-& N'urop-#,ecrease or loss o' !ibratoryLo%% o5 p&$pr&0 %'$%-&o$
Dr# %0&$
A4+o(&$) +&%-'$%&o$
Nausea an! vomiting
Constipation
Hig glucose
7!1" "B
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Cauda Euina $yndrome
.ow bac) pain.ower limb motor wea)ness an! sensory
deficits
/rinary !ysfunction
Bowel disturbances- constipation
.oss of anal tone an! sensation
Sexual dysfunction
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Pernicious -nemia and ")0,eciency
Peripheral loss of vibratory sense
.oss of posisition senseposition
0efle, loss an! mil!$to$mo!erate wea)ness
Babins)i1s responses an! ata,ia
2mpairment of pain te!perature and touch
sensations.
L-"O+-TO+%
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L-"O+-TO+%
;IN,ING$G)#'-'+ H'(o*)o4&$ A1
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L-"O+-TO+%
;IN,ING$N'r' o$+u-&o$ %-u+&'%u$-&--&' %'$%or# -r'%o)+% %o/%
')'-'+ &4r-&o$ p'r'p-&o$ -r'%o)+ - -'
-o'%,/&- $or() )'')% - -' 6$*'r%.T' oo)&$*9+'-'-&o$ $+ H'-9+'-'-&o$
-r'%o)+% r' ')'-'+ &$ -' 5''- $+ $or()&$ -' $+%.
7!1" ";
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;inal ,iagnosis,iabetic Neuropaty
7!1"Hrr&%o$% Pr&$&p)'% o5 I$-'r$) M'+&&$',1- E+&-&o$ ">
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E"#DE$%E BASED
&ED#%#$E
Evaluation of post-operative flow and dia!eter changes in brachial and ulnar
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Evaluation of post-operative flow and dia!eter changes in brachial and ulnar
arteries in coronary artery bypass surgery patients in which the radial artery is
used as graft. O"?ECTI5E:
T' r+&) r-'r# &% /&+')# u%'+ &$ oro$r# 4#p%% %ur*'r#. I$ -'%' p-&'$-%, 5or'r(
$+ $+ &ru)-&o$ &% pro&+'+ 4# -' u)$r r-'r#. T&% %-u+# &('+ -o &$'%-&*-'po%-9op'r-&' $*'% &$ o/ $+ +&('-'r &$ 4r&) $+ u)$r r-'r&'% &$ p-&'$-%u$+'r*o&$* oro$r# 4#p%% %ur*'r# &$ /& -' r+&) r-'r# &% u%'+ % *r5-.
#ETHO,$:
'-/''$ S'p-'(4'r 2BB7 $+ S'p-'(4'r 2BB@, 2B p-&'$-%