Neurology

Answer 1 Peripheral nerves. This patient has an acute sensory-motor syndrome affecting the legs and arms, with a distal predominance. Reflexes are diffusely absent, with loss of vibration in a stocking pattern. The presence of areflexia and a distally predominant sensorimotor deficit suggests a diffuse large-fiber polyneuropathy of motor and sensory nerves. The patient has no ataxia or nystagmus suggesting a cerebellar disorder. The presence of sensory symptoms and distally predominant weakness argue against a disorder of the neuromuscular junction or muscle. A spinal cord disorder would be expected to produce a sensory deficit to pain and temperature below a segmental spinal level and upper motor neurons signs (eg, hyperreflexia, Babinski’s sign). SUGGESTED READINGS 1. Pascuzzi RM, Fleck JD. Acute peripheral neuropathy in adults. Guillain-Barré syndrome and related disorders. Neurol Clin 1997;15:529-47. Click here to return to the questions

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