Numb Extremity

[FeatherWeight]

So this last weekend I was in LA working as a standby EMT for a boy scout camp and we had this PT with numbness in his left foot up to his knee. He had full muscle range, cap refill was normal, but his sensation was shot. NKA, no Hx, no medications, and his skins were warm and dry. His vitals were normal as well.

I didn't know what to tell the poor kid...can anybody tell me if they have seen this before or what I could have done different?

Thanks

 

[Zeroo]

Maybe his foot "fell asleep"? lol Best answer I could come up with. I know that it doesn't last long but I have had it happen to me from my knee all the way down to my foot...

 

[FeatherWeight]

I doubt it. The PT stated it was a slow onset that has gotten worse over the past several hours.

 

[bigbaldguy]

Could be some kind of inflammation placing pressure on nerve to leg. Something similar that can occur in the arms is called thoracic outlet syndrome. I'm sure there's an analog for the leg.

Something like this perhaps. http://en.wikipedia.org/wiki/Sciatica

 

[Sasha]

Any swelling?

 

[FeatherWeight]

Nope no swelling and no pain. His socks were dry and his shoes weren't super tight either

 

[mycrofft]

Up to the knee means popliteal. Getting worse means progressing.Get him seen.

For sheets and grins, does the numbness follow a dermatkme or is it all over ("gloving", or I guess "Stocking-ing")?

 

[FeatherWeight]

His numbness was circumferential. My thoughts were maybe he had a allergy he was unaware of because when I eat peanuts I get tingles in my hands and feet but it doesnt progress and follows with a nice migraine

 

[mycrofft]

If i was allergic you wold have seen other dermatologic and respiratory effects. Insult or accident in the popliteal space affects what structure?

Also, if it doesn't follow a dermatome, it might not be neuro; if it doesn't cause claudication or other circa signs (pallor, coldness, engorgement, purplement, or change pulses, it probably isn't circulatory. IF it occurs either soon after arrival or either before or right after a fearsome event, it may be Munchausen six*.



(*"Camp Granada Syndrome",
[YOUTUBE]http://www.youtube.com/watch?v=9jjiWS__Mp0&feature=related [/YOUTUBE]

 

[Veneficus]

Did the loss of sensation start distally and slowly advance up the leg over hours?

Food for thought...

I have seen this a few times before.

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001704/

 

[medickat]

That almost sounds like Guillan-Barre Syndrome.

That's probably not what it was but, just throwing it out there.

 

[mycrofft]

Gullian Barre can be fatal and chronic. So my niece was told when she had it. It includes muscle weakness and paralysis, not described here.

OP describes absence of objective s/s, pt described "numbness" (is it anesthesia or buzzing like nerve compression/foot's asleep?) circumferentially below the knee. (Bandlike, or "gloving", including feet and toes?). No description of pedal pulses, gait, stance, seat.

USUALLY, in my tainted experience (and absent a "zebra" or local mechanical insult), circumferential or complete "gloving" loss of sensation in an extremity is often supratentorial.

 

[mycrofft]

Circumferential paresthesia of the lower leg crosses multiple spinal nerve dermatomes. Therefore, either the cause is topical, or it is in the mind.

 

[firetender]

Any bug bites?

 

[Dwindlin]

Guillian Barre also tends to be symmetric, not unilateral.

 

[Veneficus]

Guillian Barre also tends to be symmetric, not unilateral.

I am not suggesting that it was GBS, only that it is a reasonable consideration of a differential dx.

 

[Anonymous]

Could be diabetes, herniated disk, anxiety, vitamin deficiency, thyroid issue etc, I would get him seen.

 

[mycrofft]

OP, what was the answer, if any?

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