Dr. J.E Ahlskog Mayo Neurologist never ordered a T spine MRI!
Absolutely no help.
Nov-21-2003
PHYSICAL EXAMINATION:
Neuro: Mr.xxxx’s neurologic examination was entirely within normal limits. This included thoracic outlet maneuvers. He also had sitting and standing blood pressures that were quite similar at around 130/90. When he first stood up, the systolic pressure dropped by about 10 mm of mercury but then came back up again.
IMPRESSION/REPORT/PLAN:
Mr. Nier has a number of symptoms that all developed concurrently starting in approximately May of this year. This has included some numbness and pain in his distal feet as well as thoracic outlet syndrome types of symptoms in the upper extremities plus symptoms reminiscent of epicondylitis that occurred after hammer work in addition to impaired bladder emptying and diarrhea. Seemingly, there is some single explanation for all of these, but I do not know what that is. I note that his EMG came back negative arguing against a peripheral neuropathy. Similarly, his neurologic examination was unremarkable. I did consider the possibility that there might be a small fiber neuropathy that might explain more than one aspect of this. However, his total symptom picture is really not a very good fit with that. Thus, I do not think it is highly likely that this is a primary neurologic problem. Obviously, with numbness and tingling being one component of his multiple symptoms. The peripheral nervous system must likely be involved. However, I do not believe that it is Primary peripheral nervous system problem. I am going to order and get a few additional blood tests. However, these are low probabilities and do not anticipate that these will provide the answer. He is going to follow-up with internal medicine here. We discussed all of this.
DIAGNOSES:
#1 Subacute development of multiple symptoms including numbness and pain in the distal feet, thoracic outlet symptoms, diarrhea, impaired urinary emptying
JEA:jlw
Electronically signed Nov-21-2003 19:11 by J.E. Ahlskog, MD, PhD