Peripheral neuropathy - Lead astray?

摘要

In January, 2012, an 80-year-old woman presented to us with a 6 week history of progressive, painless arm weakness, starting as an inability to extend her left middle finger and which progressed to bilateral wrist and finger extensor weakness over 2 weeks. She lived alone in a farmhouse and was admitted when she was unable to complete activities of daily living because of weakness. She had no sensory or lower limb symptoms, and was systemically well apart from mild constipation. Her medical history included atrial fibrillation and she was taking metoprolol, digoxin, and warfarin. Several months previously, she had been treated for suspected Lyme disease after developing a rash after a tick bite. Physical examination confirmed a symmetrical, upper limb, predominately distal, motor neuropathy, with noticeable bilateral wrist drop (figure), and absent upper limb deep tendon reflexes. Sensory examination was normal.