12/2/2023 0 Comments Arsenic poison antidote medbullet![]() ![]() Motor bulk and tone are normal, but there is slight bilateral muscular weakness in dorsiflexors of the toes and ankles, wrist extensors, and hand intrinsics. Neurologic examination reveals diminished proprioception in the hands and feet, with a hyperesthetic response to pinprick sensation on the soles. Family history is unremarkable his wife, parents, and two younger brothers are in good health. He takes one multivitamin a day but no prescription medications. The patient consumes one to two alcoholic drinks a week, and quit smoking 2 years ago after a 15-pack-year history. Approximately 10 months ago he was married and moved with his wife, an elementary school teacher, into a newly built home on an adjacent parcel of land. For the last 10 years, he has lived in a rural, wooded area in a home he built. Further questioning reveals the patient has been a carpenter since completing high school 17 years ago. The patient’s medical history is remarkable for a flu-like illness approximately 4 months ago characterized by 3 to 4 days of fever, cough, diarrhea, and myalgias, which resolved spontaneously. ![]() ![]() Except as noted, the review of systems is otherwise negative. No ataxia, dysphagia, visual symptoms, or bowel or bladder incontinence have been noted, and he has not complained of headaches, back or neck pain, or confusion. In the past 2 to 3 weeks, the tingling has taken on a progressively painful, burning quality and he has noted weakness in gripping tools. His symptoms began approximately 3 months ago, with the insidious onset of numbness and tingling in his toes and fingertips, progressing slowly in the ensuing weeks to involve the feet and hands in a symmetric “stocking-glove” fashion. A 35-year-old carpenter with peripheral neuropathy and skin lesionsĪ 35-year-old, fair-skinned male is referred to your clinic for evaluation. ![]()
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