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1、CaseReport病例：53岁女性伴下肢麻木无力2017年06月发表于新英格兰杂志资料来源于麻省总医院A53-year-oldwomanwithrheumatoidarthritis.Thepatienthadbeeninherusualhealthuntil4monthsbeforethisadmission,whenhypoesthesiadevelopedinthelateralaspectoftheleftfoot.PresentationofCase53岁女性，有类风湿关节炎病史。首发症状为左足外侧感觉减退。病史4
2、个月。病例介绍Duringthefollowing2daysThehypoesthesiaspreadtoinvolvethetoesandmidfoot;chroniclow-backpain,whichradiatedtothebuttocks,hadincreasedinintensity,buttherewasnopaininthelegs,fever,weightloss,orbowelorbladderchanges.Examination:Perceptionoflighttouchandpinprickwasa
3、bsentonthelefttoesandleftforefoot;theremainderoftheexaminationwasnormal.Lab:ESR,VB12,glycatedhemoglobin,thyrotropinwerenormal.PresentationofCase病例介绍首次症状出现后2天：症状：感觉减退逐渐发展到左足趾及左脚掌，同时存在慢性背痛，并放射到臀部，且程度加强，无双下肢疼痛，无发热，无体重减轻，无大小便异常。查体：左足趾及左脚掌浅感觉及针刺觉缺失，余查体未见明显异常。检查化验：血沉、维生素B
4、12、糖化血红蛋白、促甲状腺素未见异常。Duringthenext5dayshypoesthesiaprogressedtoinvolvetheproximalportionoftheleftfoot,aswellastheankleandthelaterallowerleg,butnopainorbowelorbladderincontinence.Examination:cranial-nerveexaminationswerenormal.Strengthwas4+outof5duringflexionandextens
5、ionofthetoesontheleftfoot,dorsiflexionandplantarflexionoftheleftankle,eversionandinversionoftheleftfoot,andflexionoftheleftknee.Perceptionofvibrationwasmarkedlydiminishedatthelefthallux.Perceptionoflighttouchandpinprickwasdecreasedontheleftfootandtheleftlateralleg.D
6、eep-tendonreflexesofthearmsandlegswerenormal.Theplantarreflexwasflexorontherightsideandabsentontheleftside.PresentationofCase病例介绍此后的5天：症状：感觉减退逐渐进展至整个左脚、左脚踝、左小腿外侧，但无肢体疼痛及大小便失禁。查体：颅神经查体未见异常。左足趾屈伸运动、左踝关节趾屈和背屈、左足内外翻、左膝关节屈曲肌力检查4+级。左足趾震动觉明显减退。左足、左小腿触觉、针刺觉减退。四肢腱反射正常。左侧足跖反射
7、消失，右侧正常。7dayslater(3monthsbeforethisadmission)Thesensoryandmotorresponseswerenormalandsymmetric.F-waveminimallatenciesinthetibialnerveswerenormal.H-reflexwasabsentattheleftsoleusandnormalattherightsoleus.Needleelectromyographyoftheleftlegshoweddiminishedrecruitmento
8、flong-duration,polyphasicmotor-unitpotentialsinproximalanddistalmusclesoftheL5myotome.Resultsofelectromyographyoftherightlegwerenormal.Ner
