Case of the Month #18: Peripheral Neuropathy by Dr Lorraine de Gray

Published: 29/07/2022


Examination should particularly look at:

1.    A thorough neurological examination, including sensory testing for touch, temperature, power, reflexes, clonus and plantar reflexes

2.    Check for an enlarged thyroid

3.    Check for enlarged lymph nodes and abdominal examination

Mr X on examination had normal power in his lower limbs, with dampened reflexes and down-going plantars.  He had reduced sensation to touch in a stocking distribution to the mid shins/calves bilaterally.  He also had reduced sensation to touch which was less dense in his hands bilaterally.
He had small shotty axillary lymph nodes and examination of the thyroid gland revealed no enlargement or palpable lumps.  Examination of his abdomen was difficult as Mr X was somewhat overweight, but it appeared that he may have an enlarged spleen although this was not very clear cut.

You advise Mr X that you would like to do some investigations.  What would you wish to investigate him for?