Case 1
CASE 1: DESCRIPTION
A 35-year-old left handed woman, gravida 1, para 1 (G1P1), presents post-partum day 2 with left foot drop. Labor was notable for prolonged 2nd stage of labor after which she underwent an uncomplicated cesarean section. Upon resolution of anesthesia, she noted numbness and tingling affecting the top of her left foot and lateral lower leg and upon ambulating began tripping over her toes on the left. Denies any cognitive changes, arm symptoms, no bladder/bowel incontinence. She has never had any numbness or weakness of her extremities previously. Denies radiating pain from the low back.
SHx: Works as a nurse, no substance use, South-Asian descent
Vitals: T 37, BP 110/70, HR 65 and regular, RR 12, O2 sat 99% RA.
Neurologic Exam:
Mental status: Alert, oriented and appropriate with normal, fluent speech and appropriate fund of knowledge.
CN: Normal facial strength and sensation
Motor: 2/5 strength of left foot dorsiflexion and eversion. Foot inversion is 5/5, all other muscles 5/5. Normal bulk and low tone in the left foot.
Sensation: decreased to all modalities over the dorsum of the left foot and anterolateral leg including the first web space.
Reflexes: 2+ and symmetric throughout the bilateral upper and lower extremities
Coordination: Normal finger-to-nose; heel-knee-shin evaluation limited by post-partum pain
Gait: steppage gait on left. Unable to walk on left heel, able to walk on toes