 |  nbme 3, short but difficult question!!
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| Author | 11 Posts |
nadiabarati
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an 82 yr old male who has a history of COPD,BPH and glaucoma presents with papular and vesicular lesions over the right leg on the anterior and posterior shin.there is also weakness of right knee flexion ,ankle dorsiflexion,plantiflexion,eversion and inversion.the right ankle reflex is also absent.there is decreased sensation to cold and pin prick on the right lower leg.what is the cause of this condition.
a.syphilis
b.polio
c.herpes simplex
d.varicella zoster
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| vanshita
Forum Guru
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D
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| sprint123
Forum Guru
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Posts: 870
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I can't get an idea at all..Let me try..
Loss of cold and pinprick--->Loss of spino-thalamic tract!-->Can't be syphilis which is tabes dorsalis--Loss of posterior column.
papules--->Can rule out polio
Between Herpes simplex and VZ ....Herpes--->Only mucosal and genital!
I go for Varicella Zoster!! ?!
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| hanialkhadher
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Posts: 262
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syphilis !
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| sprint123
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aNY OTHER SUGGESTIONS??
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| doc_clotaire
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 d.varicella zoster BIG TIME
CLUES
Old guys , depressed immune system secondary to chronic disease , papular and vesicular lesions , sensory loss , motor weakness
ALL ARE FEATURES OF VARICELLA ZOSTER
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| sprint123
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| | 05/30/07 - 11:55 AM
1 of 3 forum leaders found this post helpful
| #7 |
Thanks clotaire..Can skin lesions affect only the right leg as in this case in VZ?? Can you tell more about the neurological complications in VZ?
Is it a reactivation of al;tent infection--??-->Then it should be called Herpes zoster..right?
In herpes zoster, we could get sensory loss and motor weakness...But in VZ??Wat's the difference clotaire?
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| doc_clotaire
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As far as I know Sprint
Herpes Zoster , Varicella Zoster , Shingles , Post-herpetic Neuralgia are all SYNONYMS
Can skin lesions affect only the right leg as in this case in VZ?
The answer is :
Other important neurologic complications could be involvement of the anterior horn cells which can give you muscular weakness, cranial nerve palsies, diaphragmatic paralysis, neurogenic bladder, and colon pseudoobstruction. Wider involvement of the spinal cord can produce Guillain-Barré syndrome, transverse myelitis, and myositis
I hope that answered to your questions !
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| sprint123
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Thanx clotaire! I was just confused what to name a plain chicken pox infection in adult--"Varicella-Zoster?".....I think VZ can be assigned to both primary infection and reactivation in adults.
In this case, the vesicular distribution is along some dermatome? or is there any distribution along a nerve? I thought if both anterior and posterior tibial nerves are involved in this patient--so VZ can also affect individual nerves??!!
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| doyoudig
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usully it has a typical dermatomal distribution. and yes does not have to present just bilateral, you can also see that in Pt w/ shingles affecting just one side of the face or flank
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| ARJ
Forum Guru
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VARICELLA ZOSTER
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