An Older Man With Leg Numbness

A 65-year-old man presented with a 1-year history of slowly progressive numbness in the feet and hands, without weakness.

Past medical history was noncontributory, except for a history of hyperlipidemia treated with statins. He did not smoke or drink.

Neurologic examination revealed normal mentation and cranial nerves. Motor examination was intact except for 4/5 weakness of both feet and toe dorsiflexors and foot evertors. There was no atrophy. Reflexes were 1+ in the upper extremities and absent in the lower extremities. There were no pathologic reflexes. Sensory examination showed decreased pinprick and touch sensation to the mid-calf, absent vibration sense in the toes, and decreased in the fingers and ankles; position sense was decreased in the toes. There were no fasciculations, Babinski signs, or nerve hypertrophy. He had a normal gait and coordination. Romberg test was negative.

What are the Most Likely Diagnostic Possibilities?

This patient had sensorimotor polyneuropathy. He did not have diabetes or hypothyroidism by history, although these should be considered. Both hyperlipidemia ¹ and the statin family of cholesterol-lowering agents have been reported to be associated with a peripheral neuropathy. ² He denied exposure to alcohol or toxins or excessive use of vitamins.

What Should the Workup Include?

Initial workup, including fasting blood sugar, glycosylated hemoglobin, complete metabolic panel, lipid profile, B ₁₂ /folate levels, and thyroid function tests, and a complete blood count were all normal.