Hi Aneed333

Well it is good if the neurologist has cleared him of neurological disease - as long as nothing has been missed.

It is however concerning if there is a segmental distribution as that may indicated something organic. It would be more reassuring if he had nerve conduction testing and an Wikipedia reference-linkMRI to be sure. I would be concerned about serious spinal cord disease

did you find anything on examination:
  • weakness
  • changes in deep tendon reflexes
  • changes in tone
  • abnormal reflexes like babinski or clonus?
  • sensory changes
  • bladder and bowel


What about his gait is there a consistent disordered pattern?


Given that the patient is falling down when he walks that should be taken very seriously. I think I would advocate for a detailed neurological workup, not just a CT. These are after all severe symptoms suggestive of cord signs including potential

However if it isn't organic he may have some form of somatoform disorder. The fact that he raised the issue about the loss of sexual function could be read at face value and cord be a sign of serous cord pathology. However it could also indicate rather odd behaviour - depending on the context that the topic arose. did you feel comfortable when he said this? - sometimes that can be a clue.

Are you familiar with somataform disorders? These are psychiatric disorders where the patient presents with physical symptoms that can not be explained by organic causes. One type is somatisation disorder which your patient could have:

Somatization disorder: Somatization disorder is characterized by many somatic symptoms that cannot be explained adequately based on physical and laboratory examinations. Specific characteristics of somatization disorder include the following:

* Onset of unexplained medical symptoms in persons younger than 30 years
* Multiple and chronic complaints of unexplained physical symptoms
* Multiple pain symptoms involving multiple sites, such as the head, neck, back, stomach, and limbs
* At least 2 or more unexplained gastrointestinal symptoms, such as nausea and indigestion
* At least 1 sexual complaint and/or menstrual complaint
* At least 1 pseudoneurological symptom, such as blindness or inability to walk, speak, or move
Somatoform Disorders: eMedicine Psychiatry

If the patient does have this it is important to take the patient seriously and not dismiss the symptoms as not real or "in their head". these patient can be helped by supportive physiotherapy but you do need to work along side a psychiatrist or a clinical psychologist on the case. You should never try to treat them on your own. Quite often patients may have a depressive problem or post traumatic stress or some other kind of psychiatric condition. But instead of displaying these anxiety or mood symptoms they "physicalise" their symptoms. sometimes the patient is distressed. or can be very demanding. Sometimes they may be very blasé about their symptoms

Personally I think the patient has a right to be really thoroughly checked out and I don't think a CT is a complete examination