A 68-year-old woman who presents after a fall reports progressive difficulty climbing stairs for the past 3 months. She also feels a loss balance when rising from a chair. She has a 5-year history of diabetes mellitus for which she takes metformin. Examination demonstrates intact cranial nerve function; normal sensory examination except for mildly decreased touch and vibration in her toes, normal motor function except for 4+/5 deltoid power and 4+/5 hip power bilaterally, and an inability to stand on her toes. Deep tendon reflexes are 2+ but 1+ at the ankles; plantar responses are flexor; cerebellar function is normal except for mild difficulty with heel-knee-shin testing. She has difficulty rising from a chair without pushing up with her hands. These clinical findings are best explained by dysfunction in which of the following regions of the nervous system?A. anterior horn cellB. muscleC. nerve plexusD. peripheral nerveE. spinal cord

spinal cord and nerve plexus

Explanation:

Faced with this clinical picture, we would be talking about the affection of the spinal cord and the peripheral nerves that sensually perceive the areas of the epithelium, that is, they give the sense of touch, since the patient is diabetic, it could be deduced that the microangiopathies that this generates Chronic disease over time, can affect the irrigation of certain areas and therefore their inventions, due to lack of supply of oxygen and nutrients.

Diabetics are at risk of affecting both upper and lower limbs, because over time they lose the vascularization and winterization of these areas, thus generating infections or pain imperceptible by the patient.

On the other hand then, it would be ideal to say that the spinal cord with the peripheral nerves that innervate the affected areas, and the cerebellum are affected by the lack of balance or spatial disposition of the patient in relation to their body size.

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