CARPAL TUNNEL SYNDROME SYMPTOMS VERSUS TODD’S PALSY – A CASE REPORT

Introduction and Objective: In march 2015, a 49 year old healthy caucasian male, went to the Hospital Emergency Unit complaining of pain in the right shoulder and radial epicondyle and of paresthesia in the right forearm and palm. No changes were described on neurological examination and Tinel’s sign and Phalen’s maneuver were positive. A diagnosis of epicondylitis and carpal tunnel syndrome were made and the patient was advised to do an electromyography and an elbow x-ray with is family doctor. Nevertheless, when he came to the family doctor someone listened to his story again and noticed that the symptoms could be caused by seizures followed by a brief period of temporary paralysis. After an appropriate neuroimaging study, a cystic meningioma was found. The aim of this work is to highlight the importance of a good clinical inquire, followed by adequate clinical examination. Methods: Review of the clinical process with emphasis in carpal tunnel syndrome tests, diagnosis and differential diagnosis. Results and Conclusions: This case exemplifies the diagnostic challenges that family doctors face every day. The list of signs and symptoms is giant and the diagnostic drawers where we can fit each patient’s complaints are correspondingly extensive. Moreover, “fitting” a patient into one diagnosis doesn´t mean to stop our investigation. If this patient electromyography ended up being suggestive of carpal tunnel syndrome and no one carefully listened to his story, the outcome would probably be a carpal tunnel release surgery and a delayed diagnosis of a meningioma, with a significant addition of iatrogeny, morbidity and perhaps mortality.