Young Man with Pins and Needles

Abstract

20-year-old man was referred to neurology clinic for pins and needles in both hands. Symptoms started 6 months ago. Symptoms were provoked by physical activity and became much worse after busy day; he worked hard as a joiner. He was referred as a suspected diagnosis of multiple sclerosis (MS). He did not have any other symptoms. On objective examination reflexes were present and not increased; apart from absent ankle jerks bilaterally. Plantars were negative. Muscle strength was normal. There were no sphincter symptoms. He did not have any symptoms on examination but paresthesias in his hands did not seem to respect any particular dermatome. Vibration sense was reduced in legs (ankle level) but light touch and pin prick were normal. Cranial nerves were normal and there was no ataxia.