Question

A 79-year-old male with atrial fibrillation is brought to the clinic by his daughter due to progressive weakness of the right leg and difficulty walking over the past 3 months. The patient complains of back pain in addition to difficulty walking. On exam, there is atrophy, decreased tone, and weakness of the right quadriceps muscle; weakness of right hip flexion; and decreased sensation of the anteromedial thigh. The right patellar reflex is absent. Laboratory testing reveals an INR of 4 (normal range is up to 1.4). Which one of the following is the most likely etiology of the patient's weakness?

A. Femoral neuropathy due to psoas muscle hematoma
B. Sciatic neuropathy due to piriformis hematoma
C. L5 radiculopathy due to disc herniation
D. Tibial nerve compression in the tarsal tunnel
E. Left middle cerebral artery cardioembolic stroke

Answer 1

The most likely etiology of the patient's weakness is L5 radiculopathy due to disc herniation.

Step-by-step explanation:

The most likely etiology of the patient's weakness is C. L5 radiculopathy due to disc herniation.

Based on the patient's symptoms and examination findings, it is consistent with compression of the L5 nerve root in the lumbar spine, which can cause weakness and sensory deficits in the distribution of the nerve.

This compression could be caused by disc herniation, which is a common cause of radiculopathy.