ABSTRACT
A 74-year-old man presented to the out-of-hours general practitioner in the emergency department with a 1-week history of numbness of his fingers. He had initially noticed occasional ‘pins and needles’ sensations in all 10 digits when he was using his hands, for example when chopping vegetables. Over the past few days, a progressive loss of sensation in the fingers had developed and he now complained of generalised weakness of the hands bilaterally. He denied any recent trauma. His past medical history included asthma diagnosed by his general practitioner 6 months earlier. His only medications were seretide and salbutamol inhalers and he denied use of over-the-counter or herbal drugs. Systems review identified a 2-week history of a cough productive of colourless sputum and shortness of breath on exertion. On direct questioning he admitted to approximately 10 kg of unintentional weight loss over the preceding 2 months and a feeling of general malaise. He was a retired tax inspector who lived alone. He had never smoked and drank no alcohol. He had not travelled abroad for more than 30 years.
