总结一下上周各位大虾观点：①周围神经病变可能  因系中年女性，病程进行发展，考虑性质可能有肿瘤、感染、中毒、营养、遗传等等，进一步需要在过去史、个人史和家族史方面了解有无肿瘤、感染、糖尿病、酗酒、吸烟、职业、用药及家族史等情况；②不典型的脊髓病变？③不典型的脑病？

本次补充患者的过去史、个人史和家族史如下——

Case 1 (part 2)

The patient was a 43-year-old, right-handed woman who presented in 1991 with a 1-year history of intermittent paresthesias in both hands.  This was not accompanied by numbness or weakness and the paresthesias intensified over the 6 weeks prior to her admission.  In the month prior to admission, she began to experience paresthesias of the right leg and a sensation of heaviness in both legs.  She had trouble keeping up with her young children and had a tendency to drag the right leg.  She also developed paresthesias in the perineal region without any disturbance of bowel or bladder function.  The patient thought her memory was unaffected, but she acknowledged that she did not feel mentally clear.  She had no headaches, visual or bulbar symptoms and no back pain.

The patient did not smoke or drink alcohol. There had been no recent travel. She had no prior neurologic symptoms or medical illnesses. There was no history of hypertension, diabetes, or any chronic illness. She did not take any medications. There was no family history of neurologic disease.