Adeline, a 38-year-old woman, developed progressive weakness in her hands over several months, beginning in the right hand, and then involving the left. Even before the weakness started, however, she had both burned and cut her right hand without feeling any pain.
On examination, the intrinsic muscles of both hands were atrophic and weak. She could not abduct nor adduct the fingers, adduct the thumb, nor oppose the fifth digit. The wrist flexors and extensors were also weak, although less so, and these forearm muscles were only slightly atrophic. Pain sensation was lost over the medial side of both hands, from the little finger to the mid-palm, including the ring finger and part of the middle finger. The area of sensory loss extended up the arms to the axilla; it involved the medial half of the anterior surfaces, and nearly half of the dorsal surfaces of both forearms and upper arms. The area of disturbed pain sensation also extended onto the chest so that pain sensation was lost over the thorax from the level of the axilla down to just below the nipples bilaterally (See Diagram). Position and vibratory sense were normal, however. Both eyelids drooped, particularly the right, and the right pupil was constricted. The right eyeball appeared to be more deeply set in the orbit. The remainder of her examination was normal.
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