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Sensory loss following injury in the sea around Cuba.
I would be grateful for any advice please from those of you with experience in the Gulf of Mexico.
I have just seen a 58 yo male who was walking in the sea off the coast of Cuba 2 years ago. He cut the lateral border of his left ankle, just below the lat malleolus on what he assumes was a rock. Following this he developed painful sensory loss in the left lateral foot extending up the left lower antero-lateral leg and a "scab-like" lesion over a patch on the shin which coincides with a red patch on a tattoo. This lasted a few weeks and after it settled the hairs of this part of the leg turned white and have remained white since. His strength is normal, but his left ankle jerk is absent.
Neurophysiologically the only abnormality is the left sural SNAP is 14uV, whilst it is 26uV on the right. Superficial peroneal (fibular) nerves and motor responses are normal.
Here in the UK we can get a painful neuropathy from standing on a weaver fish, but I have not heard of anything matching this description of events. Any ideas as to aetiology? Is there any useful advice as to management?
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