PARAPARESIS CASE 2

I've been given this case data to solve in an attempt to understand and analyize the topic "PARAPARESIS" based on patient clinical data in order to develop competency in reading and comprehending clinical data related to Paraparesis and come up with a suitable diagnosis.

You can find the original case in the link below-

FOLLOWING IS THE PROBLEM LIST ACCORDING TO PATIENT'S PRIORITY:

MAIN COMPLAINTS:

    1.Difficulty in walking
    2.Weakness of both lower limbs
    3.Pain in lower limb calf muscles
    4.Fever


EACH COMPLAINT IN DETAIL:

    1.DIFFICULTY IN WALKING:

  • Since 1 month
  • PROBABLE DIAGNOSIS:
    • Orthopaedic problems (skeletal deformities,osteoarthritis) --but there is no history of any fractures and no such  findings on X-Ray. --ruled out

  •  Medical conditions
    • Heart Failure --no such history
    • Arterial disease --here, there is no skin atrophy claudication --so it is ruled out
    • Obesity --not in this case
  • Neurological
    • Nerve related
    • Muscle related

    2.WEAKNESS OF LOWER LIMBS:
  • since 1 month
  • ONSET:Gradual
  • Progressive in nature
  • Site:. Both legs below the knee i.e near calf 
  • PAST HISTORY:initially had felt from getting down from tractor one month ago and then walked with wall support
  • PROBABLE DIAGNOSIS:
    • Lower motor neuron lesions
    • Gullian barre syndrome
    • UMN Lesions -- but pain and temperature sensations are intact -- ruled out.
    • Peripheral Neuropathy

    3.PAIN IN LOWER LIMB CALF MUSCLES:

  • Since 1 month
  • Aggravated while walking
  • Calf tender positive
  • H/O difficulty in standing from sitting position
  • H/O difficulty in climbing stairs
  • H/O difficulty in holding footwear

       4.FEVER:
  • Since one week
  • Temperature Charting:


The cause of pain may be due to inflammation of these nerves and fever may be due to this inflammation of nerves.

PAST HISTORY:
  • No similar complains in the past and no H/O Trauma
  • Not a known case of HTN,Diabetes,EPILEPSY,CVA,CAD
GENERAL EXAMINATION: Normal except that there is mild pallor and presence of fever

MOTOR SYSTEM:

  • Decreased bulk and tone of lower limb muscles
  • Power of all lower limb muscles is found to be 3/5 -- indicating FLACCID PARALYSIS
CRANIAL NERVES are intact

No Cerebellar or Meningeal signs

Superficial and Deep tendon reflexes--Normal

OTHER PROBLEMS:

SCABIES:
  • On examination it came to know that he is having scabies  as the lesions are present in the webspaces and on asking history he told there are same lesions in his group of members and acquired from each other.(contagious)
  • There is history of alcohol intake and anemia -- this may have led to deficiency of various vitamins leading to PERIPHERSL NEUROPATHY.
  • INVESTIGATIONS:

    ANATOMICAL LOCATION OF THE PROBLEM:

    • CREATININE KINASE  Levels are found to be normal -- NEUROMUSCULAR CONDITION ruled out
    • SEROLOGY negative -- no VIRAL involvement
    • THYROID PROFILE is normal -- THYROID MYOPATHY ruled out
    • There is history of difficulty in holding chappals and wasting and thinning of muscles, difficulty in standing from sitting position, difficulty in climbing stairs -- so may be NERVE related.
    • Chest x-ray and ECG are done for the most patients as general investigations to rule out other comorbid conditions and have a baseline ECG and chest x-ray.
    • Neuromuscular junction disorder is ruled out as the electromyography is normasl in this case.
    • There is HYPOTONIA,FLACCIDITY,HYPOREFLEXIA -- pointing towards LMN lesion
    • Deep tendon reflexes 
                           Right.             Left
      Biceps.          P.                     ---
      Triceps.         ---                   ---
      Supinator.     ---                    ---
      Knee             ---                    ---
      Ankle.           ---                    ---
      Tone   ul.     normal.         Normal
                LL.  hypotonia.      hypotonia

         Power:almost all the muscles in the leg are showing 3/5 power indicating flaccid paralysis.

    • Nerve involvement is confirmed by NERVE CONDUCTION STUDIES as it helps to know whether defect is in axon or myelin sheath.

    The study shows: 
    Bilateral common peroneal and sural nerve axonal neuropathy(peripheral neuropathy)
  • TREATMENT:
    • Pharmacological component
      • T pcm 650 mg thrice daily for fever
      • Inj neomol 100ml IV infusion if fever greater than 101° f
      • T.bcomplex once daily for peripheral neuropathy
      • Permethrin 5% lotion for scabies 
    • Non-pharmacological component
      • Physiotherapy and proper diet are recommended.
    REFERENCES:

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PARAPARESIS

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I've been given this case data to solve in an attempt to understand and analyize the topic " PARAPARESIS " based on patient clinical data in order to develop competency in reading and comprehending clinical data related to Paraparesis and come up with a suitable diagnosis. You can find the original case in the link below- https://vaish7.blogspot.com/2020/05/medicine.html?m=1 FOLLOWING IS THE PROBLEM LIST ACCORDING TO PATIENT'S PRIORITY : MAIN COMPLAINTS : Weakness of both lower limbs Vomitings Gluteal abscess Scrotal abscess EACH COMPLAINT IN DETAIL :      1.  WEAKNESS OF BOTH LOWER LIMBS : ONSET :Sudden Since 5 days ASSOCIATED SYMPTOMS :Tingling and Numbness PAST HISTORY :had a fall when he got up for urination and was picked up by his father PROBABLE DIAGNOSIS : Peripheral Neuropathy INFECTIVE SPONDYLODISCITIS(spine infections-Most commonly-Tuberculosis) Gullian-Barre Syndrome/Multiple Sclerosis Sciatica Myasthenia Gravis Spinal lesion or tumor/Toxins INVETIGATIONS...
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