PARAPARESIS CASE 3

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. Weakness of bilateral lower limbs since 20 days
     2. Bilateral Edema in both legs
     
EACH COMPLAINT IN DETAIL:

 1.WEAKNESS OF BOTH LOWER LIMBS:
  • Since 20 days
  • ONSET: Insidious
  • Gradually progressive
  • Started in proximal region 2 yrs back
  • Later progressed to B/L distal region
  • ASSOCIATED FEATURES:
    • H/O difficulty in squatting position and getting up from squatting position
    • H/O difficulty in wearing and holding footwear
  • PROBABLE DIAGNOSIS:
    • Myopathy
    • Peripheral Neuropathy
    • UMN/LMN lesions
    • Drug induced
 2.BILATERAL EDEMA:
  • Non-pitting type
  • PROBABLE CAUSE:
    • may be due to inflammation
The systems to be examined closely according to the complaints for this case are CNS and NEUROMUSCULAR SYSTEMS.

PAST HISTORY:
  • No similar complains in the past and no H/O Trauma
  • Not a known case of HTN,Diabetes,EPILEPSY,CVA,CAD
FAMILY HISTORY- not significant

No known food or drug allergies

GENERAL EXAMINATION: 

Patient was conscious, coherent and cooperative,moderately built and nourished.

  • no signs of pallor, Icterus, clubbing, cyanosis, lymphadenopathy elicited.
  • Bilateral calf hypertrophy noticed. 

CVS EXAMINATION:
  • Heart sounds heard
  • Palpable thrill in neck suggesting hyperdynamic circulation.

LOCAL EXAMINATION of CNS and NEUROMUSCULAR SYSTEM:

Patient well oriented to time, place and person

Normal higher mental functions.

Cranial nerves- intact function.


MOTOR SYSTEM:
  • NORMAL TONE of the lower limb muscles
  • Power of 4/5 in all lower limb muscles
  • Reflexes: absent in both lower limbs
SENSORY SYSTEM: Normal/Intact

 

No meningeal signs and cerebellar signs.



TO RULE OUT VARIOUS FACTORS(Investigations):


Weakness is a very common symptom with many causes and they need to be investigated for and ruled out to come to a diagnosis.

ANATOMICAL LOCATION OF THE PROBLEM:
  • UMN Lesions are characterised by hypereflexia,spastic paralysis,hypertonia -- absent in this case --so ruled out
  • LMN Lesions can occur at the level of anterior horn cells,peripheral nerves,neuromuscular junction or at muscles
    • For ruling out lesion at level of anterior horn cell/peripheral nerves -- NERVE CONDUCTION STUDIES HAVE TO BE DONE -- to check if the problem is NEUROGENIC
    • To rule out NEUROMUSCULAR JUNCTION DISORDERS --ELECTROMYOGRAPHY is done which is NORMAL -- NMJ ruled out.
    • HISTOPATHOLOGICAL REPORTS of the muscle shows that the problem is in the MUSCLE.



                    

TREATMENT:

  • T.Prednisolone 15 mg po od -- glucocorticoid to treat CIDP
  • T.Pantop 40 mg bbf -- to prevent gastric irritation
  • T.Met xl 12.5mg od -- Beta blocker for cardiac problem
  • Cap. Becosules od -- multivitamin formulation
  • T.Chymerol forte od -- for pain and inflammation
  • T.Vit C od
  • T.Ultracet sos -- for pain

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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