18YR OLD MALE WITH DIFFICULTY IN WALKING
ANKAM SATHYA KISHORE (07)
You can find the entire real patient clinical problem in this link here..
https://hitesh116.blogspot.com/2020/05/elog-13th-may-2020.html?m=1
Current issues of the patient:
*Difficulty in walking and weakness of lower limbs:
Onset :sudden
Duration.:since 1 month
Site:. Both legs below the knee i.e near calf
Associated complaints:
H/o difficulty in standing from sitting position.
H/o difficulty in climbing stairs
H/o difficulty in holding chappals
H/o wasting and thinning of
*ANATOMICAL LOCATION OF THE PROBLEM:
We observed that there is hypotonia,hyporeflexia,flaccid paralysis are seen a characteristic of LMN LESION(LOWER MOTOR NEURON)
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.
*SPECIFIC ANATOMIC LOCATION:
Specific anatomical location should be studied to know whether the disease is from either 1)neurogenic 2)myogenic or 3) neuromuscular junction
1)if suspecting myogenic cause then creatine kinase and muscle biopsy should be done.
CREATININE KINASE- 92 IU/L which is normal so muscle related cause is ruled out.
2)If suspecting Neuromuscular junction cause then electromyography should be done which is also normal in this case so it is ruled out.
3)if suspecting neurogenic cause then..
Nerve conduction studies should be done.
The study shows
Bilateral common peroneal and sural nerve axonal neuropathy(peripheral neuropathy)Investigations:
NERVE CONDUCTION STUDIES:
From the history of the patient he is alcoholic and there is anaemia. Due to alcohol consumption there is deficiency of vitamins like b1,b3,b6 which is one of the cause of peripheral neuropathy.
Calf pain is most common in ALCOHOLIC NEUROPATHY. Due to this there will be metabolic disturbances where there is accumulation of fructose and sorbitol in Schwann cell causing axonal degradation.
*Pain and fever:
The cause of pain may be due to inflammation of these nerves and fever may be due to this inflammation of nerves
Temperature charting:
personal history:
mixed diet with normal appetite and normal bowel/bladder movements
h/o alcohol since 2y weekly twice.
No h/o smoking
no significant family history.
General examination:
Moderately built;poorly nourished
afebrile
Pallor present
Icterus negative
No cyanosis,clubbing,lymphademopathy,Edema.
no short neck
no scars;no h/o tropic ulcers
no neurocutaneous markers
Bp 100/60 mmhg
Pr 80 bpm
Cvs s1 s2 hears no murmurs
Rs bae + nvbs hears
P/a soft ,nontender
Other examinations:
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)
Diagnosis:
*Paraparesis secondary to peripheral neuropathy (bilateral common peroneal nerves and sural nerves).
*scabies
Treatment:
*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
Some points on this case:
{*Sural nerve biopsy should be done to know
pathology
*Nerve conduction study to know whether the
defect is in axon or myelin sheath
*other conditions where it can be progressing
otherthan viral and demyelination diseases
*Cause for hypofunction of thyroid in spinal
injury to be outlined
*Physiotherapy is to be given
*Proper diet should be continued}