18 year old male with difficulty in walking:
A 18 year old male with difficulty in walking:
I've been given this case to solve in an attempt to understand the topic of "patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with a diagnosis and treatment plan.
You can find entire patient clinical data in the link here: https://hitesh116.blogspot.com/2020/05/elog-13th-may-2020.html?m=1.
Chief complaints:
1) difficulty in walking since 1 month
2) weakness of both lower limbs since 1 month.
3) pain in calf muscles since 1 month
Associated with
-h/o of difficulty in standing from sitting position
- h/ o difficulty in climbing stairs
- h/ o of difficulty in holding chappals
- h/ o of wasting and thinning of muscles.( LL>UL)
On examination hypotonia , absent reflex suggestive of LMN lesion
Anatomical location ??
1) anterior horn cell
2) ganglion
3) spinal nerve root
4) plexus
5) peripheral nerves
6) neuromuscular junction
7) muscle
* Anterior horn cell - no asymmetric involvement, fasciculation, atrophy.
* Dorsal root ganglion - no severe sensory ataxia,no posterior column involvement.
* Spinal nerve root-no pain along distribution of nerve root
* Neuromuscular junction - no fluctuating weakness and fatigue
* Muscle - creatinine kinase at normal levels.
Hence ,probable anatomical location is peripheral nerves.
Ethiopathology:
Peripheral neuropathy may be due axonal neuropathy and demyelinating neuropathy.
On nerve conduction test , it suggestive of axonal neuropathy( large fibre neuropathy)
- As patient is alcoholic and anemic there may be possible deficiency of B1,B3,B6,B12 which may lead peripheral neuropathy.
Probable diagnosis :
Paraparesis secondary to peripheral neuropathy ( bilateral common peroneal and sural nerve).
Treatment :
Tab B complex
Physiotherapy.
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