Case of 18 years Old boy with weakness of lower limbs

V.Priyanka

Roll no:176  

I have been given this case to solve in an attempt and 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 diagnosis and treatment plan.

Entire real patient clinical problem in this link.

herehttps://hitesh116.blogspot.com/2020/05/elog-13th-may-2020.html?m=1

A 18 year old male patient came with complaints of difficulty in walking,bilateral lowerlimbweakness,pain in calf muscles since 1 month.

 

Analaysis of the case:

By above mentioned data in the link .The features may be of lower motor lesions.

LOWER MOTOR LESIONS:at the level of 

-anterior horn cells

-nerve roots

-peripheral nerves

-neuromuscular junction

-muscle

ANTERIOR HORN CELLS:may be effected by polio,spinal muscular atrophy(mainly along areflexia and weakness,hypotonia,may involve repiratory muscle genetic disorder which can be put patient donot have respiratory problems and it is ruled out.Diagnosed by genetic testing,CT,MRI.Hence ruled out.

NERVE ROOTS (RADICULOPATHIES):disc herniations may be due to traumatic caused there is no traumatic history so it can be rules out.CT,MRI can be used to rule out.

PERIPHERAL NERVES:peripheral neuropathy can be diagnosed by nerve conduction studies  which are done and diagnosed as sural nerve ,common peroneal nerve neuropathy.By the features and nerve conduction studies it may be the cause of symptoms in patient.

NEUROMUSCULAR JUNCTION:there are no features suggestive of myasthenia gravis.

Diagnosis can be by clinical feature:electromyography,blood test,edrophonium test.

MYOGENIC CAUSES:

Genetic muscle dystrophy can be diagnosed by serum creatinine kinase levels-which were normal levels in patient (92IU/L),muscle biopsy,genetic testing(dystropin gene),ultrasound(muscle thickness).

INFLAMMATORY CAUSES:polymyositis can be diagnosed by muscle biopsy.

ENDOCRINE CAUSES:thyroid myopathy(thyroud profile is normal) so it can be ruled out.

INVESTIGATIONS:

RENALFUNCTION TESTS:levels of calcium,phosphorous,potassium level detection ,complete urine examination can be used to rule out rhabdomyolysis.

E CG can be done to find out the cardiac muscle involvement.

PAIN,FEVER this may be due to inflammation in muscle.

The feature may be caused due to vitamin deficiency occured due to alcohol intake and poor diet (B1,B12).

SCABIES:on examination there are lesions of scabies.

ANATOMICAL REGION INVOLVED:Peripheral nerves (sural nerve,common peroneal nerve).

PHYSIOLOGICAL DISABILITY:weakness of lower limbs  causing difficulty in walking ,standing from sitting position,wearing of foot wear ,in climbing stairs.

PATHOLOGY:axon or myelin level or cell body level of nerve(wallerian degeneration)

TREATMENT:paracetamol,Bcomplex,permethrin ointment (scabies).

Non pharmacological:physiotherapy,acupuncture,diet.

References:https://hitesh116.blogspot.com/2020/05/elog-13th-may-2020.html?m=1

• https://www.healthline.com.(peripheral neuropathy).