GM-CASE

GENERAL MEDICINE  CASE-2

18 year old male patient with bilateral difficulty in walking and lower limb weakness and pain in calf muscles.

Presented by SAI DEEPIKA. K

                      ROLL NO-85.

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 the entire details of patient in the following link-

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

PATIENT'S HISTORY-

18 yr old male patient came with the chief complains-

1.difficulty in walking since 1month

2.bilateral lower limb weakness since 1 month

3. Pain in the calf muscles while walking since 1 month.

Associated with

h/o difficulty in climbing stairs

h/o difficulty in standing from sitting position

h/o difficulty in holding chappal

h/o wasting and thinning of muscles

PAST HISTORY-not significant.

PERSONAL HISTORY-

Diet-mixed

Appetite-normal

Sleep-adequate

Bladder and bowel movements- regular 

Addictions-ALCOHOLIC WEEKLY TWICE  SINCE 2 YEARS.

FAMILY HISTORY- not significant.

Few important things-

1.The patient is anemic.

2.Higher mental function intact

3. Motor system- bulk of muscle decreased 

Tone of muscle decreased 

Power of muscle decreased 

4.Reflexes are absent 

5.Thyroid profile shows hypothyroidism 

6.Scabies is present.

INVESTIGATIONS- 

1.CBP showing microcytic hypochromic anemia.

2.SERUM ELECTROLYTE- normal in range

3.SEROLOGY- negative

4.CHEST X-RAY- normal

5.THYROID PROFILE- hypothyroidism 

6.NERVE CONDUCTION STUDY- bilateral common peroneal and sural axonal neuropathy.

DIFFERENTIAL DIAGNOSIS- 

1.STROKE-If it's th e cause, the patient should even complain of confusion, difficulty in speaking and others.

2.SPINAL INJURY OR LESION-  The patient compains of hypotonia, hyporeflexia which are complains of LMN lesion. If there is spinal cord injury patient should also have UMN lesion complains.

3.ELECTROLYTE IMBALANCE- The serum electrolytes are normal in range. 

4.PERIPHERAL NEUROPATHY- It is caused by injury,infection, diabetes mellitus, HYPOTHYROIDISM, Vitamin - B deficiency. 

The patient has hypothyroidism. 

The nerve conduction study shows bilateral peroneal and sural axonal neuropathy. 

May be its the cause for the paraperesis.

5.TOXINS- Here in our patient, he is alocoholic,leading to ALCOHOLIC NEUROPATHY. 

The pain in  the calf muscles signifies it may be Alcoholic neuropathy. 

6.LMN LESION- The patient has hyporeflexia, hypotonia,muscle weakness, muscle wasting and reflexes are also absent.

The causes of LMN lesion are spinal cord injury spinal cord injuries and PERIPHERAL NEUROPATHY .

So the probable diagnosis may be LMN LESION secondary to peripheral neuropathy.

TREATMENT-

1T.bcomplex once daily for peripheral neuropathy

2.permethrin 5% lotion for scabies 

3.Physiotheraphy and good diet.

REFERENCES-

1.https://www.healthline.com/health/weakness-in-legs

2.https://en.wikipedia.org/wiki/Peripheral_neuropathy

3.https://en.wikipedia.org/wiki/Lower_motor_neuron_lesion

4.https://en.wikipedia.org/wiki/Neuritis

Answers-

1.Three different anatomical locations for cause of paraperesis- 

Nerve,muscle,Neuromuscular Junction

In this case it is the nerve.

2.Pathology and etiology of condition-

LMN LESION caused by peripheral neuropathy due to alcohol, hypothyroidism. 

3.Therapeutic options- Vitamin B complex and physiotherapy and good diet.