A23 yr old patient with bilateral lower limb weakness

I have 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

Complaint of the patient: bilateral lower limb weakness with numbness and tingling
Differential diagnosis
1) peripheral neuropathy
2) multiple sclerosis
3) spondylodiscitis
PERIPHERAL NEUROPATHY :Every nerve in your peripheral system has a specific function, so symptoms depend on the type of nerves affected. Nerves are classified into:
  • Sensory nerves that receive sensation, such as temperature, pain, vibration or touch, from the skin
  • Motor nerves that control muscle movement
  • Autonomic nerves that control functions such as blood pressure, heart rate, digestion and bladder

Signs and symptoms of peripheral neuropathy might include:

  • Gradual onset of numbness, prickling or tingling in your feet or hands, which can spread upward into your legs and arms
  • Sharp, jabbing, throbbing or burning pain
  • Extreme sensitivity to touch
  • Pain during activities that shouldn't cause pain, such as pain in your feet when putting weight on them or when they're under a blanket
  • Lack of coordination and falling
  • Muscle weakness
  • Feeling as if you're wearing gloves or socks when you're not
  • Paralysis if motor nerves are affected

    • If autonomic nerves are affected, signs and symptoms might include:

    • Heat intolerance
    • Excessive sweating or not being able to sweat
    • Bowel, bladder or digestive problems
    • Changes in blood pressure, causing dizziness or llightheadednes
    • This patient has no autonomic symptoms and lack of coordination
  • Multiple sclerosisWhole body: fatigue, dizziness, heat intolerance, poor balance, or vertigo
    Urinary: excessive urination at night, leaking of urine, persistent urge to urinate, or urinary retention
    Sensory: pins and needles, abnormality of taste, reduced sensation of touch, or uncomfortable tingling and burning
  • This patient does not have any autonomic and sensory involvement

Spondylodiscitis:ankle clonus and positive Babinski sign due to anterior spinal tract involvement
ANATOMICAL location:
Involvement of spinal cord , anterior spinal involvement,hence upper motor signs are seen
Gradullaly progresses to posterior cloumn involvement causing sensory symptoms

Pathogenesis
Inhalation of bacilli - inflammatory response - inter feron gamma- granuloma- ghon focus - hematogenous spread- rich foci in spine - spondylodiscitis
Pharmacology: TREATMENT :
T.ATT 3 tabs/day fdc
T.Benadon 40mg/od
T.pregabalin 75mg/po/h/s
OINT.MEGAHEAL FOR LOCAL APPLICATION
SITZ BATH WITH BETADINE TID

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