MYELONEUROPATHY
This case was given to us to understand the topic of MYELONEUROPATHY
The entire case history can be found here:
A 65 year old male patient came to the OPD with chief complaint of weakness in both lower limbs since
15 days ( left more than right )
• H/o difficulty in squatting
• severe arching pain in lower limbs which was progressive
• got able to get up from bed since the last 4 days
PAST HISTORY:
• patient was well until he was 30
• In his early 30s he started developing episodes of pounding palpitations which started as once in 2-3 months and progressed to one episode every week.
No h/o chest pain, cough
• 5 years later for the first time he experienced breathless.
• By the age of 50, his breathless progressed to a level where he became dyspneic even on walking
• At the age of 60, he had an episode of where he suddenly woke up from sleep, gasping for breath and sweating profusely.
He had to walk around for the breathless to relieve
He had 2 such episodes
No h/o orthopnea, chest pain or pedal edema at any point
H/o increased intake of alcohol
H/o troubling pain in knees and back
H/o fall and injury to hip
H/O NSAID abuse since the past 5 years for pain
EXAMINATION:
Patient is conscious, coherent and cooperative
Pulse- 76 bpm
BP- 130/ 70 mmhg
CVS- S1 S2 heard.
• Duroziez sign positive
It is sign of aortic insufficiency.
Consists of audible diastolic murmur heard over femoral artery with bell of telescope.
• Pulsus Bisferiens positive
Aka biphasic pulse, in an aortic waveform with 2 peaks per cardiac cycle .
It is a sign of problem with aorta including aortic stenosis and regurgitation and hypertrophic cardiomyopathy causing sub aortic stenosis
RS: bae +
Normal breath sounds- heard
P/A- soft, non tender
CNS
• higher mental function- intact
• Cranial nerves- intact
• sensory system - normal
• no cerebellar and meningeal signs
• motor system- tone -normal
decreased power in lower limbs
(Left> right )
• reflexes
Biceps, triceps , supinator, knee - present
Ankle- absent
Plantars- extensor
• Beevor’s sign - positive
Indicates selective weakness of lower abdominal muscles. Includes movement of navel towards head on neck flexion.
• tenderness over dorsal and lumbar region.
INVESTIGATIONS:
• ECG- normal
• X Ray chest - no significant findings
• Hemogram- Hb- 8.8 gm/dl
• 2D echo
* ejection fraction- 55%
* dilated IVC and right ventricle
* RSVP- 38 mmhg
* Mild tricuspid regurgitation with pulmonary artery hypertension
* trivial aortic regurgitation
* good LV systolic function
• RPR- ruled out tabes paresis
• USG- grade 2 prostatomegaly
On dre- flat, non nodular prostrate
• MRI LS SPINE:
Lesions at D8 D10 L2 causing cord compression
DIAGNOSIS:
Myeloneuropathy secondary to spinal cord compressions with lesions at T8 T10 L2
TREATMENT:
• inj thiamine
• inj optinueron
• tab Ciprofloxaccin
• syrup lactulose
MYELONEUROPATHY:
It is a condition characterised by simultaneous damage to spinal tracts and peripheral nerves of lower limbs .
Clinical Manifestations:
- difficulty in walking
- weakness of lower limbs
- ataxic gait
- sensory manifestations in glove and stocking distribution.
On Examination:
Myelopathic signs:
- hyperreflexia
- spasticity
- extensor plantar responses
- bowel and bladder disturbances
- Romberg sign- indicates posterior column involvement
Neuropathic signs:
- glove and stalking sensory loss
- absent or diminished ankle jerk
- distal limb atrophy
- vision loss if optic nerve involvement is present
" Variety of nutritional, toxic, metabolic, infective, inflammatory, and paraneoplastic disorders can present with myeloneuropathy. Deficiencies of vitamin B12, folic acid, copper, and vitamin E may lead to myeloneuropathy with a clinical picture of subacute combined degeneration of the spinal cord. "
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